PRACTICE PEARLS

To meet maintenance of certification (MOC) requirements, physicians periodically need to do a Performance Improvement (PI) project for the American Board of Family Medicine (ABFM), or a similar project for the American Osteopathic Board of Family Physicians. Instead of facing that with dread, look at the recent projects you’ve done in your practice. Changes to the MOC process now allow many common quality improvement (QI) projects to qualify as a PI project through ABFM’s self-directed path.¹

For example, did you change the way you gave flu shots this year to miss fewer opportunities? Did you track no-shows for a few weeks and change a process to reduce them? Did you use artificial intelligence to write a patient questionnaire about adherence to home blood pressure monitoring and experiment with using it to improve hypertension care? Collecting a small amount of data about your QI effort is essentially a mini Plan-Do-Study-Act cycle. Most family physicians regularly tweak things in their practice and are just one tiny step away from an acceptable PI project.

Even if you don’t need to do this for MOC purposes, make sure you are talking to your team about what needs improving. This shows good leadership, encourages staff creativity and buy-in, and might lead to a process improvement idea you hadn’t considered.

For family physicians who do procedures, asking the right questions during job interviews can help ensure you’ll be able to practice the scope you desire.

1. Has a family physician ever obtained privileges for this procedure within the hospital or health system affiliated with the practice? If not, it may take more work to obtain privileges.
2. Which department is responsible for recommending privileges for this procedure? Clarify whether it will be handled by the family medicine department, a primary care department, or another specialty. Understanding the process up front will help you choose the best strategies for navigating it.
3. What are the proctoring requirements? Ask about the number of cases you’ll need to have proctored before privileges are granted and whether another family physician will proctor you. Every facility sets their own proctoring guidelines, so there is no standard number for each procedure, but the guidelines should be outlined in their medical staff bylaws.²
4. What will your practice location and setup be? Does the office already have the space, supplies, and trained staff to perform this procedure? If there is another location where you would be doing it, how often would you rotate to that location? Can other physicians in your group refer to you for this procedure? Do patients need to be referred out for any services, such as imaging, related to the procedure? Processes that inconvenience patients will impact your ability to attract and retain them.
5. Who are the backups for this procedure? If it requires potential consultation or coordinated care with another specialty, has that person or group worked with family physicians in this capacity before?
6. Does the office have everything in place to bill for this work? It may require some preparatory work to properly code and bill for this procedure if it isn’t already being done by family physicians.