Background: The introduction of mandatory or quasimandatory certification processes for general/family doctors has become common in many countries, including Australia. Whether certification effects the care provided is rarely investigated.
Objectives: The objective of this study was to determine whether certification of general/family physicians is associated with clinical performance.
Research design: We conducted a secondary comparative analysis of data from an Australian national cross-sectional survey (April 2000-March 2002).
Subjects: Subjects consisted of a random sample of 1982 general practitioners (GPs)
Methods: Each participant provided demographic details and information about 100 consecutive patient encounters (total 197,500). We compared characteristics of certified and uncertified general practitioners (GPs), their patients, encounters, problems, management actions, and tested 34 performance indicators. We investigated whether differences identified in descriptive analyses were explained by other factors.
Results: Of 1975 GPs who indicated certification status, 659 (33.4%) were vocationally certified. Certificants were more likely to be female, younger, Australian graduates, working fewer sessions, in larger practices, in accredited practices, and using computers for clinical purposes. Their patients were younger, more often female, and less likely to hold a healthcare concession card. Their consultations were longer; they prescribed fewer medications and more clinical treatments and procedures, ordered more pathology tests, and referred more to other health professionals. After adjustment for GP/practice, patient and morbidity differences, certificants had longer consultations, did more therapeutic procedures, prescribed less overall, prescribed fewer nonsteroidal antiinflammatory drugs in the elderly, and fewer antibiotics for upper respiratory infections.
Conclusion: Certification of general practitioners has a significant association with consultation behavior and patient management.