Factors Influencing Texas Family Medicine Residents' Intended Scope of Practice

Abstract of Journal Article - June 2008  

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Tex Med. 2008;104(6):55-61.

By  Peter Valenzuela, MD, MBA, FAAFP

In Texas, 196 of the 254 counties are medically underserved. In counties with limited providers, broader services are needed. This study assessed the comfort level of Texas family medicine residents performing 25 procedures commonly encountered in rural areas, identified the procedures residents plan to perform in practice, and cited residents' reasons for choosing not to perform certain procedures.

Questionnaires regarding training and comfort in 25 core procedures and skills encountered in rural practice were mailed to the program directors at all 28 Texas family medicine residencies (n=681 residents). Eighty-two percent of packets were returned with 248 (36%) questionnaires. Comfort levels were higher among third-year residents than first-year residents ( P <.000) in all categories except endoscopy ( P <.676). Women were less comfortable than men with endoscopy ( P <.005), genitourinary procedures ( P <.032), and hospital care ( P <.018). No statistical difference was found in comfort level between US and international medical graduates. The procedures never performed during residency were esophagogastroduodenoscopy (EGD), vasectomy, colonoscopy, dilatation and curettage (D&C), and cesarean section (C-section). Most residents plan to exclude colonoscopy, EGD, C-section, D&C, vaginal delivery, and vasectomy in future practice. "Limited competency" was the most common reason for exclusion in all categories except vaginal deliveries, which cited "liability."  

Most Texas family medicine residents have low comfort levels performing several important primary care procedures. Family medicine residencies should teach a set of core procedures and skills to enable these physicians to practice in any community.



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