The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians

Abstract

Background: A survey of general internist members of the American College of Physicians (ACP) in 1986 found that they did a large number and variety of procedures in their practices. Since then, changes in the practice of medicine, regulatory requirements, and availability of subspecialists may have affected the number and type of procedures done by internists.

Objective: To determine the number and types of procedures currently done by general internist members of the ACP compared with 1986.

Design: Mailed questionnaire.

Setting: National probability sample of general internists.

Participants: Respondents to a national survey of 2500 general internist members of the ACP who were similar in characteristics to those who participated in the 1986 survey. Of the 1389 questionnaires that were returned, 990 were from general internists who had completed the survey.

Measurements: Responses to questions about procedures done and practice characteristics.

Results: The number and variety of procedures done by general internists has decreased dramatically. On average, the percentage of general internists doing each procedure now is less than half of that in 1986. The average number of different procedures done in practice decreased from 16 in 1986 to 7 in 2004. As in the 1986 survey, the number of procedures related strongly to personal and practice characteristics. Internists who practice in smaller towns and smaller hospitals do twice as many procedures on average as those in larger cities and larger hospitals. The number and variety of procedures done by internists also increased with greater time spent in total patient care.

Limitations: The number and type of procedures were determined by self-reporting, not direct observation.

Conclusions: Both the number and variety of procedures done by general internists have decreased considerably since 1986. As in the 1986 survey, general internists who practice in smaller cities and smaller hospitals and those who spend more hours in patient care perform more procedures. Recommendations and practices for internal medicine residency training in procedures should be reexamined in light of these changes.