Early career family physicians who provide a broader scope of practice, specifically, inpatient medicine, obstetrics, or home visits, reported significantly lower rates of burnout. Our findings suggest that comprehensiveness is associated with less burnout, which is critical in the context of improving access to good quality, affordable care while maintaining physician wellness.

We thank Alexandra Junn, AB, and Alexandra Jacob, MS, for data support (compensated in the normal course of their employment); Elizabeth Linos, PhD (uncompensated), and Amy J. Markowitz, JD (compensated), for critical editing; and the members of Physician Moms Group (uncompensated) for their participation.

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Background: Medical certifying boards' core mission is assuring the public that Diplomates have the requisite knowledge, skills, and professional character to provide high-quality medical care. By understanding their Diplomates' workforce and practice environments, Boards ensure that certification is relevant to the profession and accountable to the public. Current and reliable data are key to meeting this function. The objective of this article was to describe American Board of Family Medicine (ABFM) data collection procedures and demonstrate the capacity to compare cohorts by examination year. Methods: We used data from ABFM examination application practice demographic questionnaires from 2013 to 2016. Descriptive and bivariate statistics assessed variation in Diplomate and certification candidate characteristics across examination cohorts. Results: From 2013 to 2016, 55,532 family physicians applied for either initial certification (n ‫؍‬ 15,388) or to continue their certification (n ‫؍‬ 40,144). Diplomate characteristics varied slightly from year to year with more International Medical Graduates and fewer men in later cohorts but, these differences were not large between cohorts. Initial certification candidates were more likely to be women, and racial or ethnic minorities than Diplomates seeking to continue their certification, and each year's cohort was characterized by increasing numbers of female and US medical graduates. Discussion: Data collected from Diplomates as part of examination registration have proved invaluable to serving the mission of the ABFM and advancing knowledge about the specialty of family medicine. Continued refinement of data collection to enhance data reliability and usefulness, while reducing collection burden, will continue.

Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.

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Purpose Educational debt is increasing and may affect physicians’ career choices. High debt may influence family medicine residents’ initial practice setting and fellowship training decisions, adversely affecting the distribution of primary care physicians. The purpose of this study was to determine whether debt was associated with graduating family medicine residents’ practice and fellowship intentions. Method The authors completed a cross-sectional secondary analysis of 2014 and 2015 American Board of Family Medicine (ABFM) examination registration questionnaire data and ABFM administrative data. They used multivariate logistic regression to determine whether educational debt was associated with graduating residents’ practice (ownership and type) and fellowship intentions. Results Most residents (89.7%; 3,368) intended to pursue an employed position, but this intention was not associated with their debt. Residents with high debt ($150,000–$249,999) had lower odds of intending to work for a government organization (odds ratio [OR] 0.57; confidence interval [CI] 0.41–0.79). Those with high or very high debt (> $250,000) had lower odds of choosing academic practice (OR 0.55, CI 0.36–0.85 and OR 0.62, CI 0.40–0.96, respectively) or a geriatrics fellowship (OR 0.36, CI 0.20–0.67 and OR 0.29, CI 0.15–0.55, respectively). Conclusions High educational debt may contribute to national shortages of academic primary care physicians and geriatricians. Existing National Health Service Corps loan repayment opportunities may not offer adequate incentives to primary care physicians with high debt. The medical community should advocate for policies that better align financial incentives with workforce needs.

Background Training in quality improvement (QI) is a standard component of family medicine residency education. Graduating family medicine residents' ability to lead QI initiatives is unknown. Objective We assessed the preparedness of graduating family medicine residents to lead QI projects and to identify factors that may increase such readiness. Methods Milestone data for all graduating family medicine residents were linked to a practice demographic questionnaire completed by the same residents who registered for the American Board of Family Medicine certification examination between 2014 and 2017. The change in self-assessed QI preparedness over time and its association with faculty-assigned milestone ratings were examined using descriptive and regression analyses. Results The questionnaire had a 100% response rate (12 208 responded). Between 2014 and 2017, the percentage of residents who self-reported being “extremely” or “moderately” prepared to lead QI projects increased from 72.7% (2208 of 3038) to 75.8% (2434 of 3210, P = .009). Self-reported QI team leadership was associated with 93% higher odds of feeling extremely prepared compared to moderately prepared (odds ratio 1.93, 95% CI 1.58–2.35). The average midyear faculty-assigned milestone rating for QI among residents who felt “extremely” prepared was 3.28 compared to 3.14 among those who felt “not at all” prepared. Conclusions Over the past 4 years, family medicine residents' self-assessed preparedness to lead QI projects has barely increased. There was no correlation between self-assessed preparation and faculty-assigned milestone rating. However, we found a small association between self-reported QI leadership and self-assessed QI preparedness.