Which procedures are performed by general internists practicing primary care in Germany? - a cross-sectional study.

Background: Due to differences of residency training programs' emphases - inpatient vs office-based - internal medicine and family medicine residents consistently reported differences in preparedness to care for common adult conditions. Study's aim was to add knowledge about procedures that a) are performed by general internists working in primary care and b) should be learned during residency in general internists' appraisal.

Methods: A cross-sectional postal survey was carried out by using a questionnaire that comprised 90 procedures relevant in primary care. Each procedure implied the two questions "Do you perform this procedure in your own practice?" and "How important do you think it is to learn this procedure during residency?" The final questionnaire was sent to 1002 general internists working in primary care in Germany in May 2015. Data analysis was performed using SPSS Version 24.0 (SPSS inc., IBM). Next to descriptive statistics subgroup analyses were performed using cross tabulation and Chi-square tests for evaluation of differences in the performance of most frequently performed procedures in urban or rural areas as well as by male or female physicians.

Results: Twenty-eight percent of sent questionnaires (276/1002) could be included in analysis. Mean age of participants was 52 years with 13 years of practice experience; 40% were female. Twenty-nine (32%) of 90 given procedures were performed by at least half of the participants, foremost technical diagnostics, punctures, procedures of the integument and resuscitation. After Bonferroni correction, five of those procedures were performed by more male than female physicians and two procedures by more physicians working in a rural practice than physicians practicing in an urban location. Moreover, 46 (51%) procedures were assessed as important to learn during residency by at least 50% of participants.

Conclusions: General internists working in German primary care perform a narrow scope of procedures offered by primary care physicians. In order to provide best ambulatory care for patients, residency training programs must ensure training in procedures that are necessary for providing high quality care. Therefore, a consensus aligned with patients' and health-systems' needs on procedures required for working as a general internist in primary care is necessary.