Use of Internet Technology by Obstetricians and Family Physicians

To the Editor.—We conducted a study to determine whether practice differences of family physicians (FPs) vs obstetricians (OBs) would lead to a difference in their Internet use.

All OBs (172) and FPs (438) practicing obstetrics in Iowa received a questionnaire exploring attitudes and practice patterns. Age, specialty, and type of degree (MD vs DO) were obtained from a University of Iowa College of Medicine registry. The data were analyzed using the χ² statistic, odds ratios, and multiple logistic regression. We fit multiple logistic regression models with physician age (10-year increments), sex, degree, practice location (rural vs urban), and specialty (OB vs FP) as independent variables. Separate models were used for each outcome variable. All variables were forced into the model and retained regardless of their statistical significance.

The response rate was 87.9% (610 invited, 536 responded); (OB, 146 [85.5%] of 172 vs FP, 389 [88.9%] of 438; P>.25). Family physicians were more often male (328 [84.3%] of 389 vs 112 [76.2%] of 147; P=.03) and younger (age, 43.7 years vs 45.4 years; P<.05) than OBs. Obstetricians and FPs (67 [45.9%] of 146 vs 192 [50.0%] of 385; P=.41) were similar in their level of Internet access (through a commercial or other server). The majority of OBs and FPs perceived the Internet to be a valuable clinical resource (90 [64.3%] of 140 vs 229 [61.1%] of 375; P=.50), more so for those with access than without (176 [69.6%] of 253 vs 142 [54.8%] of 259; P≤.001). Multivariate analysis (Table 1) showed that urban (practice city population >50000) and rural physicians had equal access to the Internet. However, urban physicians more frequently participated in user groups and exchanged questions and answers with other medical professionals. Younger physicians and physicians graduating within the past 10 years were more likely to consider the Internet a valuable medical resource (graduated 1-9 years, 80 [74.1%] of 108; 10-19 years, 105 [61.8%] of 170; 20-29 years, 52 [61.2%] of 85; >30 years, 82 [54.0%] of 152; P=.002). Few physicians reported currently exchanging information with other physicians (FPs, 55 [29.1%] of 189 vs OBs, 19 [28.4%] of 67; P>.90) or asked for or offered answers to medical questions over the Internet (FPs, 39 [20.7%] of 188 vs OBs, 7 [10.5%] of 67; P=.06). Female physicians were less likely than male physicians to participate in user groups.

Our study found few differences between OBs and FPs in Internet use. Nearly half used the Internet, suggesting that it could provide another means of disseminating information such as practice guidelines to physicians in different specialties caring for patients with similar medical problems and could possibly reduce practice differences. The Internet can provide immediate access to clinical protocols, authoritative textbooks¹ and peer-reviewed medical journals, consultation with specialists, and continuing medical education.² We found that female physicians use the Internet less often than male physicians but the gender difference is not as pronounced as is often assumed. To our knowledge, few data concerning Internet use are available in the medical literature to provide guidance in developing this medium for physicians. As more physicians gain familiarity with the Internet, we expect they will integrate it into their clinical practices. This suggests benefits for development of user-friendly, clinically relevant Internet sites for medical personnel. New medical graduates bring with them a stronger understanding of the clinical applications of computer technology.