Comparison of Critical Care Provided by Family Physicians and General Internists

Abstract

Privilege conflicts and credentialing issues involving family physicians' care of hospitalized patients are controversial areas. This study compares the process and outcome of critical care provided by family physicians and general internists. We studied 523 patients admitted by these specialists to the medical intensive and cardiac care units of a large regional hospital over a one-year period. The length of stay and readmission rate in the intensive care unit and hospital, severity of illness, discharge diagnosis, proportion who died, time until death of those who died, consultation rate, and hospital charges did not differ significantly between patients cared for by physicians in the two specialties. Application of Cox's proportional hazard model to the data indicated the risk of death to be significantly related to patient race, age, and severity of illness, but not to physician specialty. Regression analysis of several morbidity variables showed no relationship to physician specialty. Lack of differences in outcome and process in the hospital studied leads us to believe that both family physicians and general internists are entitled to have equal access to the care of patients in critical care units.

Progression of Functional Disability in Patients With Rheumatoid Arthritis

“…The rheumatology specialty status of each physician was determined by membership in the Ameri¬ can College of Rheumatology or by subspecialty board cer¬ tification.24 Patients were treated by 53 rheumatologists (49 community based and four university based), and more than 200 other physicians over the course of the study. When assessed in both 1981 and 1989, there were no discrepan¬ cies between the reports by patients of a visit to a rheuma¬ tologist and the rheumatology specialty status of the phy¬ sicians they named.…”

Are vocationally trained general practitioners better GPs? A review of research designs and outcomes

“…No specific evaluation papers of vocational training as defined elsewhere were identified from the USA due to the different structure there for family medicine and the training of family physicians. However, we were directed by the American Academy of Family Physicians (1995, personal communication) to six papers which suggest that postgraduate medical training is cost‐effective and produces better doctors (Bertakis & Robbins 1987; Cherkin 1987; Hainer & Lawler 1988; Bowman 1990; McGann & Bowman 1990).…”