Although large numbers of family physicians across the country and in different practice sites participate in the American Board of Family Medicine's Maintenance of Certification for Family Physicians(www.theabfm.org), or ABFM MC-FP, program, those practicing in poorer and medically underserved areas are more likely than their colleagues in nonmedically underserved and more affluent areas to let their board certification lapse. Those are among the findings of a study(www.annfammed.org) published in the May/June Annals of Family Medicine that suggests various policy actions may be needed to support physicians in these areas.
The study involved all active family physicians who were initially certifying, recertifying or attempting certification after they had previously failed. Active physicians were defined as those directly caring for patients, doing research, teaching or working in administrative functions who were still active in their employment.
Using a combination of ABFM administrative records, 2009 AMA Physician Masterfile records and various geographic indices (e.g., 2000 Census Bureau tabulations, federally designated health professional shortage areas and medically underserved areas), the study found that 85 percent of the more than 70,000 active family physicians included in the study group have current board certification. Of those currently certified, 91 percent are participating in MC-FP.
"Participation in MC-FP appears to be robust," said the study authors, several of whom hail from the AAFP's Robert Graham Center in Washington and the ABFM. "Large numbers of family physicians are embracing MC-FP and meeting its requirements in a timely fashion."
The AAFP has developed a number of resources to guide family physicians through the maintenance of certification process, including board review resources
in multiple formats, live self-assessment module working groups,
and its Measuring, Evaluating and Translating Research Into Care program.
ABFM President and CEO James Puffer, M.D., a study co-author, elaborated. "We were highly encouraged by the results. The 91 percent participation rate was very gratifying and speaks to family physicians' sense of professionalism," he told AAFP News Now.
What also came to light, however, was that FPs who are not participating in MC-FP tend to work in poorer and underserved areas. In fact, there were significantly higher percentages of physicians working in health professional shortage areas, in medically underserved areas, with medically underserved populations, and in poorer neighborhoods who had lapsed certifications.
"As more studies have linked quality of medical care to board certification, it is particularly troubling that physicians who have not maintained certification tend to be practicing in underserved areas or caring for underserved populations," said the study authors.
Among the study's other findings are the following:
- the likelihood of engaging in MC-FP decreases with increasing age;
- although 90 percent of female FPs participate in MC-FP, only 83 percent of male FPs do so;
- among internationally trained FPs, U.S.-born international medical graduates, or IMGs, are more likely than foreign-born IMGs to have allowed their certification to lapse or have not achieved certification;
- FPs in direct patient care, either office- or hospital-based, and in medical teaching are more likely to be engaged in MC-FP than those in medical research, administrative and other nonpatient care roles;
- FPs in group practice are more than twice as likely to be board-certified and are 10 percent more likely to be engaged in MC-FP than are solo FPs;
- FPs employed by the military are more likely to be certified and involved in MC-FP than those employed by local government health agencies; and
- rural FPs are slightly more likely than urban FPs to maintain their certification.
That last finding was of particular interest to one of the study's co-authors.
"The message (of the study) is really about underserved areas," Robert Phillips Jr., M.D., M.S.P.H., director of the Graham Center, told AAFP News Now. "We were pleasantly surprised to see that rural physicians were no less likely to be doing maintenance of certification than their urban counterparts."
According to the study, potential reasons for lower MC-FP participation levels among family physicians practicing in poor and underserved could include
- employers in these areas may not require evidence of certification as a condition of employment;
- time demands are higher on physicians in these areas; and
- fewer resources are available to support MC-FP efforts.
Another study co-author, Andrew Bazemore, M.D., M.P.H., assistant director of the Graham Center, agreed that the lower participation by FPs who care for the underserved is an area of concern. He suggested that policies that aim to improve the distribution of physicians, such as payment incentives, could help solve time and money problems and also improve maintenance of certification rates.
"It's part of the broader problem of getting better funding for primary care physicians who serve those with the greatest need," said Bazemore.
All barriers to participation in MC-FP by family physicians who care for the underserved should be investigated, said the study authors.
"High levels of health care disparities and the need for high-quality care in these areas make it even more pressing to explore and understand the barriers to participation in maintenance of board certification by these physicians," they noted.
"The causal relationship between practicing in underserved areas and having allowed board certification to lapse is not established in this analysis; nevertheless, their significant association suggests a need for further investigation, policy development and intervention."