INFLUENCE OF DEMOGRAPHIC AND PROFITABILITY ON PHYSICIAN SELECTION OF FAMILY-PRACTICE PROCEDURES

Background. Family physicians must make complex decisions regarding wh ich procedures to learn in training and which to perform in practice. Factors that influence these decisions include community needs, the po tential profitability of a procedure, and the desires and skills of th e individual physician. Methods. To further clarify some of these infl uences, we surveyed members of the Wisconsin Academy of Family Physici ans. The survey instrument included questions about 27 different proce dures, including the perceived profitability of the procedure, which p rocedures they had discontinued, and which they planned to learn. Resu lts. More than 40% of family physicians reported doing skin surgery, f lexible sigmoidoscopy, nonstress obstetrical testing, breast-cyst aspi ration, multiple joint arthrocentesis, and Norplant insertion, whereas fewer than 6% perform colonoscopy, esophagogastroduodenoscopy, and na solaryngoscopy. 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 ph ysicians performed more gynecologic procedures (P<.05). There was a st atistically significant correlation (r= -.478, P<.05) between perceive d low profitability of a procedure and family physicians discontinuing a learned procedure, and a marginal correlation between perceived pro fitability and planning to learn a procedure (r= .338, P<.1). Conclusi ons. Family physicians in Wisconsin vary greatly in the number and typ es 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 discontinu e learned procedures and learn new procedures. The profitability of th e procedure influences the learning and discontinuation of procedures.