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Data from theNATIONAL HEALTH SURVEY
Characteristicsof Visits toFemaleand Male PhysiciansThe NationalAmbulatoryMedicalCare SurveyUnhlstates,1977
Based on data obtained from a national sample of office-based fe-male and maIe physicians, statistics are presented on the patient andclinical characteristics of ambulatory care office visits. The focus ofthe report is on the utilization of medicai practitioners according tothe sex of the physician. Data are provided on the distribution ofvisits by sex, race, and age of patients; and age and specialty of thephysician. Clinical aspects of the medical practices of female andmaIe physicians are compared.
DHHS Publication No. (PHS) 80-1710
Series 13Number 49
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health Service
Office of Health Research, Statistics, and TechnologyNational Center for Health StatisticsHyattsville, Md. June 1980
.
/
Library of Congress Cataloging in Publication Data
C)”press, Beulah K
characteristics of t’isits to f’crnalc .md m.dc llh>sicians.
(Vital and health statistics : Series 1~~. 1).!t,t from the National f~~dth s~[rl c}” ; no. ~~)(DHHS publication ;no. (PI IS) 80-1710)
Includes bibliographical references.
Supt. of Dots. no.: HE 20.6209: 13/49
1. Physician scrliccs ~ltilixati(-)rl—[~tlitc(l States-St.itistics. 2. \i”{jm(’11 ph) sicians --
L’nitccl States–Statistics. 3. .Ambulator> medical cw-e--I_~nitcd States- ~’tili<,ition- Statis-
tics. 4. Health s~lrveys--~nited St~tcs. .5. United States--Statistics, Xledic,il. I. Title. II.
Series: United States. National Centrr fol- Iiralth Statistics. \’ital .md hcallh statistics :Series 13, Data from the National Ile.dth Sui-\e>, Data on health rcso~lrccs {Itiliz.ition : no,49. 111. Series: IJnited States. Dq)t. of lIcalth and Ilurnan Ser\ices. 1)1113S l}~ihlic~ition ; no,(1’11S) 80-1710. [DNLM: 1. .Ambulatorl care -~nitcd States -Statistics. 2. Ph>sicians-
L’tilizatioll -United States .- St.ttisti~s. }. Patients--Unitecl States --Statistics. 4. Sex fac -
t(Jrs-–L’nited States-Statistics. .5. Ph\si( i.~t~~,I!’f)nlcn - Utilizatio]l (T1litcd SIJTCS. Statistics.IV2 AN148\m no. 49]
R,\407.3..A349 110. 49 [R.A410.7] }02.1’1’097:3sISJ3N 0-8406 -0191-3 I (i lo.(i9’61 80-(io71 :39 Rc\.
NATIONAL CENTER FOR HEALTH STATISTICS
DOROTHY P. RICE, Director
ROBERT A. ISRAEL, Deputy Director
JACOB J. FELDMAN, Ph.D., Associate Director for Arza/ysis
GAIL F. FISHER, Ph. D., Associate .Directorfor the Cooperative Health Statistics System
ROBERT A. ISRAEL, Acting Associate Director for Data Systems
ALVAN O. ZARATE, Ph. D., Acting Associate Director for International Statistics
ROBERT C. HUBE& Associate Director for Management
MONROE G. SIRKEN, Ph. D., Associate Director for Mathematical Statistics
PETER L. HURLEY, Associate Director for operations
JAMES M. ROBEY, Ph. D., Associate Director for Program Development
GEORGE A. SCHNACK, Associate Director for Research
ALICE HAYWOOD, Information Officer
DIVISION OF HEALTH RESOURCES UTILIZATION
W. EDWARD BACON, Ph.D., Acting Director
STATISTICS
W. EDWARD BACON, Ph. D., Acting Chiej Hospital Care Statistics Branch
JAMES E. DELOZIER, Chief Ambulatory Care Statistics Branch
MANOOCHEHR K. NOZARY, Chief Techrzical Services Branch
STEWART C. RICE, Chiej Family Planning Statistics Branch
JOAN F. VAN NOSTRAND, chief Long-Term Care Statistics Branch
Vital and Health Statistics-Series 13-No. 49
DHHS Publication No. (PHS) 80-1710
Library of Congress Catalog Card Number 80-607139
CONTENTS
Introduction ... .... . .. ... .. .. .... .. .. ... .. . .... .. .. ... .. .. ... . .. .... . .. ... .. .. ... .. . ..... .. .... .. . ... .. .. ... . .. .... . ... .. .. .. ... .. .. ...................Background ... . .. ... ... .. ... .. .. ... . ... ... .. .. ... .. . ..... . .. ... . .. ... .. .. .... . . ..... ... ... .. . ... ... . .... . . .... . ... ... ... .... . . ... .. .. .............Scope of the Survey .. .... . .. ... .. .. .. ... .. ... . .. ... ... .. ... .. . .... . .. .. .. .. .... . .. ... .. . .... . .. .... . .. ... . . .... . .. .... ... ... . .. ..... ... .. .. ..Source and Limitations of the Data ... . ... .. . ..... ... ... .. .. ... .. . .... . .. ... . ... ... . .. .... . .. .... . . ... .. .. ... .. . .... . . ..... . .. ... . ...
Patient Characteristics .... ... . ..... .. .... . ... .. .. .. ... ... .... .. . .... . ... ... .. .. ... . . .... .. . .... . .. ... ... . ... .. . .... . .. ... ... . ... . .. .... . .. ... .. ...Patient Sex, Race, and Age .. .... . .. .... . .. ... .. .. .. ... . .... . .. ... ... . .... .. .... .. . .... . .. ... ... . .... . . .... . ... .. ... ... ... . .... . .. .... . .. .Physician and Patient Characteristics ... .... .... . . .... .. ... ... .. . ... .. . .... .. .. .. .. .. ... .. .. ... .. .. .... .. ... . ... ... .. .. ... . . .... .. .. .Physician Specialty and Patient Age .. .... . .. ... . .. .... .. . .... .. .. ... . .. .... . . .... .. .. .. ... .. .... . . ... ... .. .. .. .. ... . .. ... .. .. .... . ...
Clinical Characteristics .. . .. ... .. ... .. .. .. ... . .. .... .. .. .. .. . .. ... .. . ..... . ... .. .. .. ... .. . .... .. .. ... .. . .... . .. .... .. .. .. . ... .. .. .. .... . . ..... . . ..Principal Reason for Visit . .. ... .. . .... . .. .... .. .. .. .. .. .... . . .... ... . .. ... .. ... .. . .... . ... .. .. .. .... . .. .... . . .... . .. ... . .. . ... . ... ... . .. ..Principal Reason for Viitand Diagnostic Services ... . ... .. .. .. ... .. .. ... .. . .... . .. ... .. .. .... . . .... .. .. ... . .. .... . .. ... .. . ...Principal Diagnosis . ... .. .. .. ... .. ... . . .... .. .. ... . .. ... ... .... .. . ... .. .. ... .. .. ... .. . .... . . ..... . .. ... ... . .... . . .... .. .. ... .. . ... ... . .... . . .. .Principal Diagnosis and Drug Therapy ... .. ... .. . .... . . ..... . . .... .. . .. ... .. ... .. . .... . ... .. ... .. .. .. .. ... .. .. .... . .. .... . .. .... . .. ..Clinical Services and Physician Specialty . ... ... .... . . ..... . .. ... .. . ... .. .. .... . . .... . . .... . ... ... .. . ..... .. ... .. .. .... . ... ... .. . ...Cliicaf Services and Physician Age ..... . .. ... .. .. ... .. . .... . . ..... ... ... . .. .... .. . .... . .. ... .. .. .. .. .. .... .. . ... .. . .... ... . ... . .. ....Status of the Vkit .... . .. ... .. .. ... .. . ... ... . .... . .. ... . ... ... .. . .... . . .... . .. ... ... . ... ... . ... .. . .... . ... ... .. . .... . . .... . .. .... . ... .. ... . ... .Seriousness of the Problem and Deposition and Duration of Visit . ... . .. ... .. .. ... .. .. .... . .. ... .. .. ... .. .. .. .. .. ....
Discussion ..... . .. .... . ... .... . .. ... .. .. .... . ... .. ... . .... . .. ... .. . ... .. .. .... . . .... . .. ... .. .. ... .. . ..... . . .... .. .. ... . ... ... . . .........................
References ..... . .. .... ... . ... .. .. .... . ... .. .. .. ... .. . .... . . ..... . ... .. . ... ... .. . .... . .. ... .. .. .... .. . ... .. . ... .. .. ... .. .. ... . .. .........................
