Scope of practice of Japanese primary care physicians and its associated factors: a cross-sectional study

Abstract

Objective: The scope of practice (SOP) of primary care physicians (PCPs) has been narrowing, with declining comprehensiveness leading to fragmented care. Identifying SOP-associated factors can help improve comprehensiveness. This study aimed to describe the SOP of PCPs working in clinics and to identify SOP-associated factors.

Design: A cross-sectional study using a self-administered questionnaire.

Setting: Shizuoka, Japan.

Participants: PCPs working in clinics offering internal medicine.

Main outcome measures: The total number of services provided, covering 109 items, was categorised into 8 clinical areas, 78 clinical activities and 23 procedures.

Results: Questionnaires were mailed to 1191 clinics, and 389 valid responses were included in the analysis. Of the 389 physicians, 254 (65.3%) were internal medicine specialists, and 382 (98.2%) worked in their own private clinics. The mean number of services provided was 60.4±17.4. Clinical activities were provided less frequently in the areas of paediatric and adolescent care, women's health, home healthcare, palliative care and mental health. Physician-related factors were more significantly associated with SOP than practice or environmental factors. Preference for broad practice was the strongest factor associated with a broader SOP, followed by completion of the Japan Medical Association (JMA) primary care training programme and rotational training experience. Additionally, younger physician age, rural practice experience, surgical specialisation, a larger number of physicians in the clinic, higher patient volume and a more rural setting were associated with broader SOP.

Conclusion: Physician preference regarding SOP, completion of the JMA primary care training programme and rotational training are key factors influencing SOP. These findings suggest that postgraduate clinical training with a broad scope not limited to internal medicine and continuing medical education after establishing a private clinic, particularly for physicians who prefer broad practice, may be important in expanding the SOP of PCPs.

Keywords: General Practice; Physicians, Primary Care; Primary Health Care.

Figure 1. Flow chart.

Figure 2. Frequency of clinical areas performed by primary care physicians. Routinely (daily to once a week), sometimes (1–2 times per month), occasionally (a few times a year) and seldom or never (once every few years or less).

Figure 3. Frequency of clinical activities provided by primary care physicians. Routinely (daily to once a week), sometimes (1–2 times per month), occasionally (a few times a year) and seldom or never (once every few years or less). BPSD, Behavioural and Psychological Symptoms of Dementia; ENT, ear, nose and throat; HPV, human papillomavirus; OC/LEP, oral contraceptive/low-dose oestrogen-progestin.

Figure 4. Frequency of procedures provided by primary care physicians. Routinely (daily to once a week), sometimes (1–2 times per month), occasionally (a few times a year) and seldom or never (once every few years or less). KOH, potassium hydroxide; PEG, percutaneous endoscopic gastrostomy.