Publications by authors named "Lars Peterson"

181 Publications

Practice Patterns of Family Physicians With and Without Addiction Medicine Board Certification.

J Am Board Fam Med 2021 Jul-Aug;34(4):814-819

From the Agency for Healthcare Research and Quality, Rockville, MD (STT); American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP); Departments of Family Medicine, and Psychiatry and Behavioral Sciences, Rush University, Chicago, IL (RMF); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP).

Background: The American Board of Medical Specialties recognized addiction medicine (ADM) as a subspecialty in 2016, which was timely given the recent rise in substance use disorder (SUD). The impact of this dual board opportunity on Family Medicine has not been described. Our study enumerates and characterizes physicians dually certified in Family Medicine and ADM.

Methods: We linked American Board of Medical Specialties data from March 2020 on physicians dually boarded in Family Medicine and ADM to responses on demographic and scope of practice questions in the American Board of Family Medicine (ABFM) National Graduate Survey and Family Medicine Certification Examination Registration Questionnaire.

Results: Of current ABFM Diplomates, 0.53% (492/93,269) are also boarded in ADM. Based on survey responses from a subset of dually certified physicians, those who are dually certified are more likely to practice in federally qualified health centers and to hold a faculty position. Dually certified physicians are more likely to provide HIV/AIDS and hepatitis C management and are as likely as non-dually certified physicians to provide newborn care, obstetric deliveries, inpatient adult medicine care, and intensive care.

Discussion: While only a small proportion of family physicians carry dual ADM board certification, those that do disproportionately serve vulnerable populations while retaining broad scope of care. Further work is needed to examine whether SUD treatment access could be addressed by implementing models that support dually certified physicians in consultative and educational efforts that would amplify their impact across the primary care workforce.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.04.200456DOI Listing
August 2020

Clinical Quality Measure Exchange is Not Easy.

Ann Fam Med 2021 May-Jun;19(3):207-211. Epub 2021 May 10.

American Board of Family Medicine, Lexington, Kentucky.

Purpose: The Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality was a randomized controlled trial which first had to test whether quality reporting could be a by-product of clinical care. We report on the initial descriptive study of the capacity for and quality of exchange of whole-panel, standardized quality measures from health systems.

Methods: Family physicians were recruited from 4 health systems with mature quality measurement programs and agreed to submit standardized, physician-level quality measures for consenting physicians. Identified measure or transfer errors were captured and evaluated for root-cause problems.

Results: The health systems varied considerably by patient demographics and payer mix. From the 4 systems, 256 family physicians elected to participate. Of 19 measures negotiated for use, 5 were used by all systems. There were more than 15 types of identified errors including breaks in data delivery, changes in measures, and nonsensical measure results. Only 1 system had no identified errors.

Conclusions: The secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation. This study reconfirms an important problem, namely, that despite widespread health information technology adoption and federal meaningful use policies, we remain far from goals to make clinical quality reporting a reliable by-product of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8118486PMC
May 2021

Debt of Family Medicine Residents Continues to Grow.

J Am Board Fam Med 2021 May-Jun;34(3):663-664

From the Sparrow-Michigan State University Family Medicine Residency Program, Michigan State University College of Human Medicine, East Lansing (JPP); American Board of Family Medicine, Lexington, KY (ZJM, AWB, LEP); Department of Family and Community Medicine, University of Kentucky, Lexington (ZJM, AWB, LEP).

The proportion of family medicine residents with ≥$250,000 in self-reported educational debt rose from 26% in 2014% to 47% in 2019. Such a rapid rise in high indebtedness is concerning, given known associations with resident distress. Previous research has also shown that highly indebted residents are less likely to choose academics, geriatrics, and service-oriented career paths.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.03.200567DOI Listing
October 2020

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents.

Fam Med 2021 Jun;53(6):423-432

American Board of Family Medicine, Lexington, KY.

Background And Objectives: Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation.

Methods: We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout.

Results: Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82).

Conclusions: We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22454/FamMed.2021.541354DOI Listing
June 2021

Using the Family Medicine National Graduate Survey to Improve Residency Education by Monitoring Training Outcomes.

Authors:
Lars E Peterson

Fam Med 2021 07 1;53(7):622-625. Epub 2021 Jun 1.

American Board of Family Medicine, Lexington, KY.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22454/FamMed.2021.719992DOI Listing
July 2021

Attitudes and Perceptions of Research Among US Family Medicine Department Chairs.

Fam Med 2021 Feb;53(2):98-103

NorthShore University HealthSystem, Department of Family Medicine, Evanston, IL.

Background And Objectives: The capacity for research within family medicine has historically been low despite its importance. The aim of this study was to learn more about the perceptions of family medicine department chairs regarding research and its role in their departments and institutions.

Methods: We analyzed a 2016 cross-sectional survey with responses from 109/142 (77% response) US chairs of allopathic departments of family medicine (DFMs) regarding departmental research capacity, research experience, and perceptions of research in the department and institution.