AppendixesI. Technical Notes .... . .. .... . .. ... .. .. .... . .. ... . .. ... ... . .... .. . .... . .. ... .. .. .. ... . .... .. . .... . .. ... .. .. ... .. .. ... . .. ... .. .. ... .. . .....II. Definition of Terms .... .. . ... ... . .... . .. .... . .. ... . .. ..... . .. ... .. . .... . .. ... .. .. ... .. .. ... . .. .... . ... ... . .. .... . .. ... ... . .. ... .. ....III. Survey Instruments . .... . ... ... .. .. ... . .. .... . .. ... .. .. ... .. .. ... . ... ... . ... ... . .. ... .. .. .... . . .... .. .. .. .. .. .... .. .... . ... .. . ... ... ..
1.
2.
3.
4.
A.
B.
LIST OF TEXT FIGURES
Annuaf rate of office visits to male physicians by sex and age of the patient: United States,1977 .... ... .. .... . . ..... . ... .. ... .. ... .. .. ... .. .. ... .. .. .... . . .... . .... .. .. .. ... . .. ... .. .. ... .. .. ... .. .. ... .. . .. .. . ... .. .. .. ....................
Annual rate of office visits to female physicians by sex and age of the patient: United States,1977 .... .. .. .. .... . ... .. ... . .... .. . .... . .. .... .. . ... .. .. .... . .. ... . .. .. . ... . ... .. .. ... .. .. ... . .. ... . .. .... . .. .... .. . ... .. ... ....................
Annual rate of office visits to male physicians by age and race of the patient: United States,1977 . .. ... ... . .... . .. ... .. .. .... .. . .... . .. .... ... ... ... . .. ... . .... . ... .. .. .. ... .. . ... .. . .... . .. .... . .. ... .. . .... . .. .... . .. ......................
Annual rate of office visits to female physicians by age and race of the patient: United States,1977 .. .... . .. .... . . ..... .. .. ... .. . .... .. . .... . .. .... . .. ... .. . .... . .. .... . ... .. . .. . ... .. . .... . .. ... .. .. ... .. .. ... .. . .... . ... .....................
LIST OF TEXT TABLES
Number and percent distribution of office visits by sex, race, and age of the patient, according tosex of the physician: United States, 1977 .. .. ... . ... ... .. . ... ... . ... . ... ... .. . ... .. .. .... . . .... . ... ... .. . .... .. .. ... . .. .... ..
Number and percent of office visits to female and mrde physicians by female patients 15 yearsand over, by age of the patient: United States, 1977 ..... .. .... .. .... .. . ... .. .. ... .. . .... .. . ... .. . ..... . . ... .. . ... .. ...
.
1111
2235
77788
10111111
15
17
192731
4
4
4
4
2
3
...Ill.
c.
D.
E.
F.
G.
H.
J.
K.
L.
M.
N.
o.
P.
Q.
R.
s.
Number and percent distribution of office visits and average number of visits per week by physi-cian specialty, according to sex of the physician: United States, 1977 .. .. ..... . .. .... .. .. ..... . .. .... . ... ... .
Median visit age in years and standard error of the median in years, by sex and specialty of thephysician: United States, 1977 ... .. .. .... .. .. ... .. .. ..... . . .. ... ... . ..... ... ... ... .. .... . . .... ... . ..... . .. .... .. .. .... .. .. .. .. .. ..
Number and percent distribution of office &.its by sex, age, and race of the patient, according tosex and specialty of the physician: United States, 1977 . .... .. ... ... .. . .... .. .. .... .. .. .... . ... ... .. . ..... .. .. .... .. .
Number and percent distribution of office visits by principal reason for visit, according to sex andspecialty of the physician: United States, 1977 . .... .. . .... . ... ... .. .. ..... . ... .. ... .. .... . ... ... .. ... ... .. .. .... ... . .....
Number and percent of office visits, by selected reasons for visit, sex of the physician, andselected diagnostic services ordered or provided: United States, 1977 .... . .... .. ... .. .. . .. .. ... . .... ... . ..... .
Number and percent of office visits to genend and family practitioners and internists, by sex ofthe physician and selected principrd diagnoses: United States, 1977 . .... .. .. .... .. .. .... . ... ... .. ... ... ... . ....
Number of office visits and percent of visits with drug therapy, by sex of the physician and princi-pal diagnosis: United States, 1977 .. . .... .. .. .... ... . .... . . ..... . ... ... .. .. ... .. ... .. .. . .. ..... . . .... .. . . ...... .. ...... .. ...... .. .
Number and percent of office visits to general and family practitioners and internists, by sex ofthe physician and selected diagnostic or therapeutic services ordered or provided: United States,1977 .... ... . .... .. . ..... .. .. .... .. . .... .. .. .... ... ..... . .. ... ... .. .... . .. .... .. ... ... . .. .... . ... .... ... ..... . ... ... .. .. ... ......................
Number and percent of office visits made by women to obstetrician-gynecologists, by sex of thephysician and selected diagnostic or therapeutic services ordered or provided: United States,1977 .... ... . .... .. . ..... .. .. ..... . . .... ... .. ... .. .. .... . ... ... .. .. ... .. .. .. .. ... . ..... .. .. ... .. .. ..... . .. .. .. . ... .... . .. .... .. .......... ........
Number and percent of office visits to general and family practitioners and internists, by sex andage of the physician and selected diagnostic or therapeutic services ordered or provided: UnitedStates, 1977 ... . .. .... .. . ..... . . .... .. .. .... .. . ..... . .. ... ... .. ... .. ... ... .... . ..... . ... ... .. .. ..... . ... .. ... .. .... .. .. .... .. .. .... . .........
Number and percent distribution of office visits by selected visit characteristics, according to sexand specialty of the physician: United States, 1977 .. ... . ..... .. . .... .. .. ..... . ... ... ... . .... . ... ... ... . .... .. .. .... .. .
Return visit rate by sex and specialty of the physician: United States, 1977 . . .. .... . .... ... .. .. .... .. .. .... ..
Percent of new patients seen by office-based physicians and percent referred by another physi-cian, by sex and specialty of the physician: United States, 1977 . .. . ..... . ... .... .. .. .. .. .... ... . .. ...... . .. .... .
Percent distribution of office visits by duration of visit, according to sex and specialty of thephysician: United States, 1977 . .... .. .. ..... . .. .... .. .. .... ... . .... .. .. .... .. .. .... . .... ... ... . ... .. ... .. .. . .. .... .. ... ... .. .. ....
Mean contact duration of office visits by sex of the patient and sex and specialty of the physi-cian: United States, 1977 .. .. .... . ..... . ... ... ... . ..... .. .. .... .. .. ... .. ... .... .. . ..... . ... .... . .. .... . ... ... ... . .... .. .. ... ... .. ....
Average number of hours per week spent in direct patient encounter, by sex and specialty of thephysician: United States, 1977 . ..... . .... .... . .. .... .. ... ... ... .. ... ... .. ... .. . .... .. ... ... ... . .... .. .. ... ... . .... .. ... ... ... . ....
5
6
6
7
8
9
9
10
11
12
13
14
14
15
15
15
SYMBOLS
Data not available-——-——-—— .-——- -- .
Category not applicable—— -—-—--——- . . .
Quantity zero–—--–-—-——
Quantity more than O but leas than 0.05— 0.0
Figure does not meet standards ofreliability or precision ——-—.-—— *
iv
●
CHARACTERISTICS OF VISITS TO FEMALE ANDMALE PHYSICIANS
THE NATIONAL AMBULATORY MEDICAL CARE SURVEYBeulah K. Cypress, Ph. D., Division of Health Resources Utilization Statistics
INTRODUCTION
Background
In 1967,4.9 percent of the nonfedera.lly em-ployed physicians engaged in office-based pa-tient care in the United States were women.1 Adecade later women constituted 6.2 percent ofthis group.2 However, women candidates enter-ing medical school increased from 9 percent ofthe total enrollment in 1970 to 25 percent in19773 portending an increased ratio of femaleto male physicians in the next decade. Becauseof the mounting interest in the performance andproductivity of women in traditionally male-dominated professions, a retrospective examina-tion was made of the utilization data collectedin the National Ambulatory Medical Care Sur-vey, with the sex of the health provider as thefocal point. Previous reports based on data fromthk survey provided information on physicianutilization without regard to the sex of the
physician.The data were collected in the National Am-
bulatory Medical Care Survey, which is a samplesurvey conducted yearly by the Division ofHealth Resources Utilization Statistics of theNational Center for Health Statistics. Detailedinformation regarding the background andmethodology of the survey were published inVital and Health Statistics, Series 2, No. 61?Summary data for 1977 were published in Vitaland Health Statistics, Series 13, No. 44.5
Data collection and processing for the 1977National Ambulatory Medical Care Survey were
the responsibility of the University of Chicago’sNational Opinion Research Center. Sample se-lection was accomplished with the assistance ofthe American Medical Association and AmericanOsteopathic Association.
