FPs and GPs Aren't the Same; Combining Them Blurs the Data

Marcia Frellick

March 12, 2020

Anyone who thinks board-certified family physicians (FPs) and self-identified general practitioners (GPs) can be lumped into one broad category should think again, according to a new study.

"Lumping GPs and FPs together risks misclassification bias and threatens validity of [research] findings," write William R. Phillips, MD, MPH, with the Department of Family Medicine at the University of Washington in Seattle, and colleagues. Their study, March 9 in the Annals of Family Medicine, was supported in part by the American Board of Family Medicine (ABFM) Foundation.

The report is interesting because it answers long-standing questions: "Why are GPs included as FPs, and who are they and what do they do?" said Jack Westfall, MD, MPH, director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, DC.

Data From More Than 100,000 Physicians

裸艺Phillips and colleagues analyzed data from 102,604 MD and DO physicians who identified as GPs or FPs and were involved in direct patient care in the United States in 2016. Of those, 6661 (6.5%) said they were GPs and 95,943 (93.5%) reported their designation as family physician.

裸艺Comparing the two groups, the researchers found that GPs were often older (average age, 64.6 years vs 49.4 years for family physicians) and a larger proportion are male (77% vs 58%).

GPs are also more likely than FPs to be DOs (28% vs 10%) and to have graduated from schools outside the United States (41% vs 23%).  Researchers found the largest percentages came from the Philippines (15.6%), Cuba (13.7%), and India (13.5%).

"[GPs] are unlikely to have any FM residency training or to have ever been ABFM [American Board of Family Medicine] certified," the authors write. GPs are also less likely than FPs to participate in Medicare (53% vs 76%) or to provide Medicare services in hospitals (13% vs 22%).

"Unlike primary care physicians of 40 years ago, present day GPs in the United States are a heterogeneous group that is distinctly different from FPs," the authors write. "The differences may impact decisions made regarding medical education, postgraduate training, specialty certification, assessments of patterns, outcomes of care, and workforce planning."

Direct Impact on Caring for an Aging Population

Westfall, who was not part of the study, told Medscape Medical News that he's taking the results to his team at the Graham Center, where they focus on workforce education and research.

"We're trying to figure out how you train a workforce of family physicians in primary care for the future needs of the United States. Understanding who's in that group right now leads us to the projections for what we'll need in 10 years, 20 years, and 40 years," he said.

裸艺The Medicare finding is particularly concerning, Westfall said, as they estimate workforce needs for an aging population.

"If GPs don't take Medicare, including them in the projections will underestimate what we need," he said.

裸艺What the paper doesn't get to, Westfall points out and the authors acknowledge, is how GPs practice, which will need future research.

"Do they do obstetrics? Do they do prenatal care or pediatrics? Without an understanding, we can't make those projections," Westfall said. "Likewise, a patient or consumer can't make decisions about whom to see."

With GPs making up 6.5% of the physicians studied, they can have a significant effect on the numbers in analyses, Westfall continued.

裸艺Another group of physicians the authors highlight are those who identify as family physicians and may have had family medicine training but aren't board certified.

Adding that group, which comprises 16% of the sample, to the 6.5% who identify as GPs makes for a sizeable group of physicians "that we don't know much about," said Westfall, who is also president of the North American Primary Care Research Group.

裸艺He noted that a conversation is necessary with the American Board of Medical Specialties (ABMS) about what other specialties are doing with groups of physicians who may not have completed residencies or are not board certified.

裸艺It's important to know what the skillset of the groups are and "make sure they are safe to practice," he said. "This may be a great group of docs that we don't need to worry about, but we need to study that."

For the current study, Phillips and colleagues linked data from the 2016 American Medical Association (AMA) Masterfile with multiple sources, including ABFM administrative data, the Medicare Public Use File, and the US Department of Health and Human Services' Area Health Resource File.

They acknowledge several study limitations, including that that the databases did not have information on whether physicians were certified by boards other than ABFM, such as osteopathic boards.

裸艺They also note that their findings don't apply to GPs in other countries where general practitioners may have different training and scope.

The study was supported by the American Board of Family Medicine Foundation. The study authors and Westfall have disclosed no relevant financial relationships.

Ann Fam Med. Published online March 9, 2020.

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