Results: Most chairs agreed that research is important (91%, n=92) and raises the prestige of the DFM (90%, n=91), though perceptions differ by chair research experience and DFM capacity for research. The mean ideal focus on research (21%, 8% SD) is greater than the actual (12%, 8% SD). Compared to the mean of all departments, those in DFMs with a high capacity for research estimated a higher actual (76% vs 26% and 7%, P<.0001) and ideal (73% vs 30% and 18%, P<.0001) departmental focus on research, as well as a higher ideal institutional focus on research (69% vs 35% and 28%, P=.001), significantly more often than chairs in moderate or minimal capacity DFMs. Those in lower capacity DFMs estimated a greater ideal research focus for their departments than they perceived their institution have.

Conclusions: Research is important to chairs of DFMs. DFMs that do not currently have major research enterprises may have the will and training required of their leader to grow. With the right support and resources, these DFMs may increase their research capacity, and subsequently their research productivity to support the needs of the discipline for more family medicine research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22454/FamMed.2021.611648DOI Listing
February 2021

Primary Care Physicians and Spending on Low-Value Care.

Ann Intern Med 2021 06 19;174(6):875-878. Epub 2021 Jan 19.

Center for Professionalism and Value in Health Care, Washington, DC.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M20-6257DOI Listing
June 2021

Factors Associated with Time Spent Practicing Sports Medicine by Those with a Certificate of Added Qualification.

J Am Board Fam Med 2021 Jan-Feb;34(1):189-195

From the Department of Family and Community Medicine, University of Kentucky, Lexington, KY (SN, LEP); American Board of Family Medicine, Lexington, KY (LEP, JCP); Division of Sports Medicine, Department of Family Medicine, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA (JCP).

Purpose: To determine those factors associated with family physicians certified in sports medicine (SM-FPs) devoting 75% or more of their professional time to the exclusive practice of sports medicine.

Methods: Data from the American Board of Family Medicine sports medicine examination registration questionnaires from 2003 to 2017 were analyzed. The characteristics of SM-FPs devoting 75% or more of their time to sports medicine were compared with those SM-FPs spending less than 75% time. Multiple regression analysis was used to determine characteristics that independently predicted devoting 75% or more of their professional time to the practice of sports medicine.

Results: One thousand one hundred twelve SM-FPs recertifying in sports medicine between 2003 to 2017 were studied. They were predominately male (85.2%), allopathic (91.7%) physicians with a mean age of 47.3 years (interquartile range (IQR), 42.1-54.2) and devoted a median 50% of their professional time (IQR, 25-80) to sports medicine. Age less than 47.3 years (odds ratio (OR), 1.53; 1.12-2.08), service as a collegiate team physician (OR 1.66; 1.10-2.50), recertification in sports medicine in 2011 to 2017 compared with earlier years (OR 2.47; 1.62-3.78), and practicing in a sports medicine clinic (OR, 6.43; 4.15-9.95) predicted greater odds of spending 75% or more of their time devoted to sports medicine.

Conclusions: Those factors found to be associated with spending 75% or more of their time practicing sports medicine by SM-FPs seem to be consistent with recent trends in the recruitment and employment of these physicians and their ability to provide added value to the health care system by virtue of their additional training and expertise.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.01.200303DOI Listing
January 2021

The Essential Role of Family Physicians in Providing Cesarean Sections in Rural Communities.

J Am Board Fam Med 2021 Jan-Feb;34(1):10-11

From the Agency for Healthcare Research and Quality, Rockville, MD (STT); American Board of Family Medicine, Lexington, KY (ARE, ZJM, AWB, LEP); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP).

Of family physicians who perform cesarean sections, more than half do so in rural communities and 38.6% provide cesarean sections in counties without any obstetrician/gynecologists. As policymakers in the United States struggle with a widening landscape of 'obstetrical deserts,' efforts to adequately train a family physician workforce prepared to provide cesarean sections could help maintain access to local obstetric services in rural communities and reduce perinatal morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.01.200132DOI Listing
April 2020

Distribution of Physician Specialties by Rurality.

J Rural Health 2020 Dec 4. Epub 2020 Dec 4.

American Board of Family Medicine, Lexington, Kentucky.

Purpose: Physicians of all specialties are more likely to live and work in urban areas than in rural areas. Physician availability affects the health and economy of rural communities. This study aimed to measure and update the availability of physician specialties in rural counties.

Methods: This analysis included all counties with a Rural-Urban Continuum Code (RUCC) between 4 and 9. Geographically identified physician data from the 2019 American Medical Association Masterfile was merged with 2019 County Health Rankings, the Census Bureau's 2010 county-level population data, and 2010 Topologically Integrated Geographic Encoding and Referencing shapefiles. Multivariate logistic regression was performed to assess the availability of physicians by specialty in rural counties.

