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 To assess changes afoot in the practice of family medicine,
researchers analyzed questionnaire data from 3,038 doctors seeking
certification for the first time as well as 10,846 physicians
renewing their credentials.
Compared to the more experienced family medicine practitioners,
those just entering the field were much more likely to report
intending to provide a wide range of services including prenatal,
obstetric, orthopedic, dermatology and cardiac care. New doctors
were also more apt to offer home visits or to see patients in
hospitals or nursing homes.
“I think young physicians are envisioning a practice where they can
do everything they trained to do,” said senior study author Dr. Lars
Peterson, a researcher in family and community medicine at the
University of Kentucky in Lexington.
“Providing different types of care, seeing the same patients in
different places – office, their home, the hospital – and doing
procedures and providing a variety of services can be intellectually
stimulating and break up the potential monotony of trying to see 20
plus patients in the office every day,” Peterson added by email.
Peterson and colleagues analyzed data from surveys doctors completed
as part of registration for an American Board of Family Medicine
certification exam in 2014.
The physicians taking the exam for the first time were around 32
years old on average, while those seeking recertification were
typically about 51.
There were more women among the newcomers – 54 percent compared with
37 percent of the more experienced doctors, the study team reports
in JAMA.
Although the majority of senior practitioners and new doctors were
white, those just entering the profession were a more diverse group
with a higher proportion of black and Hispanic physicians.
Newly-minted physicians were also more likely to work primarily in a
hospital clinic or inpatient setting, while the more seasoned
professionals were more likely to work in freestanding ambulatory
clinics and to own their practices.
About 24 percent of new doctors expressed interest in obstetrics,
compared with 8 percent of their more experienced peers. The gap was
wider for prenatal care, favored by half of newcomers but just 10
percent of their older peers.
About 55 percent of new physicians said they would offer inpatient
management, compared with 34 percent of other doctors. The gap
between newcomers and others for interest in providing nursing home
care was 38 percent versus 16 percent, while for home visits it was
44 percent compared with 9 percent.
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Regardless of their years in the profession, however, the doctors
had similarly high commitment levels to providing preventive
medicine, disease management and same-day care for acute medical
problems. While fewer of them expressed interest in pain management
or palliative care, these areas also weren’t that different between
the newcomers and the more senior members of the profession.
The differences might not signal a generational shift, noted lead
study author Dr. Anastasia Coutinho of the Santa Rosa Family
Medicine Residency Program in California.
“It may be that previous generations have had these same intentions
and for numerous reasons are not able to practice the way they
intended,” Coutinho said by email.
Even though family doctors are trained to provide a wide range of
services, the realities of the U.S. healthcare industry and
insurance reimbursement policies may shape what type of services
these physicians ultimately provide, noted Dr. Robert Schiller,
chair of family medicine at Mount Sinai Beth Israel Medical Center
and chief medical officer for the Institute for Family Health in New
York.
“The vast majority of jobs in metropolitan and suburban settings
that care for patients with commercial insurance will limit a family
physician’s scope of practice in order to meet the productivity and
financial goals of the practice,” Schiller, who wasn’t involved in
the study, said by email. “These practices require high volume with
shorter, less comprehensive visits.”
SOURCE: http://bit.ly/1lrOkoY JAMA, online December 8, 2015.
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