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Robert Wigton, M.D. |
The survey reports that on average, general internists perform 50 percent fewer procedures than they did 18 years ago.
The survey of more than 2,500 general internists was conducted by Robert Wigton, M.D., associate dean for graduate medical education in the College of Medicine at UNMC. He also conducted a similar survey in 1986.
It’s a clear sign that medical practice is changing and internists are doing fewer of the diagnostic procedures formerly done at the bedside or in the office, Dr. Wigton said.
For example, only 26 percent of general internists performed a spinal tap in 2004 compared to 73 percent in 1986. Internists in 2004 performed an average of seven medical procedures compared to an average of 16 procedures performed by internists in 1986.
“We can’t tell from the survey where the procedures are going, but we suspect they are being done by specialists or special procedure services. Some may no longer be done,” he said.
An editorial, written by Daniel Duffy, M.D., and Eric Holmboe, M.D., accompanied Dr. Wigton’s latest survey. It suggests that this referral trend “may reflect a deliberately conceived strategy for improving quality, because the second most frequent cause of hospital errors is complications of a medical procedure.”
“When we did the survey in 1986, there was no consensus on what kinds of procedures general internists should be taught in residency training,” Dr.Wigton said.
The 1986 survey led the American Board of Internal Medicine (ABIM) to specify certain procedures as part of the teaching curriculum for general internist training, to better prepare these physicians for what they would encounter in practice.
The ABIM has once again taken the first step in overhauling procedure training by revising its procedure requirements for certification in internal medicine.
The new policy acknowledges that procedures performed by internists vary widely, and that current training does not ensure competence in many procedures.
So the ABIM requires residency candidates to demonstrate core skills of common procedures, such as drawing blood and performing PAP smears.
“By focusing our teaching on those procedures residents will be doing when they get out into practice, it cannot help but improve their skill and the quality of the procedures they do,” Dr. Wigton said. “In the long run this will improve patient care and safety.”