Findings: Of the 1,947 rural counties in our sample, 1,825 had at least 1 physician. Specialties including emergency medicine, cardiology, psychiatry, diagnostic radiology, general surgery, anesthesiology, and OB/GYN were less available than primary care physicians (PCPs) in all rural counties. The probability of a rural county having a PCP was the highest in RUCC 4 (1.0) and lowest in RUCC 8 (0.93). Of all primary care specialties, family medicine was the most evenly distributed across the rural continuum, with a probability of 1.0 in RUCC 4 and 0.88 in RUCC 9.

Conclusions: Family medicine is the physician specialty most likely to be present in rural counties. Policy efforts should focus on maintaining the training and scope of practice of family physicians to serve the health care needs of rural communities where other specialties are less likely to practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jrh.12548DOI Listing
December 2020

The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas.

J Rural Health 2020 Nov 26. Epub 2020 Nov 26.

American Board of Family Medicine, Lexington, Kentucky.

Purpose: Scope of practice of family physicians (FPs) has been decreasing overall. Our objective was to determine if the distribution of declining scope occurs across urban and rural settings.

Methods: We used secondary data from practicing FPs collected on the American Board of Family Medicine examination registration demographic questionnaire from 2014 to 2016 on scope of practice merged with county-level data from the Area Health Resources File. Rurality was assigned using 4 population-based groupings from the Rural Urban Continuum Codes. Outcome measures were scope of practice score (0-30, higher score reflecting broader scope) and provision of specific types of care/procedures. Bivariate statistics assessed changes in scope of practice over time. Adjusted regression models tested associations between time, physician, practice, and county characteristics with scope of practice score.

Findings: Our sample was 27,343 practicing FPs. Overall, the scope score decreased from 15.5 to 15.0 (P value < .05) but was significant only for urban settings. Regression analysis found that scope decreased each year (β = -0.15), broader scope for rural FPs, and no interaction between year and rural.

Conclusions: The decrease in FP scope of practice is largely an urban phenomenon. FPs in rural areas have a broad scope of practice, which may ensure access to care in rural areas that rely on FPs to provide a large portion of health care services. However, county characteristics like persistent poverty and the presence of nurse practitioners, physician assistants, and other physicians were associated with changes in scope that may modify the gains associated with rurality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jrh.12540DOI Listing
November 2020

Quality Changes Among Primary Care Clinicians Participating in the Transforming Clinical Practice Initiative.

J Healthc Qual 2021 Jul-Aug 01;43(4):e64-e69

Abstract: The Transforming Clinical Practice Initiative (TCPI) was designed to provide technical assistance to clinicians and prepare practices to participate in value-based payment arrangements. In this longitudinal cohort study, we assessed whether clinician's participation in TCPI practice transformation networks (PTNs) was associated with changes in quality of care from 2016 to 2018. We extracted quarterly measure performance data from 2016 to 2018 on two NQF-endorsed measures, one for outcome (Controlling High Blood Pressure) and one for process (Use of Imaging Studies for Low Back Pain), from 1,981 primary care clinicians enrolled in the PRIME Registry. Clinicians participating in PTNs were identified and compared with their counterparts who did not participate in PTNs. We found that the performance of PTN clinicians on controlling high blood pressure and use of imaging studies for low back pain was equivalent to that of non-PTN clinicians during the first 3 years of the TCPI. Although PTNs provided assistance to help practices achieve their clinical outcomes, these findings suggest that the changes in quality of care, for the measures studied, among PTN clinicians in the first 3 years of the TCPI were attributable to temporal trends rather than participation in PTNs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000287DOI Listing
November 2020

Proportion of Family Physicians Caring for Children is Declining.

J Am Board Fam Med 2020 Nov-Dec;33(6):830-831

From the American Board of Family Medicine, Lexington, KY (ARE, ZJM, LEP); Robert Graham Center, Washington, DC (AJ); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP).

Using data from 2014 to 2018, we found that the proportion of family physicians caring for children under age 5 years and between ages 5 and 18 years has significantly declined. This has implications for the pediatric primary care workforce and may exacerbate inequities in access to care for pediatric patients in all geographies, particularly those in areas with a shortage of pediatricians.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2020.06.200089DOI Listing
March 2020

Abortion Provision Among Recently Graduated Family Physicians.

Fam Med 2020 Nov;52(10):724-729

Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY.

Background And Objectives: Family physicians (FPs) are well positioned to increase abortion access given their broad scope and diverse geographic practice regions. Previously published studies focus on physicians who received formal abortion training but do not include the full landscape of FPs performing abortions in the United States. This secondary data analysis presents a unique opportunity to examine characteristics of early-career FPs who provide abortions, including practice locations and if they received abortion training during residency.

Methods: We analyzed data from the 2016-2018 Family Medicine National Graduate Survey to generate descriptive statistics about respondents who report providing pregnancy termination, uterine aspiration/dilation and curettage, or both. We evaluated associations between physician and/or practice characteristics and providing pregnancy termination using bivariate statistics.

Results: Of the 6,319 survey respondents, 3% reported providing pregnancy termination. Nearly three-quarters of this subset reported graduating residency feeling prepared to provide pregnancy termination. Most respondents completed residency in the West or Northeast US geographic regions, and 3 years later were practicing in the West or South regions. Additional characteristics associated with providing pregnancy termination include female gender, providing continuity care, and practicing in either an academic medical center or a federally qualified health center.

