Intent to Practice: Scope of Practice Realization Among Early Career Family Physicians

Background and Objectives: Family physician scope of practice (SOP) has declined despite broad intentions upon graduating residency. Our objective was to understand the alignment between intended and actual SOP of graduating family medicine residents.Methods: We used data from a retrospective, linked survey cohort through the American Board of Family Medicine to examine whether SOP intentions materialized into actual SOP for early career family physicians. Intentions were collected on the Initial Certification Questionnaire (2017–2020). Three years after graduation, physicians completed the National Graduate Survey, which assessed SOP and practice organization characteristics. The primary outcome was a summative SOP score based on self-reported provision of 31 services. We also examined individual items within the score. We used descriptive statistics and regression analyses to assess associations between intended and actual SOP and practice characteristics.Results: Among 5,006 respondents, intended and actual SOP were significantly correlated (r = 0.58, P<0.0001). Broader SOP in early career family physicians was associated with higher SOP intentions (β = 0.32, CI: 0.30–0.34), rural practice (β = 0.89, CI: 0.69–1.09), academic settings (β = 1.42, CI: 1.21–1.63), safety net settings (Indian Health Service: β = 1.11, CI: 0.45–1.77; rural health center: β = 0.86, CI: 0.53–1.19; Federally Qualified Health Center: β = 0.83, CI: 0.61–1.04), and teaching (β = 0.97, CI: 0.81–1.13). Narrower SOP was linked to international medical graduates (β=–0.24, CI: –0.42 – –0.07) and multispecialty practices (β=–0.44, CI: –0.59 – –0.29).Conclusions: While residents with broader SOP intentions were more likely to report wider early career SOP, practice characteristics and environment remained an important determinant of realized scope.