Scope of the Survey
The basic sampling unit for the NationalAmbulatory Medical Care Survey was thephysician-patient encounter or visit. The cur-rent scope of the National Ambulatory MedicalCare Survey included all office visits within theconterrninous United States made by ambula-tory patients to nonfederalIy employed office-based physicians classified by the AmericanMedical Association or the American Osteo-pathic Association. The National AmbulatoryMedical Care Survey physician universe excludedphysicians practicing in Alaska and Hawaii, anes-thesiologists, pathologists, and [email protected] to physicians principally engaged in teach-ing, research, or administration; telephone con-tacts; and visits conducted outside the physi-cian’s office were also excluded.
The definitions for office, physician, patient,and visit that were used to determine eligibilityfor the National Ambulatory Medical Care Sur-vey are presented in appendix 11.
Source and Limitations of the Data
The estimates in this report are based on in-formation obtained from Patient Records (seeappendix III) for a sample of visits provided by a
1
national probability sample of office-based phy-sicians. The sample for the 1977 NationalAmbulatory Medical Care Survey (NAMCS) in-cluded 3,000 physicians, 507 of whom were noteligible (out of scope) at the time of the survey.Of the 2,493 physicians who were eligible, 1,932(77.5 percent) actually participated (see appen-dix I). About 5 percent of the physician partici-pants were women. (This is roughly the propor-tion of similarly described female physicians inthe universe.)
Sample physicians listed all office visits dur-ing a randomly assigned 7-day reporting period.Information was recorded on the Patient Recordor encounter form, which supplied data on a sys-tematic random sample of 51,044 visits. Femalephysicians supplied 2,339 completed PatientRecord forms; male physicians provided 48,705.
Readers are urged to peruse the appendixesto this report, which contain information neces-sary for proper understanding and interpretationof the statistics presented. Appendix I contains ageneral description of the survey methods, thesample design, and the data collection and proc-essing procedures. Methods of estimation andimputation are also presented. The statistics inthis report are based on a sample of office visitsrather than on all visits and are subject to sam-pling errors. Therefore, particular attentionshould be paid to the section on “Reliability ofEstimates” in appendix 1. Charts of relativestandard errors and instructions for their use arealso shown in appendix 1.
Definitions of the terms used in this reportand in the survey operations are presented inappendix II. Facsimiles of survey materials, suchas the introductory letter and the PatientRecord and Induction Interview forms are fur-nished in appendix III.
PATIENT CHARACTERISTICS
Patient Sex, Race, and Age
Analyses of data for the past several yearshave shown a clear pattern of proportionatelymore visits to office-based physicians by femalesthan by males. The current analysis of patientvisits according to the sex of the physician
shows that not only is this pattern continuing,but also that female patients tend to visit femalephysicians for medical care proportionatelymore than they visit male physicians, i.e., theratio of female to male patients visiting femalephysicians is higher than that of patients visitingmale physicians. Table A shows that about 72percent of the average female physician’s patientload were females, compared with 60 percent ofthat of the average male physician. Table Bshows that the tendency of women patients tovisit women physicians prevailed for women inall age groups.
However, age-specific visit rates (the averagenumber of visits per 100 in the population) re-
Table A. Number and percent distribution of office visits bysex, race, and age of the patient, according to sex of the
physician: United States, 1977
Sex, race, and aga of patient
All visits ..... .. .. ..... .. .. .... ... . ..... .. .. ... ... .
Total .... .... .. ... .... .. .. .... .. .. .... .. ... .... . .. ..
Sex—
Female .. ..... ... .. .... .. . ..... .. .. ..... .. .. .... .. .. .... .. .. ..Male .. .. .. ..... .. .. ... .... .. ... .. ... .... .. .. .... . ... .... .. .. ...
Race
White .... ... ... .. .... . .... ... .. .. .... .. .. ..... .. . .... .. .. .... .Black and all other .... .. .. .... .. .. .... .. .. .... .. . ..... .
Age—
Less than 15 years . ... ... .... . ... ... .. .. ..... .. .. .... ..15-19 years ..... .. .. .... . ... .... .. ... ... .. ... .... . ... .... . .20-24 years .... .. .. .... ... ... .. ... .. .... . .. ..... ... .. ... .. .25-29 years .... .. .. ..... .. .. .... .. .. .... . ... ..... . ... ... .. .30-34 years .... .. . ..... .. ... ... .. . ..... .. ... .... .. .. ... .. ..35-39 years .... .. . ..... .. .. .... .. .. .... .. .. .... ... . .... .. ..40-44 years ... .. .. ..... . .. .... .. ... .... .. .. ..... .. . ... ... ..45-49 years .. ... .. ..... .. . ... ... .. ..... .. .. .... .. .. .... .. ..50-54 years .... ... ... .. .. ..... . .. ..... .. . ..... ... . .... ... . .55-59 years .. .. .. ..... .. . .... .. ... .... . ... .... .. .. ..... .. . .60-64 years .... ... .... . .. .... .. .. ..... . ... .... .. .. .... .. ...65-69 years .. .. .. .... .. .. .... .. ... .... . ... .... .. . ..... ... . .70 years and over . .. .. .... .. ... .... .. .. .... .. .. .... .. ...
Sex of physician
Female I Male
Number in
thousands
22,788 I 547,264
Percentdistribution
100.0I
100.0
T71.528,6
81.318.7
26.98.09.48.28.84.94.15,,44,,25.84.53.96,1
60.139.9
90.79.3
17.86.98.18.27.05.45.15.96.56.76.15.7
10.7
2
veal an anomaly in the pattern of visits to femalephysicians. Figure 1 shows that rates for bothfemale and male patients visiting male physi-cians increased with the advancing age group ofthe patient, but the visit rates to female physi-cians shown in figure 2 were about the same re-gardless of patient age group.
When the race and age of the patient areplotted, a similar result can be observed (figures3 ~d 4). In this case, the proportion of visits tofemale physicians by patients of black andother races was about twice as high as the corre-sponding proportion of visits to male physicians(table A).
Table A also shows that the largest share ofvisits to all physicians included patients under15 years of age, but female physicians weremore likely to serve this age group than menwere. About 27 percent of these visits were tofemales, compared with about 18 percent thatwere to males. Male physicizuis, however, tendedto care for proportionately more older patientsthan female physicians did; 36 percent of thevisits made by patients over 50 years of age wereto male physicians, compared with about 25 per-cent to female physicians.
Physician and Patient Characteristics
The difference in proportions of visits by theyoungest patients was due, in part, to the distri-bution of visits by physician specialty. Althoughgeneral and farnily practice accounted for thelargest, and ahnost equal, proportions of visitsregardless of the sex of the physician, pediatri-cians had the second highest proportion of visitsto all female physicians (about 20 percent)(table C). For male physicians, internal medicineranked second, and proportionately more visitsby patients over 50 years of age were made tointernists than to any other specialty.6 Derma-tologists also ranked high on the distribution ofvisits to women (about 16 percent).
No women in the NAMCS sample (selectedrandomly by specialty) were in the specialties oforthopedic surgery, cardiovascular diseases, uro-logical surgery, and otoktryngology, which aretraditionally male-dominated fields. Relativelyfew women in the sample were in the specialtiesof general surgery, ophthalmology, and neurol-ogy-specialties rarely selected by women medi-cal school graduates. Few women in the samplerepresented general surgery, ophthalmology, and
Table B. Number and percent of office visits to female and male physicians by female patients 15 years and over, by age of the patient:United States, 1977
Age of patient
Total .... .. .. ... .. .. .... .. .. ... .. .. .... . .. .... . .. .... . .. ... .. .. .... .. . .... . .. ... .. .. ... ... .... . .. ... .. .. ... . ... ...