Conclusions: FPs are well positioned to address gaps in abortion access, and those who provide pregnancy termination practice in various US geographic regions. This is the first discussion of its kind about the scope of family physicians providing abortion care. Future research should continue to characterize FPs who provide abortions to determine where they train and practice and what type of abortions they provide.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22454/FamMed.2020.300682DOI Listing
November 2020

Does Community- or University-Based Residency Sponsorship Affect Graduate Perceived Preparation or Performance?

J Grad Med Educ 2020 Oct;12(5):583-590

Background: Residency training occurs in varied settings. Whether there are differences in the training received by graduates of community- or medical school-based programs has been the subject of debate.

Objective: This study examined the perceived preparation for practice, scope of practice, and American Board of Family Medicine (ABFM) board examination pass rates of family physicians in relation to the type of residency program (community, medical school, or partnership) in which they trained.

Methods: Predetermined survey responses were abstracted from the 2016 and 2017 National Family Medicine Graduate Survey of ABFM and linked to data about residency programs obtained from the websites of national organizations. Descriptive statistics were used to summarize the data and logistic regression to examine differences between survey results based on type of residency training: community, medical school, or partnership.

Results: Differences in the perception of preparation as well as current scope of practice were noted for the 3 residency types. The differences in perception were mainly noted in hospital-based skills, such as intubation and ventilator management, and in women's health and family planning services, with different program types increasing preparedness perception in different domains.

Conclusions: In general, graduates of family medicine community-based, non-affiliated, and partnership programs perceived they were prepared for and were providing more of the services queried in the survey than graduates of medical school-based programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4300/JGME-D-19-00907.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594780PMC
October 2020

Meaningful Use And Medical Home Functionality In Primary Care Practice.

Health Aff (Millwood) 2020 11;39(11):1977-1983

Robert L. Phillips Jr. is the founding executive director of the American Board of Family Medicine Foundation Center for Professionalism and Value in Health Care, in Washington, D.C.

To improve health care quality and decrease costs, both the public and private sectors continue to make substantial investments in the transformation of primary care. Central to these efforts is the patient-centered medical home model (PCMH) and the adoption and meaningful use of health information technology (IT). We used 2018 national family medicine data to provide a perspective on the implementation of PCMH and health IT elements in a variety of US physician practices. We found that 95 percent of family medicine-affiliated practices used electronic health records (EHRs) in 2018, but there was wide variation in whether those EHRs met meaningful-use criteria. Federally qualified health centers and military clinics were significantly more likely than other settings to have adopted PCMH elements. Adoption of PCMH elements was lowest among independently owned practices, which make up one-third of the primary care delivery system. Our findings suggest that achieving PCMH transformation across all types of practices will require a coordinated approach that aligns strong financial incentives with tailored technical assistance, an approach similar both to that used in federally qualified health centers over the past decade and to that used to drive EHR adoption a decade ago.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1377/hlthaff.2020.00782DOI Listing
November 2020

Family Physician Burnout Does Not Differ With Rurality.

J Rural Health 2020 Sep 14. Epub 2020 Sep 14.

American Board of Family Medicine, Lexington, Kentucky.

Purpose: Burnout affects about half of family physicians (FPs). Minimal research exists which examines the impact of urban and rural practice settings on FP burnout. In this study, we examined whether rural practice is associated with FP burnout.

Methods: Data from the 2017 and 2018 American Board of Family Medicine Family Medicine Certification examination registration questionnaire were used. We limited our sample to FPs in continuity care in the United States. The questionnaire is a mandatory component of registration, resulting in a 100% response rate. Burnout was measured via 2 questions validated against the Maslach Burnout Inventory. We used logistic regression to determine associations between burnout and rural location, controlling for practice and personal characteristics.

Findings: Of the FPs surveyed, 2,740 met our inclusion criteria. Rural FPs were older, more likely to be male, and had a broader scope of practice than urban FPs. Rural FPs had a nonsignificantly higher burnout rate than urban FPs (45.1% vs 43.0%). Burnout was more common in younger and female FPs. We found no rural/urban differences between job satisfaction, practice environment, workload, and job stress; however, all of these characteristics were associated with burnout. In adjusted analyses, rural location was not associated with burnout (odds ratio = 1.15, 95% CI: 0.87-1.52).

Conclusion: In a large national sample, we found no difference in burnout between rural and urban FPs. This suggests there is nothing unique about rural practice that predisposes to burnout and that a common pathway to reduce burnout may exist.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jrh.12515DOI Listing
September 2020

Characteristics of Family Medicine Residency Graduates, 1994-2017: An Update.

Ann Fam Med 2020 07;18(4):370-373

American Board of Family Medicine, Lexington, Kentucky.

Purpose: The purpose of this study was to characterize graduates of family medicine (FM) residencies from 1994 to 2017 and determine whether they continue to practice family medicine after residency.

