Impact of Training Length on Scope of Practice Among Residency Graduates: A Report From the Length of Training Pilot Study in Family Medicine

Background and Objectives: Associations between training length and scope of practice in family medicine are unknown. We compared scope of practice among family medicine graduates from 3YR and 4YR training programs. Methods: We compared survey responses 1 year after graduates started their first job as an independently practicing physician according to their length of training. Comparisons were made across three groups: (1) 3-year program graduates with 36 months of training (3YR–36); (2) all 4-year program graduates with either 36 or 48 months of training (4YR–36/48); (3) 4-year program graduates with only 48 months of training (4YR–48). Results: Our sample included 1,136 graduates. Of these 423 (37.2%) were in 3YR programs, 447 (39.4%) were in 4YR–36/48, and 266 (23.4%) were in 4YR–48 months. Participant demographics and practice characteristics were similar across groups. Graduates with 4 years of training were more likely to provide pediatric inpatient care than 3YR program graduates (4YR–48 [43.6%] vs 3YR [35.1%], P=.032); and more 4YR program graduates provide adult inpatient care (3YR [39.8%] vs 4YR–48 [52.5%], P=.002). Graduates of 4YR programs (both groups) were statistically more likely to include 13 of 24 procedures in practice compared to those from 3YR programs, including point-of-care ultrasound, vaginal delivery, joint injection/aspiration, circumcision, and vasectomy. Graduates of all participating programs reported performance that exceeded national means for 20 of 32 (62.5%) clinical practice areas and procedures. Conclusions: Graduates of 4YR programs reported obtaining a unique set of skills and undertaking a broader scope of practice postgraduation compared to graduates of 3YR programs.