Procedures performed by general practitioners and general internal medicine physicians - a comparison based on routine data from Northern Germany

Strumann, Christoph; Flägel, Kristina; Emcke, Timo; Steinhäuser, Jost

doi:10.1186/s12875-018-0878-3

Cited by 6 publications

(5 citation statements)

References 52 publications

(48 reference statements)

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“…In 2020, 1929 (53%) of the 3609 internists have been practicing as primary care physicians in the federal state Baden-Württemberg [ 37 ]. However, we did not assign this specialty to the group of generalists, since their postgraduate training was based on hospital organ-centered specialist care [ 38 ]. To increase the robustness against this specification, we alternatively classified internists to the generalist group and obtained qualitatively very similar results.…”

Section: Discussionmentioning

confidence: 99%

Identifying desired qualifications, tasks, and organizational characteristics of practice managers—a cross-sectional survey among group practice physicians in Germany

Schricker

Strumann

Steinhäuser

2022

BMC Health Serv Res

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Background The increase of centralization developments in primary and secondary care practices may cause the organizational needs to increase as well, as the practices grow in size. This continuous change is observed in different stages in various countries since, from the perspective of a physician, it is reinforced by the benefits it adds to flexible work configuration, professional exchange and specialization. However, in order to benefit from the joint practice system, the proper managerial skills of practice managers are required, as doctors are not naturally prepared to fulfill such tasks. This study thus aims to gain insight into physicians' views in group practices and acquire a greater understanding of expectations towards practice management and the emerging role of practice managers (PM). Methods A cross-sectional study design was employed which utilized an anonymous online questionnaire. In total, 3,456 physicians were invited to participate in the study between February 8th and March 17th 2021 by the Association of Statutory Health Insurance Physicians of Baden-Württemberg, Germany. Bivariate and multivariate analyses were applied to characterize the expectations of physicians towards practice management. Results The survey yielded 329 replies (9,5%). 50% of the participating practices already had a PM employed. In general, these practices were larger than practices without a PM. Most physicians (85%) considered a medical background to be essential for the task of a PM. While practices without a PM considered it important for PMs to have medical qualifications, practices with a PM favored qualifications in business administration. 77.2% of physicians preferred to educate and recruit PMs out of their current practice staff. Competence in organizational tasks, such as coordination of tasks and quality management, was considered to be an essential skill of a PM and had the highest agreement levels among those surveyed, followed by staff management of non-physicians, billing, bookkeeping, staff management of physicians and recruiting. Based on multivariate regression analysis, larger practices valued the role of a PM more and were more likely to employ a PM. Notably, the effect that size had on these items was more substantial for generalists than specialists. Conclusions The benefits and importance of PMs as well as the potential for delegation are recognized, in particular, by larger practices. The positive feelings that physicians who already employ PMs have towards their contribution to ambulatory care are even more significant. Pre-existing medical support staff has been identified to be the most desirable candidates for taking on the role of PM.

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Section: Discussionmentioning

confidence: 99%

Identifying desired qualifications, tasks, and organizational characteristics of practice managers—a cross-sectional survey among group practice physicians in Germany

Schricker

Strumann

Steinhäuser

2022

BMC Health Serv Res

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“…Procedures performed by most general internists were technical diagnostics and emergency procedures. A more technical style of care by general internists has already been described [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…Comprehensively structured primary care is seriously needed. Strategies proposed to sharpen the status of general internists working in primary care must be realized [20,32,33] in order to prevent further deficits in performance quality and physician quantity. Additional structured post residency training as one mean of broadening the scope has already been identified [27], and can be an opportunity to fill gaps after board certification.…”