Method: We sampled physicians who completed FM residency training from 1994-2017 using 2017 American Medical Association (AMA) Physician Masterfile linked with administrative files of the American Board of Family Medicine (ABFM). The main outcomes measured were characteristics of FM residency graduates, including medical degree type (Doctor of Medicine, MD vs Doctor of Osteopathic Medicine, DO), international medical school graduates (IMGs) vs US graduates, sex, ABFM certification status, and self-designated primary specialty. Family medicine residency graduates were grouped into 4-year cohorts by year of residency completion.

Results: From 1994 to 2017, 66,778 residents completed training in an ACGME accredited FM residency, averaging 2,782 graduates per year. The number of FM residency graduates peaked in 1998-2001, averaging 3,053 each year. The composition of FM residents diversified with large increases in DOs, IMGs, and female graduates over the past 24 years. Of all the FM residency graduates, 91.9% claimed FM as their primary specialty and 81% were certified with ABFM in 2017. FM/sport medicine (2.1%), FM/geriatric medicine (0.9%), internal medicine/geriatrics (0.8%), and emergency medicine (0.7%) were the most common non-FM primary specialties reported.

Conclusions: DOs, IMGs, and female family medicine residency graduates increased from 1994 to 2017. With 9 in 10 graduates of family medicine residencies designating FM as their primary specialty, FM residency programs not only train but supply family physicians who are likely to remain in the primary care workforce.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358018PMC
July 2020

Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic.

Health Aff (Millwood) 2020 Sep 25;39(9):1605-1614. Epub 2020 Jun 25.

Bruce E. Landon is a professor of health care policy, Department of Health Care Policy, Harvard Medical School, and a professor of medicine and practicing internist at Beth Israel Deaconess Medical Center, in Boston.

As a result of the coronavirus disease 2019 (COVID-19) pandemic, virtually all in-person outpatient visits were canceled in many parts of the country between March and May 2020. We sought to estimate the potential impact of COVID-19 on the operating expenses and revenues of primary care practices. Using a microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements, including telemedicine visits, we estimated that over the course of calendar year 2020, primary care practices would be expected to lose 67,774 in gross revenue per full-time-equivalent physician (the difference between 2020 gross revenue with COVID-19 and the anticipated gross revenue if COVID-19 had not occurred). We further estimated that the cost at a national level to neutralize the revenue losses caused by COVID-19 among primary care practices would be $15.1 billion. This could more than double if COVID-19 telemedicine payment policies are not sustained.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1377/hlthaff.2020.00794DOI Listing
September 2020

Team Configurations, Efficiency, and Family Physician Burnout.

J Am Board Fam Med 2020 May-Jun;33(3):368-377

From American Board of Family Medicine, Lexington, KY (MD, LEP); Center for Excellence in Primary Care, Department of Family & Community Medicine, University of California, San Francisco (RW-G, KG); University of California, Berkeley (MK); University of Florida, Gainsville (SAL); Department of Family and Preventive Medicine, University of Utah, Salt Lake City (MKM); Department of Family and Community Medicine, University of Kentucky, Lexington (LEP).

Introduction: The delivery of team-based care relies on team structure and teamwork. Little is known about the landscape of team configurations in family medicine practices in the United States. Teamwork between diverse team members likely impacts both performance and physician well-being. We examined team configuration and teamwork and whether they are associated with family physician (FP) well-being.

Methods: We used data from practice demographic questionnaires completed by FPs who registered for the American Board of Family Medicine Family Medicine Certification Examination in 2017 and 2018. We grouped 14 types of health care professionals into medical assistant (MA)/nurse, nurse practitioner (NP)/physician assistant (PA), and specialist, and we characterized 3 common team configurations. We used FPs' subjective ratings to measure perceived teamwork efficiency and a validated single-item measure to identify FPs who were burned out.

Results: Among 2575 FPs in our sample, 22% worked collaboratively with MA/nurse only; 40% with MA/nurse and NP/PA or specialist; and 38% with MA/nurse, NP/PA, and specialist. The distribution of perceived teamwork efficiency was not statistically different across team configurations. In teams with greater perceived teamwork efficiency, FPs were less likely to be burned out. For FPs working with expansive teams, optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout after controlling for practice and physician characteristics.

Conclusion: Most FPs practice in multidisciplinary teams. Regardless of the team structure, FPs who perceived their teams as having greater efficiency were less likely to be burned out. We found that optimal perceived teamwork efficiency was associated with significantly reduced odds of burnout for FPs in all types of team configurations. Improving teamwork efficiency may be an effective strategy for practice organizations to support not only team functioning but also physician well-being.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2020.03.190336DOI Listing
July 2021

Burnout Among Family Physicians by Gender and Age.

J Am Board Fam Med 2020 May-Jun;33(3):355-356

From the American Board of Family Medicine, Lexington, KY (AE, ZM, LP); Robert Graham Center for Policy Studies, Washington, DC (YJ, EW); and the Department of Family and Community Medicine, University of Kentucky, Lexington, KY (LP).

