• B C Eliason, S A Lofton, and D H Mark.
• Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee.
• J Fam Pract. 1994 Oct 1; 39 (4): 341-7.

BackgroundFamily 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.MethodsTo 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.ResultsMore 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).ConclusionsFamily 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.

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