Changing Practice Patterns of Family Medicine Graduates: A Comparison of Alumni Surveys from 1998 to 2004

Article Figures & Data

Table 1.

Total Survey Response by Year of Residency Graduation

Characteristic	Year of Survey
Characteristic	1998		2001		2004
Number of surveys returned/number sent out (%)	177/225	(78)	199/261	(76)	172/297	(58)
Year of residency graduation ‘N (%)’
1975 to 1983	54	(30.5)	59	(29.6)	46	(26.7)
1984 to 1993	80	(45.2)	80	(40.2)	55	(32.0)
1994 to 2003	43	(24.3)	60	(30.2)	71	(41.3)

Table 2.

Characteristics of Residency Graduates and Their Current Practices (%)*

Characteristic (N missing)	Year of Residency Graduation (N)			P Value^†
Characteristic (N missing)	1975 to 1983 (67)	1984 to 1993 (98)	1994 to 2003 (94)	P Value^†
Personal information
Board certification	91.0	91.8	97.9	.06
CAQ	23.9	17.4	7.4	.004
CAQ in geriatrics	17.9	8.2	2.1	<.001
CAQ in sports medicine	4.5	3.1	4.3	.99
Practice information
Size of community <25,000 (18)	21.9	33.0	44.9	.003
More than 30 miles to a metro area (16)	23.8	17.6	36.0	.05
Number of outpatients per week (14)^‡
Less than 50	33.7	28.4	14.3	.01
50 to 99	25.0	20.4	31.8
100 or more	38.3	51.1	54.0
Current practice type^§
Solo	0.0	7.1	6.4	.10
Partnership	17.9	12.2	19.2	.70
FM Group	35.8	21.4	22.3	.08
Multispecialty group	22.4	25.5	22.3	.93
Salaried	29.8	20.4	30.8	.70
Full-time ER	10.4	7.1	7.4	.53
Urgent Care	0.0	4.1	10.6	.003
Student Health	6.0	2.0	3.2	.42
Academic	32.8	15.3	14.9	.009
Academic fellow	1.5	0.0	4.3	.14
Administrative medicine	7.5	4.1	0.0	.01
Rural health clinics	4.5	3.1	9.6	.12
National Health Service Corps site	0.0	2.0	6.4	.02
Health Profession Shortage Area (HPSA)	4.5	2.0	6.4	.44

* For respondents who returned more than 1 survey, the latest survey was used.
† The P value for the Mantel-Haenszel χ² test for trend.
‡ Question not asked in 2004 survey. The latest survey as of 2001 (N = 225) was used.
§ Respondents could choose as many practice types as applied. The total therefore exceeds 100%.

Table 3.

Scope of Current Practice for Residency Graduates Surveyed from 1998 to 2004*

Characteristic (N missing)	Year of Residency Graduation (N)			P Value^†
Characteristic (N missing)	1975 to 1983 (67)	1984 to 1993 (98)	1994 to 2003 (94)	P Value^†
Hospital privileges
Care for hospital inpatients	52.2	55.1	60.6	.28
Obstetrical privileges
Any obstetrics since residency	76.1	51.0	40.4	<.001
Currently practice obstetrics	16.4	24.5	27.7	.11
Currently provide C-sections	1.5	3.1	4.3	.32
ICU privileges
Have ICU privileges	35.8	49.0	42.6	.52
Emergency medicine
Provide primary care for patients in ER	16.4	23.5	7.4	.06
Full-time ER doc providing coverage	80.6	79.6	84.0	.53
Office procedures
Flexible sigmoidoscopy	23.9	23.5	10.6	.02
Colposcopy	14.9	19.4	19.2	.53
Obstetrical ultrasound	7.5	4.1	6.4	.87
Vasectomy	7.5	12.2	7.4	.86
Exercise EKG	14.9	9.2	5.3	.04
Upper GI endoscopy	1.5	1.0	0.0	.27
Laryngoscopy	7.5	10.2	2.1	.11
Geriatrics
Regularly see nursing home patients	47.8	41.8	43.6	.66
Nursing home medical director	7.7	5.3	3.0	.24
Work schedule^‡
Hours per week worked (12)
35 or less	7.8	20.2	10.0	.26
36 to 45	21.9	33.7	43.3
More than 45	70.3	46.1	46.7
Days on call per month (17)
None	29.5	26.1	13.6	.03
1 to 4	31.2	27.3	28.8
More than 4	39.3	46.6	57.6
Practice management
Assume risk	31.3	27.6	38.3	.27
Have an office manager	79.1	69.4	75.5	.75
Negotiate own MC contracts	17.9	23.5	13.8	.39
Other
Teaching medical students	62.7	53.1	60.6	.94
Teaching residents	44.8	35.7	30.8	.08

* For respondents who returned more than one survey, the latest survey was used.
† The P value for the Mantel-Haenszel χ² test for trend.
‡ Question not asked in 2004 survey. The latest survey as of 2001 (N = 225) was used.