15-19 years .... .. ... .. .. .... ... .. ... . .. .... .. .. ... .. .. ... . ... .... . .. .... .. . ... .. .. .... . . .... .. .. ... .. . .... . .. ... . .. ... .. .. ... .20-24 years .. . ..... .. . .... ... . .... ... . .... .. .. .... . .. .... .. . .... . ... .... . . .... ... . ... . . .. ... . ... .. .. .. ... .. . ... .. .. ... .. . .... .25-29 years .... ... .. ... ... ... . ... .... . ... .. .. .... . .. .... . ... ... .. . .... .. . .... .. .. .... . .. ... .. .. ... .. .. .. .. .. ... .. .. ... . .. ... ..30-34 years .. . ..... .. .. ... ... . .... .. .. .... . .. ..... . .. .. .. ... ... .. . .... .. .. ... .. .. ... .. .. .... . .. .... . .. ... .. . .... . . .... . ... ... .35-39 years ... .... . .. . .... ... . .... .. .. ... .. . ..... .. . .... .. . .... .. . ..... . .. ... .. ... .. .. . ..... . . .... . .. ... .. .. .... . . .... .. . ... ..404$4 years ...... .. . ..... .. .. .... . ... ... .. .. ..... . .. .... . .. ... .. .. .... .. . ... ... .. ... . ... ... . .. .... . .. .... . .. ... . .. .... . .. ... ..45-49 years .. .... .. .. ..... .. . .... . ... ... .. ... ... .. . .... . ... ... ... . .... . ... ... .. .. ... .. . .... .. . .... ... ... .. . .... . .. ... . ... ... ..50-54 years ...... . .. .... ... .. .... . .... .. .. .. ... ... .. ... . ... ... .. .. .... . .. .... . .. ... .. .. .... . .. .... . .. ... .. . .... .. . .... . .. ... ..55-59 years ..... .. ... ... .. .. ... ... .. .... .. .. .... . .. ... .. ... ... .. .. ... .. . .... .. .. .... . .. ... .. .. ... . ... ... .. . .... . .. .... . .. ... . .60-84 years .... .. .. ..... . ... .... . .. .... .. .. .... ... . .... . .. ... .. .. .... .. . .... . .. .... .. . ..... . . .... .. .. .. .. .. ... .. .. ... . .. .... . .65-89 years ...... . . .... .. ... .... .. .. ... .. . .. ... ... .... .. .. ... ... . .... ... .... . .. .... .. . ..... .. . ... . .. ... . .. ..... . .. ... . .. ... .. .70 years and over .... ... . ... .. ... ... .. .. .... .. .. ... .. ... .. .. .. .... .. . .... . ... ... .. .. ... .. . .... . .. ... .. . .... .. . .... . . .... .. .
Sex of physician
Female Male
All Percent All Percent
visits of visits ofin female in female
thousands patients thousands patients
16,669
1,8252,1441,8702,0031,112
936
1,220965
1,3191,019
8791,377
79.1
82.686.887.180.577.175.880.174.077.562.174.373.7
449,627
37,68244,10944,93838,18229,54127,747
32,08135,77936,59133,21031,25758,529
62.7
59.069.170.067.761.162.2
61.158.559.256.459.163.3
3
Female
J I I I I I I ILess 1S24 25.34 3644 45.54 55.64 65.74 75xhan and15 PATIENT’SAGE IN YEARS ovel
White
Black andall other
-1-
than am15 we
PATIENT’S AGE IN YEARS
Figure 1. Annual rate of office visits to mele physicians by sexand age of tha patient: Unitad States, 1977
Figure 3. Annual rate of office visits to male physicians by ageand rata of the patiant: United States, 1977
TI
Less 15.24 25.34 35.44 45.54 55.e4than
65.74 75
15and
PATIENTS AGE IN YEARS over
Figure 2. Annual rate of office visits to female physicians bysex and age of the patient: United States, 1977
neurology, which are also specialties selected byrelatively few women.
The average number of visits per week arelisted by sex and specialty of the physician intable C. This rate is obtained by dividing thetotal number of annual visits by 52 and then by
o~—L__JLess 15.24 25.34 35.44 45.54 55.64 65-74 75than and15 PATIENT’S AGE IN YEARS over
Figure 4. Annual rate of office visits to female physicians by ageand race of the patient: United Statas, 1977
the weighted number of physicians in the sam-ple. Except for dermatologists, male physiciansin all listed specialties saw more patients on aweekly average than women did. These averagesmay reflect the length of the practice-week andworkday and the duration of visits. Time spent
4
Table C. Number and percent distribution of office visits and average number of visits per week by physician specialty, according to sex
of the physician: United States, 1977
Physician specialty
All specialties .... . ... ... .. .. ... .. .. ... .. .. ... .. .. ... .. . .... .. .. ... .. . .... . . ..... . .. .... .. . ... . .. ....
Total .. ... ... . .. ..... .. . ... .. .. .... . ... .... ... ... .. .. ... .. . .... . ... ... .. . ... .. .. .... . .. ... .. .. ... .. . .... .
General and family practice .... .. . .... .. . ..... . .. ... .. .. .... . .. .... . . .... .. . .... . .. .... .. .. ... .. .. .. .. .. .... .Internal medicine .... .. .. .... .. .. ... .. . ..... . . .... ... . ... .. .. .... .. .. .... .. ... ... . ... .. .. ... .. . .... . .. .... . .. ... ..Pediatrics .. ... . .... .. .. ... . .. ...... . .. ... .. . ... .. .. ..... . .. .... . . .... .. .. ... .. .. ... .. . .... . .. .... .. .. ... . .. ... . .. .... ..General surgery .... ... . ... .... . .. .... .. .. ... .. .. ... . .. .... .. .. ... .. . ..... . .. ... .. .. ... .. .. ... . .. .... .. . ... . ... .. ...Obstetrics and gynecology .. ... . .. .... .. .. ... ... . ... . ... ... ... . .... .. . ... .. ... .. ... . .... . .. ... .. . .... .. .. .. ..-Orthopedic surgew ... . .... .. .. .... .. .. .. ... .. ... .. .. ... .. .. ... .. . .... ... . .... . .. ... . ... .... . . .... .. .. ... . .. ... .. .Cardiovascular diwaws .. .. .. .... .. . ... .. .. ... ... . .... .. . .... . .. .... . .. .... . .. .... . .. .... . .. .... .. . ... .. . .... .. .Dermatology ... .. .... . .. .... .. .. .... .. ..... . .. ... .... .... . .. .... ... . ... .. .. ... . ... ... .. .. ... ... . ... .. . .... . .. ... ... .Urological surgery ... .... ... .. ... .. . .... . .. ... ... .. ... .. .. .... . .. .... .. .. ... .. . .... . .. .... .. .. .... . . .... . .. .... .. .Psych iatry .. ... .. .. ..... .. .... .. .. .... . .. ... .. .. .. ... .. ... .. .. .... .. . ... ... . .... . ... ... . .. .... .. .. .... . . .... . .. ... .. ..Ophthalmology . .... . ... ... .. .. .... . . .... .. .. ... .. ... .. .. .. .... .. . ... .. ... ... . .. .... .. . .... .. .. .. .. . ..... . .. ... .. ..Neurology ..... .. . .... ... . ... ... .. ... .. . .... .. .. ... ... . ... .. .. .... . .. ... ... . .... . .. ... .. .. .... .. .. ... . . ..... .. .... .. ..Otolaryngology .... ... .. .. ... .. ... .. . .... .. . ... ... . .... ... ..... . .. ... .. .. .... . .. ... .. .. ... ... . ... .. .. ... .. . ... ... . .Other specialties ... .. .. .... .. .. ... .. . .... .. . ..... . .. ... .. . ..... . . ... ... .. ... . .. .... .. .. ... ... . .. ... . .... . ... .. .. .. .
in direct patient encounter is discussed inanother section of this report. The length of thepractice-week and workday will be variablesused in a future publication based on the prac-tice activity of physicians.
The specialty in which a physician practicescontributes more than any other variable to dif-ferences between physicians. Therefore, compar-isons between female and male physicians in thisreport are limited to contrasts within specialtieswherever possible. The primary care specialtiesof generaI and family practice, internal medi-cine, pediatrics, and obstetrics and gynecologyconstituted more than two-thirds of the visits toboth female and male physicians. Dermatologyand psychiatry are fields in which many femalephysicians are active. Therefore, these specialtieswere selected for analysis. As a matter of prac-ticality all specialties are not shown in sometables. Where a variable is not a significant factorin a particular specialty, that specialty is notshown. The reader should note the specialtynames (when they are shown) in the titles of thetables.
Sex of physician
Both Female Male Female Malesexes
Number in thousands
570,052 II 22,788 I 547,264 I 22,788 I 547,264
Percent distribution I Visits per week
100.0
39.111.4
9.66.38.63.51.12.92.02.84.70.52.84.7
100.0
34.96.2
19.9●1.O11.7
15,5
5,8*1.O*1.1
2.9
100.0 64.3
39.3 77.011.6 37.6
9.2 82.16.6 ●34.28.5 64.53.71.12.4 149.92.12.7 23.24.9 *45.70.5 ●
2.94.5 ---
74.5
110.058.5
108.047.871.965.433.6
120.152.331.579.527.582.5
. . .
