US family doctors plan to provide more varied care in future

U.S. family doctors entering the profession today plan to provide a wider variety of medical services than their predecessors, a recent study suggests.

To assess changes afoot in the practice of family medicine, researchers analyzed questionnaire data from 3,038 doctors seeking certification for the first time as well as 10,846 physicians renewing their credentials.

Compared to the more experienced family medicine practitioners, those just entering the field were much more likely to report intending to provide a wide range of services including prenatal, obstetric, orthopedic, dermatology and cardiac care. New doctors were also more apt to offer home visits or to see patients in hospitals or nursing homes.

"I think young physicians are envisioning a practice where they can do everything they trained to do," said senior study author Dr. Lars Peterson, a researcher in family and community medicine at the University of Kentucky in Lexington.

"Providing different types of care, seeing the same patients in different places - office, their home, the hospital - and doing procedures and providing a variety of services can be intellectually stimulating and break up the potential monotony of trying to see 20 plus patients in the office every day," Peterson added by email.

Peterson and colleagues analyzed data from surveys doctors completed as part of registration for an American Board of Family Medicine certification exam in 2014.

The physicians taking the exam for the first time were around 32 years old on average, while those seeking recertification were typically about 51.

There were more women among the newcomers - 54 percent compared with 37 percent of the more experienced doctors, the study team reports in JAMA.

Although the majority of senior practitioners and new doctors were white, those just entering the profession were a more diverse group with a higher proportion of black and Hispanic physicians.

Newly-minted physicians were also more likely to work primarily in a hospital clinic or inpatient setting, while the more seasoned professionals were more likely to work in freestanding ambulatory clinics and to own their practices.

About 24 percent of new doctors expressed interest in obstetrics, compared with 8 percent of their more experienced peers. The gap was wider for prenatal care, favored by half of newcomers but just 10 percent of their older peers.

About 55 percent of new physicians said they would offer inpatient management, compared with 34 percent of other doctors. The gap between newcomers and others for interest in providing nursing home care was 38 percent versus 16 percent, while for home visits it was 44 percent compared with 9 percent.

Regardless of their years in the profession, however, the doctors had similarly high commitment levels to providing preventive medicine, disease management and same-day care for acute medical problems. While fewer of them expressed interest in pain management or palliative care, these areas also weren't that different between the newcomers and the more senior members of the profession.

The differences might not signal a generational shift, noted lead study author Dr. Anastasia Coutinho of the Santa Rosa Family Medicine Residency Program in California.

"It may be that previous generations have had these same intentions and for numerous reasons are not able to practice the way they intended," Coutinho said by email.

Even though family doctors are trained to provide a wide range of services, the realities of the U.S. healthcare industry and insurance reimbursement policies may shape what type of services these physicians ultimately provide, noted Dr. Robert Schiller, chair of family medicine at Mount Sinai Beth Israel Medical Center and chief medical officer for the Institute for Family Health in New York.

"The vast majority of jobs in metropolitan and suburban settings that care for patients with commercial insurance will limit a family physician's scope of practice in order to meet the productivity and financial goals of the practice," Schiller, who wasn't involved in the study, said by email. "These practices require high volume with shorter, less comprehensive visits."