Table 4.

Selected Practice Characteristics by Graduate’s Gender, Year of Graduation, and Rural/Urban Practice Location

Characteristic^*	Year of Residency Graduation			P Value^†
Characteristic^*	1975 to 1983	1984 to 1993	1994 to 2003	P Value^†
Care for hospital inpatients
Female	30.8	34.5	55.0	.002
Male	57.4	63.8	64.8
Rural	78.6	75.9	80.0	<.001
Urban	48.0	54.2	51.0
1998 survey	70.4	66.2	69.8	.011
2001 survey	57.6	55.0	76.7
2004 survey	54.4	49.1	59.2
Currently practice obstetrics
Rural	35.7	41.4	35.0	.005
Urban	12.0	20.3	24.5
1998 survey	33.3	35.0	48.8	.002
2001 survey	22.0	30.0	40.0
2004 survey	15.2	21.8	26.8
Currently have ICU privileges
Male	30.8	27.6	32.5	.003
Female	37.0	58.0	50.0
Rural	64.3	58.6	57.5	.006
Urban	30.0	52.5	34.7
1998 survey	50.0	57.5	53.5	.02
2001 survey	39.0	46.2	56.7
2004 survey	32.6	45.4	37.4
Provide care for patients in the ER
Rural	28.6	37.9	10.0	.026
Urban	14.0	20.3	6.1
1998 survey	33.3	30.0	20.9	<.001
2001 survey	20.3	26.2	8.3
2004 survey	10.9	14.6	5.6
Perform flexible sigmoidoscopy
Female	0.0	3.4	2.5	<.001
Male	29.6	31.9	16.7
1998 survey	37.0	30.0	23.3	.002
2001 survey	33.9	28.8	20.0
2004 survey	23.9	18.2	4.2
Perform colposcopy
Rural	28.6	27.6	27.5	.026
Urban	12.0	18.6	14.3
Assume risk
Rural	42.9	37.9	52.5	.013
Urban	28.0	27.1	30.6
1998 survey	53.7	42.5	41.9	<.001
2001 survey	30.5	27.5	23.3
2004 survey	30.4	25.4	39.4

* For analysis by year of survey, all surveys were used (N = 548). For analysis by rural location or gender, the latest response for each graduate was used (N = 259).
† Cochran-Mantel-Haenszel test for general association.

Table 5.

Topics for Which Graduates Believe More Training Would Have Been Helpful*

Topic^†	Year of residency graduation			P Value^‡
Topic^†	1975 to 1983	1984 to 1993	1994 to 2003	P Value^‡
Adult inpatient medicine	0.0	1.0	5.3	.02
Pediatric outpatient medicine	0.0	5.1	5.3	.11
Pediatric inpatient medicine	0.0	5.1	10.6	.004
Prenatal care	1.5	1.0	0.0	.27
Inpatient OB (routine)	7.4	2.0	1.1	.03
Inpatient OB (high risk)	1.5	5.1	9.6	.03
Emergency medicine	0.0	1.0	1.1	.48
ICU/MICU	4.5	9.2	17.0	.01
Geriatrics	14.9	4.1	2.1	.002
Behavioral science	7.5	3.1	3.2	.23
Practice management	14.9	20.4	31.9	.009
Procedural skills	11.9	27.6	20.2	.33
Cross-cultural medicine	3.0	3.1	2.1	.72
Use of computers in medicine	7.5	12.2	9.6	.76
Nursing home medicine	13.4	5.1	6.4	.14
Orthopedics	3.0	7.1	5.3	.61

* For respondents who returned more than one survey, a positive response on any survey was included. N = 259 respondents.
† Responses to open-ended question, “For areas in which you did not feel adequately prepared, what specific additional training would have been helpful.”
‡ Mantel-Haenszel χ² test for trend.