Physician Specialty and Patient Age
The median visit age’ of patients in the of-fices of female physicians in all specialties was28.6 years, which is significantly younger thanthe median age of 36.8 years for visits to malephysicians (table D). However, when visit age isadjusted for physician specialty, this statistic isclearly influenced by the large proportion ofvisits to women pediatricians where most pa-tients are under 15 years of age. The medianvisit age of patients visiting male general andfardy practitioners is higher than that of pa-tients visiting females in the same specialty, butmedian visit ages are about the same for patientsseen by female and male internists, obstetrician-gynecologists, and psychiatrists.
Table E provides detailed statistics on visitsto women and men specialists according to thesex and age of the patient and the patient’s race.
aMedian visit age should not be confused withmedian patient age. The median vs%itage is based on ini-tial and return visits some of which maybe by the samepatient.
5
Table D. Median visit age in years and standard error of the median in years, by sex and specialty of the physician: United States, 1977
Sex of physician
Female I Male
Physician specialtyMedian Standard Median
visit error visitage in of the age inyears median years
Standarderrorof the
median
All specialties ...... . . ..... . ... .... .. .. ... .. .. ... .. .. . .... . .. ... ... .. .... .. .. ... ... . .... .. .. .... .. .. ... .. . ..... ..
T1728.6 1.53 36.8 0.34
33.9 2.38 39.1 0.6656.0 4.28 56.0 0.66
5.0 0.95 4.4 0.2128.9 1.74 28.8 0.3633.2 2.21 33.9 0.74
General and family practice .. . . ..... .. . .... .. .. .... . ... .... .. . ..... . .. ..... .. .. ... .. ... ... .. . .... .. .. ... ... .. .... . .. .... . .Intarnal medicine ... .. .... .. .. .... . .. ..... .. .. .... .. .. ... .. ... ... .. ... ... .. .. .... .. .. .... .. . .... .. .. .... .. .. ... .. .. .... .. . .... ..Pediatrics ..... ... .. ... ... .. ... ... .. .... .. .... .. ... ..... . .. ... .. ... ... .. .. .... .. .. .... .. .. .... .. . ..... . .. .... .. ... ... .. . .... . ... .....Obstetrics and gynecology ... . .. ..... . .. .... .. .. ... ... .. .... .. . ..... .. .. ... .. .. .... .. .. .... ... .... .. .. .... .. .. .... . .. .... ..Psychiatry ... .. . .... ... . ..... .. . ..... .. .. .... .. .. .... .. .. ... . .... ... . ... ... .. ... ..... . . ..... . .. .... .. .. .... .. .. .... .. . ..... . .. .... ..
1 Includes visits to other specialties not shown in the table.
Table E. Number and percent distribution of office visits by sex, age, and race of the patient, according to sex and specialty of thephysician: United States, 1977
Sex and specialty of physician
Female I Male
Sex, age, and race of patient General andfamily
practice andinternal
medicine
General andfamily
practice andinternal
medicine
Obstetricsand Psychiatry
gynecology
Obstetricsand
gynecologyPsychiatry
Number in thousands
1,319 I 278,508
Percent distribution
2,661 I I 46,612 I 14,877All visits . ... .. .. .. .... .. .. ..... . .. .... .. .. ... .. . ... 9,37
100.0 100.0Total ... .. .. .... .. .. .... .. .. .... . ... ... ... . .... . .. ... 100.0 100.0
100.0
100.0
99.1
100.0
Sex and age
‘71.7 59.4 57.9Female .... ... . .... .. . ..... .. .. .... .. . .... ... ..... .. . .... 74.7
*2.58.7
31.913.3
1.5
42.1
Less than 15 years . ...... . .. .... .. .. ... .. .. ..... . .. .... .. . ....15-24 years .. .. ..... .. . .... ... . .... .. .. ... .. .. .... .. .. .... .. . ....25J14 years .. . ..... .. .. .... .. . ..... .. .. .... . .. .... .. . ..... .. . ....45-84 years .. .... .. .. .. .... .. .. .... .. . .... .. .. .... . .. ... ... . .....65 years and over .. .... ... ... ... . ... ... .. . ..... . .. .... . ... ... .
10.011.620.320.712.0
“0.934.647.6
●14.6●2.4
*2.6*11.1
48.4*9.7
28.3
6.19.1
14.616.613.0
40.6
“0.429.152.913.8
2.9
0.9Male ... ..... . .. .... .. .. .... .. .. .... . .. ... .. .. .... .. .. .... . 25.3
4.27.3
20.19.8
*0.7 .
Less than 15 years .... ... . .... .. .. .... .. .. .... . .. .... .. . ..... .15-24 years .. ..... .. . ... .. . .. .. .. .. .. ... ... . .... .. .. .... .. .. ... ..25-44 years .. ..... .. . .... .. .. .... . ... .... . .. .... .. .. ... ... .. .... .45-64 years . ..... .. .. .... .. .. .... . .. ... .. .. ..... .. .. ... .. .. .... ..
65 years and over .... .. .. .... .. .. ... ... .. .. .. ... .... . ... ... .. .
6.1*3.4
5.76.5
*3.7
*4.O*1.9
*1 8.8*3.6
95.2*4.8
5.95.69.4
12.17.6
88.2*11.8
90.010.0
Race
White .... . .. .. ... .... . .... . .. ... ... .. ... .. ... .... .. . ..... . ... .. ... ..Black and all other ... .. ... .. .. ... .. .. .... ... . ..... . . .... .. ...
79.021.0
90.59.5
95.44.7
6
CLINICAL CHARACTERISTICS
Principal Reason for Visit
Information obtained in item 6 of the Pa-tient Record form represents the reasons for vis-iting physicians’ offices. The physician records,as nearly as possible in the patient’s own words,the reason, complaint, or symptom that in hisjudgment was the most important reason for thepatient visit. These data have been classified andcoded according to A Reason for Visit Classij?ca-tion for Ambulato~ Care (RVC), which hasbeen published in Series 2, No. 78 of Vital andHealth Statistics. 7 Detailed tables showing asummary of reasons for visit are included inSeries 13, No. 44.5 Similar tables by sex of thepatient (but not by sex of the physician) werepublished in Series 13, No. 45.8
Proportionately more visits were classified inthe symptom module of the RVC to female phy-sicians than to male physicians in the specialtiesof general and family practice and internal med-icine, and obstetrics and gynecology (table F).The larger proportion of visits in the diseasemodule recorded by male general and familypractitioners and internists reflects their rela-
tively high proportion of visits by elderly pa-tients. (Visits by patients with prior diagnoses ofhypertension and heart disease, for example, arelikely to fall in this group.)
Male pediatricians were proportionatelymore likely to see patients for diagnostic, screen-ing, and preventive care (chiefly, well-baby ex-aminations) than were female pediatricians.
Other differences in proportions of visitsshown in table F are not statistically significant.
Principal Reason for Visit andDiagnostic Services
The kinds of diagnostic services ordered orprovided when patients presented differenttypes of symptoms are listed in table G. In thistable complaints constituting the major part ofthe symptom module (S001-S999) are groupedas general symptoms or symptoms referable toselected body systems (e g., $400 -S499 repre-sents symptoms referable to the respiratorysystem only).
The clinical response of female and malephysicians to the presentation of these symp-toms was about the same because the differencesin the proportions of visits for most comparisons
Table F. Number and percent distribution of office visits by principal reason for visit, according to sex and spacialty of the physician: United States, 1977
Principal reason for visit andRVC codel
All reasons for visit . . . . . . . . . . . .
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Symptom module ., . . . .. . . . . .. S001-S999
Disease module ............... DOOI-D999Diagnostic, screening, and
preventive module . . . . . . . . XI OO-X599
Treatment module . . . . . . . . . .. TIOO-T899
Injuries and adverse effects
module .. . .. . . . . . . . . . . . . . . . . . . . . . . JOO1-J999Teat results module . . . . . . . . . R1OO-R7OO
Administrative module . . . . A1OO-A14O
Otherz . .. . . . .. . . . . . . . . . . . . . . . . . . . . U990-U999
Sex and specialty of physician
Female I Male
General and General and
family Obstetrics family Obstetrics
practice and and Pediatrics Psychiatry practice and and Pediatrics Psychiatry
internal gynecology internal gynecology
medicine medicine
Number in thousands
9,371 I 2,661 I 4,535 I 1,3191 278,506 I 46,612 I 50,227 I 14,877
Percent distribution
100.0 100.0 100.0
68.5 36.8 69.9
6.1 +5.0 ‘6.2
13.2 50.4 14.44.6 ●5.4 ‘3.0
●1.5 “0.2 *4.2●1.5 “2.24.4 +1.9
‘0.3 “0.6
=Rt+●1.8
I
16.8 I 60.6● 22.9 5.6 7.5
100.0 I 100.0
53.8 60.95.7 2.5
127.3 +2.0
7.7 32.5
2.3 “0.5‘0.1 ‘0.0
1.9 ‘1.01.2 “0.5
lRea~on for “i~it ~roup~ and cOdes are based on A Reason for Vim-tCla@iCdOn for .4 MWatocv ca~ (RvCh21nclu,je~ b]a” ka; ~roblems, complaints not elsewhere classified: en trY of “none”: and ille8ible.
