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4. What Do Family Physicians Do?

Family physicians are trained to deliver comprehensive, continuous care across the lifespan, including preventive services, chronic disease management, behavioral health, maternity care, inpatient medicine, and procedures; this focus on comprehensiveness is associated with improved health outcomes. They also support patients’ health through counseling on nutrition, lifestyle, and preventive risk, including genetic risk assessment. Using national data from family physicians and residents, this analysis examines preparedness, early‑career intentions, and how clinical scope evolves over time, highlighting substantial variation by career stage, geography, and practice environment.

Commentary

Family physicians receive broad training to care for patients across the lifespan and settings, including maternity care, inpatient and outpatient medicine, behavioral health, chronic disease management, population health, and prevention. This breadth of preparation results in wide variation in clinical scope, shaped further by region, physician characteristics, and practice environment. Recent concerns highlight a declining scope of practice, particularly in urban areas, driven in part by corporatization and reduced physician autonomy, creating a growing gap between intended and actual practice across cohorts.

Connections and Context

The unique comprehensiveness of skills shown here among family physicians, and their ability to address a wide range of patient needs across conditions, settings, and stages of life, is a foundational feature of high-performing primary care systems, associated with better patient outcomes, higher patient experience, and more efficient health care use (Starfield, 2012; Bazemore et al, 2015). That the intended practice scope declared by family medicine residents exceeds their actual scope in practice suggests that organizational structures, employment models, and payment may be limiting family physicians ability to fully deploy their trained skills to optimally meet community health needs (Wang et al, 2022). Prior studies demonstrate that declines in scope of practice are particularly concentrated in urban settings (Nasim et al, 2021), despite increasing demand for robust primary care there. Encouragingly, emerging care delivery and payment models offer potential pathways to support and sustain broader scope in practice (Russell et al, 2021; Henry et al, 2022).

Commentary

ABFM is one of 24 specialty boards within the American Board of Medical Specialties (ABMS), collectively responsible for setting and maintaining certification standards across medical disciplines. Some family physicians pursue certification from other specialty boards based on their clinical training or practice focus.

 

Connections and Context

Dual board certifications in family medicine represent structured pathways for aligning physician training with documented workforce needs in emergency care, behavioral health, and population health crises such as addiction (Tong et al, 2021). Collectively, such pathways have contributed to workforce flexibility by supporting integrated models of care, particularly in rural, underserved, and safety‑net environments, without fragmenting primary care delivery or displacing core family medicine roles, such as emergency medicine (Bennett et al, 2021).

Commentary

Family physicians may pursue additional specialization through Certificates of Added Qualification (CAQs), which are available after completing additional training or demonstrating sustained focused practice in a particular area. Roughly 1 in 14 (7.1%) family physicians held a CAQ as of January 1st, 2025. These credentials are designed to recognize focused expertise and are renewed through the continuous certification process.

Connections and Context

CAQs are a common way for family physicians to obtain additional training and specialization to meet the needs of their patients, with sports medicine and geriatrics dominating these sectors, and key evidence emerging in recent years to evaluate these specific areas of additional qualification (Cox et al, 2020;  Jo et al, 2023). As newer CAQs become more common, further research will be needed to examine the impacts of these additional certifications on our health system and its evolution, especially relative to Health Care Administration, Leadership, and Management (HALM) education becoming evidence-based in residency training (Nguyen et al, 2025). Unsurprisingly, an aging U.S. population has seen growth in the number of family physicians adding training in the care of patients over 65 (Jo et al, 2023).

Commentary

Many family physicians also serve as generalist scientists, teaching, conducting research, and leading quality improvement while continuing to provide patient care in academic and community settings. Currently, approximately one in three family physicians serve as educators.

Connections and Context

Studies show that many family medicine residents are interested in becoming teachers and faculty physicians, yet fewer ultimately move into or remain in these roles due to workload, limited support, and unclear career pathways (Weidner et al., 2021). At the same time, residency programs across the country report growing difficulty recruiting and retaining faculty, which can limit how many new family physicians can be trained (Yu & Schenk, 2025). Research on academic family medicine leadership further shows that sustaining these teaching roles requires intentional investment and support, as leadership and core faculty positions are especially vulnerable to burnout and turnover (Ringwald et al, 2025). Accountability for public investment in graduate medical education depends in part on a robust academic family physician workforce capable of training future clinicians and helping align the workforce with community health needs (Phillips et al, 2022). By training future physicians and advancing research, academic family physicians help build a workforce responsive to community needs, particularly in underserved and rural areas. 

These data reinforce that family physicians are broadly and comprehensively trained, many with additional areas of expertise and important roles as teachers. Despite being prepared to provide whole-person care across settings, conditions, and procedures, the differences between intended and realized scope shown in this chapter suggest that organizational structures, employment models, and health system policies influence how fully physicians are able to use their training in practice. As a result, changes in scope over time appear to reflect evolving practice environments rather than diminished preparation, highlighting the importance of systems that support comprehensive primary care.

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The term family physicians as used above refers to ABFM board-certified family physicians (Diplomates) and datasets related to ABFM proprietary surveys.