Section: Discussionmentioning

confidence: 99%

Which procedures are performed by general internists practicing primary care in Germany? - a cross-sectional study

et al. 2020

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Background: Due to differences of residency training programs' emphasesinpatient vs office-basedinternal medicine and family medicine residents consistently reported differences in preparedness to care for common adult conditions. Study's aim was to add knowledge about procedures that a) are performed by general internists working in primary care and b) should be learned during residency in general internists' appraisal. Methods: A cross-sectional postal survey was carried out by using a questionnaire that comprised 90 procedures relevant in primary care. Each procedure implied the two questions "Do you perform this procedure in your own practice?" and "How important do you think it is to learn this procedure during residency?" The final questionnaire was sent to 1002 general internists working in primary care in Germany in May 2015. Data analysis was performed using SPSS Version 24.0 (SPSS inc., IBM). Next to descriptive statistics subgroup analyses were performed using cross tabulation and Chi-square tests for evaluation of differences in the performance of most frequently performed procedures in urban or rural areas as well as by male or female physicians. Results: Twenty-eight percent of sent questionnaires (276/1002) could be included in analysis. Mean age of participants was 52 years with 13 years of practice experience; 40% were female. Twenty-nine (32%) of 90 given procedures were performed by at least half of the participants, foremost technical diagnostics, punctures, procedures of the integument and resuscitation. After Bonferroni correction, five of those procedures were performed by more male than female physicians and two procedures by more physicians working in a rural practice than physicians practicing in an urban location. Moreover, 46 (51%) procedures were assessed as important to learn during residency by at least 50% of participants. Conclusions: General internists working in German primary care perform a narrow scope of procedures offered by primary care physicians. In order to provide best ambulatory care for patients, residency training programs must ensure training in procedures that are necessary for providing high quality care. Therefore, a consensus aligned with patients' and health-systems' needs on procedures required for working as a general internist in primary care is necessary.

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“… 7 There are significant differences in the types of screening, testing and procedures performed by General Practice/FM physicians compared to GIM physicians. 8 Patients with anxiety and depression are more likely to receive an antidepressant if treated in FM as compared to GIM. 9 Sexual history taking for adolescent females is significantly less likely among internal medicine compared to FM providers.…”

Section: Introductionmentioning

confidence: 99%

Differences Between General Internal Medicine and Family Medicine Physicians’ Initiation of Pre-Exposure Prophylaxis

Drallmeier,

Salas,

Keegan Garrett

et al. 2023

J Prim Care Community Health

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Objective: Preexposure Prophylaxis (PrEP) is under-utilized in primary care. Given differences in treatment approaches for other conditions between family medicine (FM) and general internal medicine (GIM), this study compared PrEP-prescribing between FM and GIM physicians. Methods: De-identified electronic health record data from a multi-state health care system was used in this retrospective observational study. The time period from 1/1/13 to 9/30/21 was used to identify PrEP eligible patients using measures of current sexually transmitted disease and condomless sex at the time of eligibility. Receipt of PrEP was measured in the 12 months after PrEP eligibility. The odds of receiving PrEP in GIM as compared to FM was computed before and after adjusting for demographics and physical and psychiatric comorbidities. Results: The majority of eligible patients were 18 to 39 years of age, 60.9% were female and 71.6% were White race. Among PrEP eligible patients, 1.1% received PrEP in the first year after index date. Receiving PrEP was significantly more likely among patients treated in GIM versus FM (OR = 2.30; 95% CI:1.63-3.25). After adjusting for covariates, this association remained statistically significant (OR = 2.02; 95% CI:1.41-2.89). Conclusions: PrEP is grossly under-utilized in primary care. The majority of Americans enter the health care system through primary care and not through HIV providers or other specialties. Therefore, educational interventions are needed to increase confidence and knowledge and to encourage PrEP prescribing by FM and GIM physicians.

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Procedures performed by general practitioners and general internal medicine physicians - a comparison based on routine data from Northern Germany

Cited by 6 publications

References 52 publications

Identifying desired qualifications, tasks, and organizational characteristics of practice managers—a cross-sectional survey among group practice physicians in Germany

Identifying desired qualifications, tasks, and organizational characteristics of practice managers—a cross-sectional survey among group practice physicians in Germany

Which procedures are performed by general internists practicing primary care in Germany? - a cross-sectional study

Differences Between General Internal Medicine and Family Medicine Physicians’ Initiation of Pre-Exposure Prophylaxis

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