Using data from 2017 to 2018, we found that female family physicians, especially those younger than 40 years of age, experience burnout at higher rates than males. This has implications for the primary care workforce and suggests pathways for policy makers and health system administrators to more effectively tackle burnout in their organizations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2020.03.190319DOI Listing
July 2021

Harmonized Outcome Measures for Use in Depression Patient Registries and Clinical Practice.

Ann Intern Med 2020 06 12;172(12):803-809. Epub 2020 May 12.

University of Texas Southwestern Medical Center, Dallas, Texas (M.H.T.).

Major depressive disorder is a common mental health condition that affects an estimated 16.2 million adults and 3.1 million adolescents in the United States. Yet, a lack of uniformity remains in measurements and monitoring for depression both in clinical practice and in research settings. This project aimed to develop a minimum set of standardized outcome measures relevant to both patients and clinicians that can be collected in depression registries and clinical practice. Twenty-nine depression registries and related data collection efforts were identified and invited to submit outcome measures. Additional measures were identified through literature searches and reviews of quality measures. A multistakeholder panel representing clinicians; payers; government agencies; industry; and medical specialty, health care quality, and patient advocacy organizations categorized the 27 identified measures using the Agency for Healthcare Research and Quality's supported Outcome Measures Framework. The panel identified 10 broadly relevant measures and harmonized definitions for these measures through in-person and virtual meetings. The harmonized measures represent a minimum set of outcomes that are relevant to clinicians and patients and appropriate for use in depression research and clinical practice. Routine and consistent collection of these measures in registries and other systems would support creation of a national research infrastructure to efficiently address new questions, improve patient management and outcomes, and facilitate care coordination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M19-3818DOI Listing
June 2020

Practice Patterns of Family Physicians With and Without Sports Medicine Certification.

Clin J Sport Med 2020 05;30(3):210-215

American Board of Family Medicine, Lexington, Kentucky.

Objective: To update information regarding practice patterns of family physicians with a certificate of added qualifications (CAQ) in Sports Medicine (SM), because it has been over 10 years since the last comprehensive study.

Design: Cross-sectional analysis of 2017 and 2018 American Board of Family Medicine (ABFM) Family Medicine Certification and SM CAQ examination registration practice demographic questionnaire data.

Setting: N/A.

Participants: Family physicians with a CAQ in SM [sports medicine family physicians (SM-FPs)] and family physicians without a CAQ registering for the ABFM Family Medicine Certification or SM CAQ examinations.

Intervention: N/A.

Main Outcomes: Self-reported time spent practicing SM, activities in SM, scope of practice, and practice setting.

Results: Sports medicine family physicians are predominately men (78.7%) and below 49 years (65.8%). Most SM-FPs spend 60% of their time or less practicing SM and the scope of practice of SM-FPs is only slightly narrower than that of their family physician counterparts without a CAQ. In addition, 92.8% of SM-FPs are practicing in an urban setting.

Conclusions: The similarity of scope of practice for SM-FPs and family physicians without a CAQ and the time spent practicing SM by SM-FPs suggests that most SM-FPs are spending a significant amount of time continuing to practice their primary specialty. Sports medicine family physicians are largely attracted to urban practice settings, most likely because of the higher likelihood of employment opportunities. Finally, factors that may be dissuading women from entering the field of SM deserve further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JSM.0000000000000838DOI Listing
May 2020

Associations Between Medical Education Assessments and American Board of Family Medicine Certification Examination Score and Failure to Obtain Certification.

Acad Med 2020 09;95(9):1396-1403

B. Clauser is vice president, Center for Advanced Assessment, National Board of Medical Examiners, Philadelphia, Pennsylvania.

Purpose: Family medicine residency programs can be cited for low pass or take rates on the American Board of Family Medicine (ABFM) certification examination, and the relationships among standardized medical education assessments and performance on board certification examinations and eventual board certification have not been comprehensively studied. The objective of this study was to evaluate the associations of all required standardized examinations in medical education with ABFM certification examination scores and eventual ABFM certification.

Method: All graduates of U.S. MD-granting family medicine residency programs from 2008 to 2012 were included. Data on ABFM certification examination score, ABFM certification status (as of December 31, 2014), Medical College Admission Test (MCAT) section scores, undergraduate grade point average, all United States Medical Licensing Examination (USMLE) Step scores, and all ABFM in-training examination scores were linked. Nested logistic and linear regression models, controlling for clustering by residency program, determined associations between assessments and both certification examination scores and board certification status. As many international medical graduates (IMGs) do not take the MCAT, separate models for U.S. medical graduates (USMG) and IMGs were run.

Results: The study sample was 15,902 family medicine graduates, of whom 92.1% (14,648/15,902) obtained board certification. In models for both IMGs and USMGs, the addition of more recent assessments weakened the associations of earlier assessments. USMLE Step 2 Clinical Knowledge was predictive of certification examination scores and certification status in all models in which it was included.

