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

C Strumann,K Flägel,J Steinhäuser,T Emcke

doi:10.1186/s12875-018-0878-3

Abstract

BackgroundIn response to a rising shortage of general practitioners (GPs), physicians in general internal medicine (GIM) have become part of the German primary care physician workforce. Previous studies have shown substantial differences in practice patterns between both specialties. The aim of this study was to analyse and compare the application of procedures by German GPs and GIM physicians based on routine data.MethodsThe Association of Statutory Health Insurance Physicians in the federal state Schleswig-Holstein (Northern Germany) provided invoicing data of the first quarters of 2013 and 2015. Differences between GPs and GIM physicians in the implementation rate of 46 selected primary care procedures were examined by means of the Pearson χ2-test. The selection of procedures was based on international and own preliminary studies on primary care procedures.ResultsIn the first quarter of 2013/2015 respectively, 1228/1227 GPs and 447/484 GIM physicians provided services in Schleswig-Holstein. Significant differences were found for 20 of the 46 procedures. GPs had higher application rates of procedures concerning health screening (e.g. adolescent health examination, well-child visits) and minor surgery. GIM physicians more often applied technology-oriented procedures, such as ultrasound scans, electrocardiograms (ECG), and 24-h ambulatory blood pressure measurements. The treatment patterns of both specialities did not vary much during the study period. Cardiac stress testing was the only significantly increased GP procedure in that time.ConclusionsOur results suggest substantial differences in the application of procedures between GPs and GIM physicians with potential consequences for the overall primary healthcare provision. The findings could foster a discussion about training needs for procedures in primary care to ensure its comprehensiveness. The results reflect scope for changes in vocational training in the future for an effective and efficient re-allocation of primary healthcare.

Highlights

In response to a rising shortage of general practitioners (GPs), physicians in general internal medicine (GIM) have become part of the German primary care physician workforce
The distribution of physicians is regulated and allocated by the Association of Statutory Health Insurance Physicians (ASHIP), which is responsible for the accreditation process to maintain a sufficient and high-quality supply of physicians [14]
There are no substantial differences between the number of distinct fee scale codes submitted by GPs and GIM physicians

Summary

Introduction

In response to a rising shortage of general practitioners (GPs), physicians in general internal medicine (GIM) have become part of the German primary care physician workforce. The aim of this study was to analyse and compare the application of procedures by German GPs and GIM physicians based on routine data. Primary care physicians are general practitioners (GPs), physicians in general internal medicine (GIM) or paediatricians who provide “care for the undifferentiated patient at the point of first contact” [4]. In Germany, most primary care physicians are traditionally self-employed. They need an accreditation for service provision for patients within the statutory health insurance scheme that covers about 90% of the population. Strumann et al BMC Family Practice (2018) 19:189 population visited a primary care physician at least once [13]. The distribution of physicians is regulated and allocated by the Association of Statutory Health Insurance Physicians (ASHIP), which is responsible for the accreditation process to maintain a sufficient and high-quality supply of physicians [14]

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