7
Table G. Number and percent of office visits, by selected reasons for visit, sex of the physician, and selected diagnostic services ordered or
Sex of physician anddiagnostic service
All visits to female physicians ................
Diagnostic service
No diagnostic wwices ............................................Limited history and examination ..........................General history and examination ...........................Pap test ............ .....................................................Laboratory procedure or test ...................... ..........Blood pressure check, ........................ .. ..................
All visits to mele physicians ...................
Diagnostic service
No diagnostic wwices ............................ ................Limited history and examination ..........................General history and examination ...........................Pap test ........................................................ .........Laboratory procedure or test ...... ..........................Blood pressure check .............................................
provided: United States, 1977
Reason for visit end RVC codel
GeneralsymptomsSool -s089
Symptoms Symptoms Symptomsreferable to referable tothe nervous
referable toto the the digestive
system (except respiratorysense organs) system
system
S200-S259 S400-S499S500-S639
Symptomsreferable
to thegenitourinary
systemS640-S829
Symptomsreferable to
the musculo-skeletalsystem
S900-S999
2,091
‘9.456.728.9‘ 5.422.632.0
41,643
8.757.225.8
1.626.541.7
705 I
+0.262.4
‘32.4‘7.2
●28.365.7
18,545 I
7.458.125.6●1.519.552.4
Number in thousands
2,870 I 1,161 I 1,611
Percentz
●3.9 ●1.3 ●2.670.4 63.3 56.423.1 ●31 .0 36.2●0.9 ●11.9 331.021.8 35.5 52.827.4 43.0 61.7
Number in thousands
59,270 I 26,480 I 29,866
Percent2
6.868.919.5‘0.116.526.7
5.259.326.9
2:::37.3
in the table were not statistically significant. Theonly statistically significant result showed thatfemale physicians were more likely to checkblood pressure during visits for symptoms refer-able to the genitourinary system than were men.
Principal Diagnosis
Conditions that were proportionately mostoften diagnosed by female and male physiciansin the specialties of general and family practiceand internal medicine reflected the characteris-tics of the patients most likely to be seen bythem. According to the data shown in table H,male physicians in these specialties treated pro-portionately more patients visiting principallyfor diseases of the circulatory system than forother diagnostic groups; female general and fam-ily practitioners and internists were more likelyto see patients with diseases of the genitourinary
5.261.023.1
416.746.135.4
1,614
38.243.515.8‘0.3●8.728.4
51,934
8.665.717,2
0.813.931.8
lReason for viait groups and codes are based on A Reason for Visft Claarif7caiion for Ambulatory Care (RVC).2Percents will not add to 100.o because most patient visits required the provision of more than 1 SeWice.30f all VjSMSto female physicians by female patienta with genitourinary problems, 32.3 percent included a paP test.40f au visits to male physicians by female patients with genitourinary problems, 23.4 Percent included a paP test.
system. The former group reflects the elderlypatients who presented symptoms typical ofthat age group to male physicians; the lattergroup reflects the younger female patients whopresented symptoms referable to the genitouri-nary system to female physicians. Other thanthe differences in these two categories, the prac-tices of female and male general and familypractitioners and internists were very similar inthe diseases they diagnosed.
Principal Diagnosis and Drug Therapy
Drugs were ordered or provided during phy-sician visits more than any other form of ther-apy (54 percent of all visits).5 Table J shows thepercents of visits in which drug therapy wasindicated in the presence of the principal diag-noses. Because most differences in the propor-tions shown in the table are not statistically sig-nificant, female or male physicians showed little
8
Table H. Number and percent of office visits to general and family practitioners and internists, by sax of the physician and selectedprincipal diagnoses: United States, 1977
Principal diagnosis and ICDA codel
All visits .. .. .. . .... .. . .... . . .... .. . .. ... . .. .... . .. .... .. .. ... . .. .... . .. ... .. .. ... . .. ... .. . .... .. .. .. .. . ... .. .. ... .. . .... .. . .... .. . .............. .............
Infective end parasitic diwaws .. .... .. .. ... . ... ... .. .. ... .. .. ... .. . ..... .. .... . .. ... .. . .... . .. ... .. . .... ... .... . . .... .. .. .. . .. .... . ... ... . .. ... . .. ..OW.l 36Neoplasms .. .... .. .. ... .. ... ... .. .. .... .. . .... .. .. .... . .. ... .. . .... .. . .... . .. ... .. . .... .. .. ... . .. .... . . .... .. . .... .. ... .. ... ... . . .............................l4O.239Endocrine, nutritional, and metabolic diseases . ... .. ... .. . .... . .. ... . .. .... .. .. ... . . ... ... . ... .. .. .. .. .. .... . .. ... .. .. ... . .. ... .. . .... .. ...24O.279Mental disorders ..... .. .. .... .. .. ... .. .. ... .. .. ... . .. .... .. .. .... . . .... .. . .... . .. ... ... . .. .. .. .... . .. ... . .. ... .. .. ... .. .. .. .. .. ... . ... .....................29O.3l 5Diseases of the nervous system and sense organs .. . .... . .. ... .. . .... .. .. ... . .. ... .. .. ... . .. ... .. .. .. ... . ... .. .. .... . .. .. ... . ... ... . ... .. ...32O.389Diseases of the circulatory system ... . .... ... ... .. .. .. .. .. .... . .. .... . .. .. .. .. .... . .. ... .. . ... .. .. ... . ... .. .. .. ... .. .. .... . . .... .. . ... ... . .... . . ..39O458Diseeses of the respiratory system .... ... . .. .... .. . ... ... . .... . . .... .. .. .. .. .. ... . .. .... .. . ... .. . .... . .. ... ... . ... .. . .... . .. ... .. .. ... .. .. ... . .. ..46O.5l9Diseases of the digestive system ... .. .. .... . . .... .. . .... ... . ... .. . ... .. .. .... . .. ... .. . ... .. .. ... . .. .... . .. ... .. .. ... .. . .... .. . ... . ... .... . .. ... .. . ..52O.577Diseases of the genitourinary system ... .. . ... .. .. .. ... . .... .. . .... .. . ... . .. ..... . .. ... . . .... . .. .... . ... .. .. . .... .. ..... . .. ... .. . .... .. . .... . .. ..58O.629Diseases of the skin and subcutaneous tissue .... ... .... . .. ... ... . ... .. .. ... .. . .... . .. ... .. . .... . .. ... .. . .... .. . ... .. . ..... . .. ... .. . .... .. . ..68O.7O9Diseases of the musculoskeletal s.y~em .. .... .. . .... .. .. ... .. . ... .. . .... . ... ... .. . .... . .. ... .. . .... . .. ... .. . .... .. . .... . .. ... . ... ... .. . .... .. . ..710-738Symptoms and illdefined conditions . ... . .... .. . .... . .. .... . .. .... . .. ... .. . .... . ... . .. . .. .. .. .. .... . ... .. .. . ... .. .. .... . . ..... ... .. .. .. ... ... . ..78O.796Accidents, poisonings, and violence ... .. .. .... .. . ... .. .. .... .. . ... .. . .... .. . ... .. . .... .. .. ... .. . ... . .. .... .. . ... .. .. ... . .. .... . .. .... . .. ... .. . ...8OO.999Special conditions and examinations without sicknes$ ... . .. .... . .. ... .. .. .. ... . .... . ... .. .. .. .. .. .. ... .. . .... .. .. ... .. . .... .. . .... . .. YOO-Y13
Sax of physician
EY-k.!LNumber inthousands
9,371 I 278,508
Percent2
5.7 4.5*1.O 1.6
4.9 6.5*3.5 3.0
5.5 4.49.2 15.7
18.1 16.5●2.5 4.310.2 5.0
4.6 4.26.9 7.54.4 5.08.9 7.8
11.6 12.0
1Based on the Eighth Reviw.on International Classs.fication of Diseases, Adapted for Use in the United States (ICDA).2Percents WM not add to 100.0 because all ICDA categories are nOt listed.
