Expectations for Physician Licensure: A National Survey of Practice

Abstract

ABSTRACT To investigate the practice characteristics of newly licensed physicians for the purpose of identifying the knowledge and skills expected of those holding the general, unrestricted license to practice medicine, a questionnaire was mailed in May 2012 to 8,001 U.S. physicians who had been granted an unrestricted license to practice medicine between 2007 and 2011. The questionnaire requested information on stage of training, moonlighting, and practice setting; it also listed 58 clinical procedures and asked respondents to indicate whether they had ordered, performed, or interpreted the results of each procedure since obtaining their unrestricted license. A strategy was implemented to identify the relevance of each clinical activity for undifferentiated medical practice. The response rate was 37%. More than two-thirds of newly licensed physicians still practiced within a training environment; nearly one-half of those in training reported moonlighting, mostly in inpatient settings or emergency departments. Physicians who had completed training and entered independent practice spent most of their time in outpatient settings. Residents/fellows engaged in a broader range of clinical activities than physicians in independent practice. Several clinical procedures were identified that were specialty-specific and did not appear to be skills expected for general medical practice. The results may help residency programs and licensing authorities identify the knowledge and skills required of newly licensed physicians as they transition from supervised to unsupervised practice. The results are relevant to the topic of moonlighting by identifying the skills and procedures required of physicians who engage in this activity. While the study identified procedures that have limited utility for licensure decisions because they are not consistent with general medical practice, the inclusion of such procedures in residency may add value by promoting beneficial variation in training experiences.