Does Changing From Solo to Group Practice Relate to Maintenance of Certification Exam Performance?

• In Event: Roundtable Session 9
  In Roundtable Session: Factors Contributing to Performance Differences of Practicing Physicians in Internal Medicine

Abstract

Research has shown the physicians in solo practice do not perform as well on maintenance of certification (MOC) exams as those in group practice (Lipner, Song, Biester, & Rhodes, 2011; Samonte, Jones, Biester, & Malangoni, 2015), that they are less likely to follow guidelines, and that their patients have poorer outcomes (Ketcham, Baker, & Maclsaac, 2011). Although these studies have identified potential deficiencies for solo practitioners, they have not determined whether a change in solo practice status would be associated with a change in exam performance. The purpose of this study was to better address the changes in solo practice status and its relationship to MOC exam performance.
Method
Participation in MOC requires that physicians complete an exam every ten years (i.e., time limited certificates). Since time limited certificates were first introduced in 1990, several cohorts of physicians have now completed the MOC program for their first (ten years since certification) and second cycle (twenty years since certification). Exam pass/fail outcomes and practice characteristics were collected for all general internists who attempted their first cycle MOC exam from 1998 to 2004. These records were then linked with the same data (exam outcomes and practice characteristics) for their first attempt at their second cycle MOC exam.
Solo practice status was captured from the practice characteristics survey that diplomates complete when enrolling in MOC and updated every 18 months. Solo practice change status was dummy-coded into three variables to reflect how a diplomate’s solo status changed over time. Diplomates were classified as changing from group to solo practice, solo practice to group practice, or remaining within solo practice at both time points. These groups were compared to the reference group of physicians who remained in group practice for both cycles. Other potentially confounding variables (e.g., initial certification exam performance, age, country of medical school training) were also included in the study to better isolate solo practice status effects. Logistic regression analyses were conducted to determine the relationship between changing solo practice status with the probability of a diplomate passing the MOC exam in their second cycle.
Results and Discussion
The results of the logistic regression analyses showed that, after controlling for relevant covariates (e.g., initial certification exam performance, age, country of medical school training) physicians who remained in solo practice across both time points had significantly lower pass rates on their second cycle exam (p = .0003) than those who stayed in group practice. Additionally, physicians who changed from group practice to solo practice had significantly lower pass rates than those who remained in group practice (p = .0005). Conversely, physicians who changed from solo practice to group practice performed similarly to those who remained in group practice (p = .8257). These results provide further support that solo practitioners perform more poorly e on MOC exams. It also revealed that those who moved to group practice exhibited similar performance to others in a group practice setting. Full results, implications and limitations will be discussed in the full paper. 

Authors

• Andrew Jones, American Board of Surgery

• Brendan J Barnhart, American Board of Internal Medicine