Table J. Number of office visits and percent of visits with drug therapy, by sex of the physician and principal diagnosis: United States,1977
Principal diagnosis and ICDA codel
Infective and parasitic diseaws .... ... .. ... .. ... ... . .. ... .. .. .. .. .. ... .. . .... .. .. ... . .. ... . ...OW.l36Neoplasms ... .. .. ... ... . ... .. .. ... . .. ... .. . .... .. . ... .. .. ... . ... .. ... . ... .. .. ... . .. ... . ... ... .. . ... .. ..l4O.239Endocrine, nutritional, and metabolic diseases .. ... .. .. .. ..... . . ... ... ... .. . .... ....240-279Mental disorders . ... .... . . .... .. .. .. .. . ..... .. .... .. . ... . ... ... .. . .... . . .... .. . .... . .. ... . ... .. . .. ..29O.3l 5Diseases of the nervous system and sense organs . ..... . . .... .. . .... . . .... . .. ... . .. ..32O-389Diseases of the circulatory system ...... .. . ... ... . .... .. . ... .. . ... .. .. .... . . .... .. .... . .. ..39O458Diseases of the respiratory system ..... ... . ... .. . .... .. .. ... . .. ... ... .... .. . ... .. .. .. .. .. ..46O.5l 9Diseases of the digestive system ... .. .. .... . . ... .. .. .... . .. .. ... . .... . .. ... . . .... .. .. .. .. .. ..52O.577Diseases of the genitourinary system ... . .... .. ... ... . .. ... . .. .... . .. ... .. . ... .. . ... . ... ..58O%29Diseases of the skin and subcutaneous tissue .... .. .. .. .. .. .. .. .. ... . .. ... . .. .... .. ...680-709Diseases of the musculoskeletal ~Sem .. ... .. .. .... .. ... ... .... .. .. ... . . ... .. .. ... . .. ...7l O-738Symptoms and illdefined conditions . .. .. .... .. . ... .. . ... . .. ... .. .. ... . .. .... . . ... .. . ....78O.796Accidents, poisonings, and violence . . .... .. ... . .. ... . .. ... . .. .... . .. ... . .. .... . . ... .. . ....8OO.999
SPecial conditions and examinations without sickness . . .. .... . . .... . .. .... . . .. YOO-Y1 3
Sex of physician
Female
Number ofvisits in
thousands
1,299674639
1,5931,693
9543,520
4551,6383,550
762877
1,3563,288
Percent ofvisits with
drugtherapy
76.1●24.6
67.333.181.8
81.385.170.867.874.662.647.2
35.418.6
Male
Number ofvisits in
thousands
21,36913,61323864722,93046,59853,74978,94617,99634,83528,36032,22124.81842;40492,720
Percent ofvisits with
drugtherapy
72.428.664.547.853.173.179.557.662.465.162.248.935.118.4
1B~s~d on & E&.hth Revi~-on inte~ationa~ c~~.fi~ation of Dr&?ese& Adapted for Use in the United Stilte&?(ICDA).
9
4
b
apparent tendency to dispense drugs differen-tially. Only when the principal diagnosis con-cerned diseases of the nervous system and senseorgans did female physicians use drug therapyproportionately more than males seeing thesame conditions. This group of diseases includedotitis media, which is the most common specificillness diagnosed by pediatricians.9
Clinical Services and PhysicianSpecialty
It was observed from the data, however, thatmale psychiatrists prescribed drugs proportion-ately more often (33 percent of their visits) thanwomen psychiatrists did (17 percent). This ten-dency of male psychiatrists to prescribe drugswas more pronounced with female patients (37percent) than with male patients (28 percent)(not shown in table J). Estimates of visits tofemale psychiatrists were too small to determineif this tendency was also significant for them.
When all diagnosed conditions were consid-ered for the specialties of general and family
practice and internal medicine, both female andmale physicians ordered drugs in about two outof three visits (table K).
The proportion of visits that includled phy-siotherapy was higher for female than for malephysicians, but the reverse was true of medicalcounseling. Differences in other therapeutic serv-ices were not statistically significant.
Blood pressure checks and Pap tests wereused for diagnosis proportionately more oftenby these women specialists than by men. Of theapproximately 7 million visits by women pa-tients to female general and family practitionersand internists, 13 percent included a Palp test; 6percent of the approximately 165 million visitsby women patients to men in the same special-ties included a Pap test. (Percents in table K arebased on visits by female and male patients.)
However, about one in three visits to femaleand male obstetrician-gynecologists included aPap test (table L). Men in this specialty weremore likely than women were to take bloodpressure measurements and order laboratorytests.
Table K. Number and percent of office visits to general and family practitioners and internists, by sex of the physician and selacted
diagnostic or therapeutic services ordared or providad: United States, 1977
Diagnostic or therapeutic servica●
No diagnostic services ..... .. .. .... . .. ..... . ... ... .. .. ... ... . .... .. .. .... .. .. .... .. .. .... . .. .... .. .. ... ... .. ... .. .. .... .. .. .... . .. ..... . ... .... . .. .. ..................Limited history and examination .... .. .. ... .. ... .... . ... ... . .. ..... .. . .... ... . ... ... .. .... . ... .. ... . ..... . ... ... .. .. .... .. .. .... .. .. .... .. .. .... . ... .... . .. ....General history and examination ..... . . .. .. .. .. .... .. .. .... .. .. .... .. . ..... .. . .... .. . .... . ... .... . ... ... .. ... .. .... . .... .. . ..... .. . ..... . .. .... .. .. ... .........Pap test .... ... . ..... . ... ... .. .. ..... . .. .... .. .. .... . ... ... .. .. .... . .. .... ... . ... ... .. ... .. .. ..... .. . ... .. ... .. .. .... ... . ... ..................................................
Laboratory procedure or test . .. . ... ... .. .. .... .. .. .... . .. .... .. .. .... . .. ..... .. . ... .. .. ..... . .. .... . .. .... .. ... ... .. .. ... ... . ..... .. .. ... ... .. ... .. ..............X-ray .. .. ... .. ... .... .... .. ... .. ..... .. .... .. .. ..... . .. .... .. .. .... .. .. ... ... . ... .. .. ..... . .. .... .. . .... .. .. .... .. . .... .. . ..... .. .. .. ................................ .........Electrocardiogram .... .. . ..... ... .... ... . ... .. .. .... .. .. .... . ... .. .... .. ... .. . .... .. .. .... . ... .... . .. ... . .... ... .. .. .... . .. ... .. .. ..... . .. .............................Blood pressure check . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..........<...............
No therapeutic sewices ..... .. . .... .. .. .... . ... ... ... .. .. .. . ... .. .. .. .... .. .. .... . .. .... . .. .... .. .. .... . ... .... . . .... ... . ..... . . ..... .. . ..... ........................Immunization or desensitization . ..... .. .. .... . ... ... .. .. .... .. . ..... . . ..... .. .. .... . . ..... . .. .... .. .. .... . .. .... .. .. .... .. . .... .. .. .... . .. ..... . .. .... .........
Drugs (prescription and nonprescription) ... . ... .. ... .. ... .. .... .. .. ... .. . .... .. .. .... . .. .... . ... .... . ... ... .. .. .... . .. .... .. .. .... .. .. .... . ... ... .. .. .... .Diet counseling .... . .... .. .. .... .. .. .... .. .. .... .. . ..... . .. ... .. .. . ... .. .. .... .. . .... .. . .... .. .. ... . .... .. ... . .... .. .. ... ... .. ... ... . .... . ... ............................Family planning . .. .. .... . .. .... .. .. .... . ... ... .. .. .... .. .. .... .. .. ... ... . .... .. . .... .. . ..... . .. .... . .. .... .. .. .... . .. ... .. ... .... . .. ....................................
Madical counseling ..... .. .. .... .. . ..... . ... ... . .. .... .. .. .... .. .. ... ....!. .. .. .. ... .. .. .... .. .. ... . ... ... .. .. .... .. .. ... ... . .... . .. .... .. .. .... .. .. ........... .........Physiotherapy ..... .. . .... .. ... .. .. .. .... .. . . .... .. .. .... .. .. .... .. .. .. .. .. .... .. .. ... ... . .... . ... ... . ... .... .. . .... . .. .... ... . .... .. .....................................Off ice surgary ..... .. . ..... . . .. .. .... .. .. ... . .... .. .. .... .. . ..... ... ... ... . .... .. .. ... .. .. .... ... .... .. .. ... .. .. .... . ... ... .. .. .... .. . .... .. ............................ ..Psychotherapy or therapeutic listening ..... .. .. .... ... .... . .. .... .. .. .... .. .. .. .. .. .... .. .. .... . .. ..... . .. ... ... . .... .. . ..... . .. .... .. .. .... . ... .... .. . .....
1Percents till not add to 100.0 because most patient viaits required the provision of more than 1 Service.
