Background: Family physicians must make complex decisions regarding which procedures to learn in training and which to perform in practice. Factors that influence these decisions include community needs, the potential profitability of a procedure, and the desires and skills of the individual physician.
Methods: To further clarify some of these influences, we surveyed members of the Wisconsin Academy of Family Physicians. The survey instrument included questions about 27 different procedures, including the perceived profitability of the procedure, which procedures they had discontinued, and which they planned to learn.
Results: More than 40% of family physicians reported doing skin surgery, flexible sigmoidoscopy, nonstress obstetrical testing, breast-cyst aspiration, multiple joint arthrocentesis, and Norplant insertion, whereas fewer than 6% perform colonoscopy, esophagogastroduodenoscopy, and nasolaryngoscopy. Fifty-seven percent of physicians had discontinued at least one procedure, and 34% planned to learn one or more procedures. Being younger, male, and practicing in smaller communities correlated with performing a greater number of procedures (P < .001), but female physicians performed more gynecologic procedures (P < .05). There was a statistically significant correlation (r = -.478, P < .05) between perceived low profitability of a procedure and family physicians discontinuing a learned procedure, and a marginal correlation between perceived profitability and planning to learn a procedure (r = .338, P < .1).
Conclusions: Family physicians in Wisconsin vary greatly in the number and types of procedures performed. Community size, sex, and age are important variables associated with the number and type of procedures performed. The performance of procedures is dynamic: physicians both discontinue learned procedures and learn new procedures. The profitability of the procedure influences the learning and discontinuation of procedures.
PIP: Physicians during their period of residency training have the opportunity to learn many procedures. Often, however, there is insufficient information to guide faculty and resident decisions about which procedures merit training emphasis. A study in general internal medicine has shown that the procedures taught during residency are not necessarily those most needed in practice. Family physicians must therefore decide which procedures to learn in training and which to perform in practice. Community needs, the potential profitability of a procedure, and the desires and skills of individual physicians influence the decision-making process. The authors surveyed 500 physicians by mail questionnaire in March 1993 in an effort to learn more about these factors. The subjects all belonged to the Wisconsin Academy of Family Practice. Despite three mailings to nonrespondents, only 65% of the family physicians responded to the survey, with only 297 actually supplying all of the demographic information requested. The survey listed 27 different procedures with regard to the perceived profitability of the procedure, which procedures they had discontinued, and which procedures they planned to learn. 76% of the sample was male and 59% younger than age 40. The doctors were evenly distributed across different community size, with family practice groups being the most common mode of practice; only 8% of surveyed doctors were in solo practices. The mean number of different procedures performed was 6.9, with a range of 0-18. More than 40% of family physicians reported doing skin surgery, flexible sigmoidoscopy, nonstress obstetrical testing, breast-cyst aspiration, multiple joint arthrocentesis, and Norplant insertion, while fewer than 6% perform colonoscopy, esophagogastroduodenoscopy, and nasolaryngoscopy. 57% of physicians had discontinued at least one procedure and 34% planned to learn one or more procedures. Being younger, male, and practicing in smaller communities correlated with performing a greater number of procedures, but female physicians performed more gynecologic procedures. There was a statistically significant correlation between perceived low profitability of a procedure and family physician discontinuing a learned procedure, and a marginal correlation between perceived profitability and planning to learn a procedure.