Impact of practice environment on procedures performed by U.S. Army general internists

Background: A recent survey reported that U.S. general internists are performing fewer procedures, although practice environment heavily influences this experience. Objective: To determine the procedures performed by U.S. Army general internists. Design: Cross-sectional cohort study. Methods: A modified questionnaire was distributed to all active duty U.S. Army internists. Respondents were asked to indicate their practice setting and the procedures they had performed in the previous year. Analysis of variance, t -tests, and Fisher's exact test were used for statistical comparisons, and Bonferroni's correction was used for multiple comparisons. Results: Eighty-two internists responded to the survey (55% response rate). Army internists performed a greater variety of procedures than the civilian benchmark (10.8 vs. 6.5, p < 0.001, t -test). Internists at Army community hospitals performed more types of procedures than individuals practicing in a tertiary care facility or troop clinic (13.8, 10.0, 9.0, respectively, p < 0.05, analysis of variance). Deployed internists performed more chest tube placements and endotracheal intubations, and internists at home were more likely to perform thoracentesis, paracentesis, graded exercise tests, and spirometry ( p < 0.0012). Conclusions: U.S. Army internists perform a greater variety of procedures than their civilian colleagues. Our findings underline the importance of procedure training in military graduate and continuing medical education.