Conclusions: For family medicine residents, more recent assessments generally have stronger associations with board certification score and status than earlier assessments. Solely using medical school admissions (grade point average and MCAT) and licensure (USMLE) scores for resident selection may not adequately predict ultimate board certification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0000000000003344DOI Listing
September 2020

The Role of Gender in the Experience and Impact of Recertification Exam Preparation: A Qualitative Study of Primary Care Physicians.

J Womens Health (Larchmt) 2020 11 26;29(11):1401-1409. Epub 2020 Mar 26.

American Board of Family Medicine, Department of Research, Lexington, Kentucky, USA.

Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care. We used an iterative recruitment approach to obtain a representative sample. We applied a team-based constant comparative analytic approach to identify and categorize themes related to how preparing for the recertification examination impacted their personal or professional lives, and then compared these themes by physician gender. We interviewed 41 male and 39 female participants. Physicians most frequently described taking time from personal rather than professional activities to study, but often said this was "no big deal." Physicians described impacts on personal life such as missing out on family or leisure time, conflicts with parenting responsibilities, and an increased reliance on their spouse for domestic and childcare duties. Female physicians more frequently described parenting and leisure time impacts than males did. Recertification examination preparation impacts physicians' personal lives in a variety of ways and are sometimes experienced differently along gendered lines. These findings suggest opportunities for employers, payers, and specialty boards to help physicians ease potential burdens related to maintaining board certification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jwh.2019.8033DOI Listing
November 2020

Autologous Chondrocyte Implantation as Treatment for Unsalvageable Osteochondritis Dissecans: 10- to 25-Year Follow-up.

Am J Sports Med 2020 04 17;48(5):1134-1140. Epub 2020 Mar 17.

Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: An unsalvageable osteochondritis dissecans (OCD) fragment has been defined as one that cannot be saved. Unsalvageable OCD lesions have been treated with various techniques, including fragment excision, microfracture, osteochondral autograft transfer, fresh osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI).

Hypothesis: Patients who underwent ACI as treatment for unsalvageable OCD more than 10 years ago would maintain satisfactory patient-oriented outcome measures and have a low need for additional open surgery, especially arthroplasty.

Study Design: Case series; Level of evidence, 4.

Methods: All Swedish and Norwegian patients (59 patients with 67 OCD lesions) who underwent ACI for OCD under the direction of the senior author between 1990 and 2005 were identified through manual chart review. Features of the patient, OCD lesion, and surgery were extracted from the medical record and intraoperative photographs. Patients were sent questionnaires to assess the Knee injury and Osteoarthritis Outcome Score, Tegner-Wallgren activity score, and Lysholm score. In addition, patients were asked whether they had to undergo further surgery, including knee replacement, of the knee that underwent ACI. They were asked whether they would have the surgery again if in the same situation.

Results: A total of 55 patients (93%) with 61 OCD lesions (91%) responded. The median follow-up duration was 19 years (range, 10-26 years) and the median age at follow-up was 43 years (range, 28-69 years). Subsequent arthroscopy was performed in the majority of cases, although many of these were scheduled "second looks" as part of a study. With respect to other subsequent surgery, 12 knees (20%) underwent any additional open surgery, but only 2 knees (3%) underwent arthroplasty. Eight knees (13%) underwent revision ACI. Most patients reached their preinjury activity level (62%) and would undergo ACI again if in the same situation (85%). If failure is defined as revision of the graft or conversion to arthroplasty, then survivorship after ACI for OCD in the current study would be 87% at 10 years, 85% at 15 years, and 82% at 20 years.

Conclusion: ACI for OCD provides a durable treatment option. At a median follow-up of 19 years, there was a very low (~3%) conversion to total knee arthroplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0363546520908588DOI Listing
April 2020

Maternity Care and Buprenorphine Prescribing in New Family Physicians.

Ann Fam Med 2020 03;18(2):156-158

American Board of Family Medicine, Lexington, Kentucky.

The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both provide maternity care and prescribe buprenorphine. Family physicians who care for pregnant women and also prescribe buprenorphine represented 50.4% of all buprenorphine prescribers. The family physicians in this group were trained in a small number of residency programs, with only 15 programs producing at least 25% of graduates who do this work.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062488PMC
March 2020

General Practitioners in US Medical Practice Compared With Family Physicians.

Ann Fam Med 2020 03;18(2):127-130

American Board of Family Medicine, Lexington, Kentucky.

Purpose: General practitioners (GPs) are part of the US physician workforce, but little is known about who they are, what they do, and how they differ from family physicians (FPs). We describe self-identified GPs and compare them with board-certified FPs.

Methods: Analysis of data on 102,604 Doctor of Medicine and Doctor of Osteopathy physicians in direct patient care in the United States in 2016, who identify themselves as GPs or FPs. The study used linking databases (American Medical Association Masterfile, American Board of Family Medicine [ABFM], Area Health Resource File, Medicare Public Use File) to examine personal, professional, and practice characteristics.

