Physician Scope of Practice

Factors Influencing Scope of Practice

US family physicians’ scope of practice has been decreasing over time, with fewer family physicians providing basic primary care services such as chronic disease management, pediatric care, prenatal care, women’s health, and mental health. At the same time, new family medicine graduates hope to provide a broader scope of practice than current practicing physicians.

Qualitative research is being conducted with MAHEC residency program graduates to understand residents’ expectations, employer needs, and physician scope of practice in Western North Carolina. Based on analysis of the qualitative data, the collaborative research team has developed a conceptual framework to explain the different factors that influence desired and actual scope of practice. 


Research has shown that a broader scope of practice is associated with lower rates of physician burnout, a critical issue for patient care and the healthcare system. The current literature focuses primarily on the personal factors that influence physicians’ scope of practice.

After conducting multiple focus groups, researchers have developed a working framework that identifies a variety of factors that influence scope of practice including personal, environmental, workplace, and population factors. Research findings will be used to inform future recruitment, workplace optimization, and workforce training needs.

Principal investigators: Amy Russell, MD, medical director of Mission Health Partners and MAHEC Family Medicine faculty; Stephen Kimmel, MD, MAHEC Family Residency graduate and rural fellow; Brittney Macdonald, MD, third-year MAHEC Family Medicine resident; and Jill Fromewick, ScD, and Kathy Foley, PhD, Department of Research, UNC Health Sciences at MAHEC.

Impact of Rural Exposure on Desired Scope of Practice

Preliminary data from a comparative study of MAHEC family medicine residency programs in Asheville and Hendersonville, NC indicate that residents in both programs desire a broader scope of practice than is currently provided by their rural preceptors. The largest gaps in desired versus actual practice were in inpatient and outpatient obstetrics and inpatient pediatrics and inpatient adult medicine.

Other findings support previous research that suggests rural exposure during medical school and residency increases the likelihood of choosing a rural practice in the future, particularly when combined with a rural background.

Principal investigators: Bryan Hodge, DO, MAHEC Hendersonville Family Medicine Residency; Jill Fromewick, ScD, and Lauren Payne, Department of Research, UNC Health Sciences at MAHEC.