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Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures

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Abstract

BACKGROUND: As a result of market forces and maturing technology, generalists are currently providing services, such as colonoscopy, that in the past were deemed the realm of specialists.

OBJECTIVE: To determine whether there were differences in patient characteristics, procedure complexity, and clinical indications when gastrointestinal endoscopic procedures were provided by generalists versus specialists.

DESIGN: Retrospective cohort study.

PATIENTS: A random 5% sample of aged Medicare beneficiaries who underwent rigid and flexible sigmoidoscopy, colonoscopy, and esophagogastroduodenoscopy (EGD) performed by specialists (gastroenterologists, general surgeons, and colorectal surgeons) or generalists (general practitioners, family practitioners, and general internists).

MEASUREMENTS: Characteristics of patients, indications for the procedure, procedural complexity, and place of service were compared between generalists and specialists using descriptive statistics and logistic regression.

MAIN RESULTS: Our sample population had 167,347 gastrointestinal endoscopies. Generalists performed 7.7% of the 57,221 colonoscopies, 8.7% of the 62,469 EGDs, 42.7% of the 38,261 flexible sigmoidoscopies, and 35.2% of the 9,396 rigid sigmoidoscopies. Age and gender of patients were similar between generalists and specialists, but white patients were more likely to receive complex endoscopy from specialists. After adjusting for patient differences in age, race, and gender, generalists were more likely to have provided a simple diagnostic procedure (odds ratio [OR] 4.2; 95% confidence interval [95% CI] 4.0, 4.4), perform the procedure for examination and screening purposes (OR 4.9; 95% CI, 4.3 to 5.6), and provide these procedures in rural areas (OR 1.5; 95% CI 1.4 to 1.6).

CONCLUSIONS: Although generalists perform the full spectrum of gastrointestinal endoscopies, their procedures are often of lower complexity and less likely to have been performed for investigating severe morbidities.

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Authors and Affiliations

  1. Agency for Healthcare Research and Quality, Center for Quality Measurement and Improvement, 2101 E. Jefferson St., Suite 502, 20852, Rockville, MD

    Gregg S. Meyer MD, MSc

  2. Departments of Medicine and Preventive Medicine & Biometrics, The Uniformed Services University of the Health Sciences, Bethesda, Md

    Gregg S. Meyer MD, MSc & Eme Y. Cheng MBA, MPH, MS

  3. National Defense University, Washington, DC

    Jeffrey Elting MD, MPH

Authors
  1. Gregg S. Meyer MD, MSc
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  2. Eme Y. Cheng MBA, MPH, MS
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  3. Jeffrey Elting MD, MPH
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Corresponding author

Correspondence to Gregg S. Meyer MD, MSc.

Additional information

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Department of the Air Force, the Department of Defense, or the Department of Health and Human Services.

Dr. Meyer’s work is funded by a Generalist Physician Faculty Scholar Award from the Robert Wood Johnson Foundation.

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Meyer, G.S., Cheng, E.Y. & Elting, J. Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures. J GEN INTERN MED 15, 188–194 (2000). https://doi.org/10.1046/j.1525-1497.2000.06039.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2000.06039.x

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