Results: Of the physicians identified, 6,661 self-designated as GPs and 95,943 self-designated as FPs. Of the self-designated GPs, 116 had been ABFM certified and were excluded from the study. Of the remaining 102,488 physicians, those who self-designated as GPs but were never ABFM certified constituted the GP group (n = 6,545, 6%). Self-designated FPs that were ABFM certified made up the FP group (n = 79,449, 78%). The remaining self-designated FPs not ABFM certified constituted the uncertified group (n = 16,494, 16%). GPs differed from FPs in every characteristic examined. Compared with FPs, GPs are more likely to be older, male, Doctors of Osteopathy, graduates of non-US medical schools, and have no family medicine residency training. GPs practice location is similar to FPs, but GPs are less likely to participate in Medicare or to work in hospitals.

Conclusions: GPs in the United States are a varied group that differ from FPs. Researchers, educators, and policy makers should not lump GPs together with FPs in data collection, analysis, and reporting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7062491PMC
March 2020

Elucidating the corrosion-related degradation mechanisms of a Ti-6Al-4V dental implant.

Dent Mater 2020 03 25;36(3):431-441. Epub 2020 Jan 25.

Laboratory for the Chemistry of Construction Materials (LC(2)), Department of Civil and Environmental Engineering, University of California, Los Angeles, CA, USA; Department of Materials Science and Engineering, University of California, Los Angeles, CA, USA; California Nanosystems Institute (CNSI), University of California, Los Angeles, CA, USA; Institute for Carbon Management, University of California, Los Angeles, CA, USA.

Objective: The Ti-6Al-4V (TAV) alloy is commercially used as a dental implant material. This work seeks to elucidates the origins of degradation of Ti-6Al-4V (TAV) implant alloys that result in peri-implant bone loss. 
Methods: In this work, a combination of microstructure, surface, and solution analyses was utilized to study the corrosion mechanism of the TAV alloy in oral environments. The corrosion of TAV alloys in the F-enriched environment of a crevice was evaluated through nanoscale surface analysis. And, the findings were further rationalized via electrochemical means. 
 RESULTS: Our results suggest the bone loss was caused by crevice corrosion and the consequential release of by-products, and the crevice corrosion was potentially induced by the buildup of corrosive species such as fluorides, which are common additives in dental products. In turn, the corrosion properties of the TAV alloy were evaluated in fluoride enriched environments. Nanoscale analysis of corroded surfaces, carried out using vertical scanning interferometry (VSI) showed that the corrosion susceptibility of the constituent phases dictates the corrosion product species. In specific, the aluminum-rich α phase preferentially dissolves under potential-free conditions and promotes the formation of insoluble Al-Ti oxides. Notably, under conditions of applied potential, oxidative dissolution of the vanadium-rich β phase is favored, and the vanadium release is promoted. 
 SIGNIFICANCE: These findings elucidate the origins of degradation of TAV-implants that result in the release of corrosion by-products into the local biological environment. More important, they offer guidelines for materials design and improvement to prevent this nature of degradation of dental implants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dental.2020.01.008DOI Listing
March 2020

Practice Predictors of Buprenorphine Prescribing by Family Physicians.

J Am Board Fam Med 2020 Jan-Feb;33(1):118-123

From the American Board of Family Medicine, Lexington, KY (LEP, ZJM); Department of Family and Community Medicine, University of Kentucky, Lexington, KY (LEP); Department of Health Management and Policy, University of Kentucky, Lexington, KY (TFB).

Introduction: Both opioid use disorder and mortality for opioid overdoses are increasing. Family physicians (FPs) can treat opioid use disorder if they are waivered to prescribe buprenorphine. Our objective was to determine personal, practice, and community characteristics associated with FPs prescribing buprenorphine.

Methods: We used data from the 2017 and 2018 American Board of Family Medicine examination registration questionnaire. The questionnaire asked about current prescribing of buprenorphine, as well as about practice size, organization, and location. Logistic regression was used to determine associations between buprenorphine treatment and individual, practice, and county characteristics.

Results: The questionnaire had a 100% response rate. After excluding FPs in noncontinuity practices and those who could not be linked to a US county, our final sample was 2726. Only 161 (5.9%) prescribed buprenorphine. Practice in a Federal Qualified Health Center (adjusted Odds Ratio [aOR] = 1.98 (95% CI, 1.08, 3.63)), in solo practice (aOR = 2.60 (1.38, 4.92)), or with a mental health professional (aOR = 2.70 (1.73, 4.22)) were positively associated with prescribing buprenorphine. Practice in a rural county or in a whole county mental health professional shortage area were not associated with buprenorphine prescribing.

Discussion: Few FPs prescribed buprenorphine, but those in practice settings with supporting mental health services were more likely to prescribe. With their training in the biopsychosocial model and a more even distribution across the rural continuum, FPs are perfectly situated to meet the increasing need for medication-assisted treatment. However, ensuring they have supporting mental health services will be central to having more FPs provide medication-assisted treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2020.01.190235DOI Listing
April 2021
-->