Sex of physician
=F
Number inthousands
9,371 I 278,508
Percentl
11.459.222.7
9.629.5
6.9*3.153.6
8.37.1
66.210.4
8.362.020.4
3.823.5
8.75.0
46.7
14.94.9
65.89.2
*1.5 0.817.2 23.311.0
L2.8
*3.1 5.25.6 3.4
10
Table L. Number and percent of office visits made by women to obstetrician-gy necologists, by sax of the physician and selecteddiagnostic or therapeutic s&vices ordered or provided: United States, 1977
Sex of physician
Diagnostic or therapeutic service
All visits . .. .... .. .. .... .. ..... . .. .... .. . ... .. . .... . .. ... . ... ... . .. ... .. .. ... . .. .... .. .. . ... . ... .. . .... . . .... .. . ... . .. ... .. .. .... . . ......... ..................
No diagnostic wwices .. ..... . .. .. ... .. ... ... . ... ... . ... .. .. ... .. . ... .. .. ... . .. ... ... .... .. .. ... . . ... ... . ... . ... .. .. .. ... .. .. ... . .. ... . .. ... ..........................Limited history and examination ... .. .. .... . .. .. ... .. .. .. .. ... . .. .... . .. ... .. . .... . .. .... . . ... .. . ... .. .. ... .. .. ... . .. ... . . ..... . . .... . .. ... . .. .... . .. ... . .. ....General history and examination .. .. .. .... . . .... . ... ... . .. .... . . ... ... . .... . .. .. ... . ... .. . .... .. . ... .. . ... ... . ... .. . ... .. . .... . .. ... .. . ... .. .. .. ... . .... .......Pap test .... .. .. ... .. .. ... .. .. ... .. . .. ... .. . .... .. .. .... . ... .. .. .. ... . ... ... ... .... . .. ... . .. ... .. . .... .. . ... .. . ... . .. . ... .. . ... ... . ..... ................................ ......
Laboratory procedure or test .. ..... .. .... .. .. .... . . .... . .. .... . ... ... .. ..... . . ... .. .. ... ... .... . .. ... .. . .... . .. ... .. .. .. .. .. .... . . ... .. .. .. . ... ... . ..............Blood pressure check ..... . . ..... .. .... .. .. ... .. . ... ... ..... .. . .... . . .... .. . .... . .. .... . .. ... . .. ... .. .. ... . .. ... . .. ... .. .. .. ... . ... .. . .... .. ..........................
No therapeutic sewices . .. .... .. .. ... .. .. ... .. .. ... . .. ... .. . .... ... . .... . .. .. .. .. ... ... .... . ... .. .. .. .. .. .. ... .. . ... . .. ... ... .. . ... .. ... . .. .. ........................Drugs (prescription and nonprescription) .. ..... . . .... . ... ... . .. .. .. . . .... .. . .... . .. .. ... . .... . . .... .. . ... .. . ... .. . .... .. . .... . .. .. ... . ... . .. ... .. .. ... .. ..Diet counwling ..... .. .... .. .. .... .. .... ... . .... . . .. .. .. .. .. .. ... ... . ... .. .. .. .... . . .... . .. ... .. . ... . ... ... . .. ... .. . ... .. . .... . .. ... . ....................................Family planning ... .. .... .. .. .... . .. ... .. .. ... .. .. .... .. . ... .. . .... . ... ... . .. ... .. . .... . .. .... . .. .. ... . ... .. .. .. .. .. ... . .. ... .. . .... . . ...................................Medical counseling .... .. .. .... . ... .. .. .. .... . .. ... ... . ... ... . .... . .. ... .. .. ... .. .. .. .. . .... . .. .... . . ... .. .. .. ... .. .. .. . .... . .. ... . .. .... .. .. .. .. .................. .....Office surgery . .. .. .. .... .. .. ... . .. .... . ... ... .. . ..... . . .... .. . ... .. .. .... . .. ... . ... ... .. . ... .. .. ... . .. ... .. . ... .. .. ... .. . .... . .. ... . .....................................
1percents WI not add to 100.o because most patient tilts required the protilon of more than 1 service.
Clinical Services and Physician Age
Women under 35 years of age specializing ingeneral and family practice and internal medi-cine were proportionately more likely to indi-cate that no diagnostic services were used duringvisits (about 31 percent) than were women inother age groups of physicians or men in thesame or other age groups. Therefore, most of thepercents of the selected diagnostic services de-tailed in table M are lower for this age group ofphysicians than for others. The large amount ofphysiotherapy (38 percent) provided by them,however, is in marked contrast to the propor-tions of such therapy provided by other groupsof female and male physicians. (These data maybe related to the fact that dermatologists com-prised the second largest group of female physi-cians under 35 years of age in the sample.)
Proportions of clinical services rendered bymale physicians did not vary appreciably amongthe three age groups shown in table M.
Status of the Visit
Female physicians were more likely to en-counter patients making initial visits (22 per-cent) than were males (15 percent). This rera-
Female I Male
Numbw inthousands
2,661 I 46,188
Percentl
6.562.729.134.531.855.1
40.539.3●7.9
‘8.5*1 5.4
●3.4
3.756.830.637.-144.066.6
34.936.9
6.511.122.4
5.5
tionship was true of all of the specialties listed intable N-.
A return visit rate for selected medicaI spe-cialties was obtained by dividing the number ofvisits made by patients that the physician hadseen before by the number of new patients(table O). Rates of return visits to male special-ists are clearly higher than those to females.These results are consistent with the increasingvisit rates to male physicians shown in figures 1and 3.
Male physicians gained proportionately morepatients by referral than females did. Of the newpatients seen by women, 20 percent were re-ferred by another physician; 26 percent of allpatients visiting male physicians for the firsttime were referred. Variation in referd by spe-cialty is shown in table P.
Seriousness of the Problem andDisposition and Duration of Visit
Physicians were requested to judge theseriousness of the patient’s problem based onthe extent of impairment that might result if nocare were available. A four-point scale rangingfrom the categories of “not serious’” to “veryserious” was used in the survey. However, such
11
Table M. Number and percent of office visits to general and family practitioners and internists, by sax and age of the physician and
selected diagnostic or therapeutic services ordared or provided: United States, 1977
Diagnostic or therapeutic service
All visits ..... .. .. .... .. . .... . .. .... ... .. ... .. .. .... .. .. .... .. . ... .. .. .... .. .. ..
NO diagnostic services . .. ... .... . .. ... .. ... ... .. .. .... . ... .... .. . .... .. .. ... ... . .... .. ..Limited history and examination .. .. .... .. . .... .. .. ... .. ... ... .. .. .... . .. .... .. ..General history and examination .. ... .. ... .. ... .. ... ... . .. .... .. .. .... .. .. .... . . .Pap test ... .... ... .. .. .... . ... ... .. .. ... .. .. .... .. .. .... .. ..... . .. . .... .. . .... .. .. .... .. .. ... .. .
Laboratory procedure or test .. . .... .. .. .... .. ... .. .. .. .... .. .. ... ... .. ... .. . ..... . .X.ray ... .... .. .. .... .. .. ... ... .. .. ... ... .. .. .. ... ... .. ... .. ... ... .. . .... .. .. .... .. .. .... .. . .... ..Electrocardiogram ... . ... ... .. .. ... .. ... ... .. .. ... .. .. .... .. ... ... . .. .... .. .. ..... .. .... ..Blood pressure check . .... ... . ... ... .. ... ... .. ... . ... ... .. .. .... .. . .... ... . ... .. .. ..... .
No therapeutic services ..... .. ... .. ... ... . .. ..... . .. .... . ... ... .. . .... .. .. .... .. . .... . .Immunization or desensitization .... .. . .... .. . ... ... .. .... .. . ..... . . .... .. .. .... ..Drugs (prescription and nonpre~ription) .. ... .. .. .... .. .. .... . . .... .. .. .... ..Diet counseling ... .. ... .. .. .... . ... .... . .. ... .. .. .... .. .. ... . .. .... .. .. ... ... . ... .. .. .... ..Family planning .. .. .... . .. ..... .. ... ... .. .... .. .. ... . .. .... .. .. .... . .. ... .. .. .... .. . .... ..Medical counsel ing .. ... .. ..... . .. ... ... .. .. .. .. .... .. .. ... .. .. ... .. .. .... . .. ... ... . .... ..Physiotherapy ... .. ... ... .. . ... .. . ... .. .. .. .... .. .. ... .. .. ... .. .. ... .. ... ... . .. .... .. .. ... ..Office surgery ... .. .. .... .. .. .... . ... .. ... .. ... .. .. ... . .. ..... . ... ... . ... .. .. .. .... .. .. ... ..Psychotherapy or therapeutic listening .. ... . ... .. .. .... . . .. ... . .. .... .. . ..... .
Sex and age of physician
Female I Male
Less than 35-54 55 years Lass than 35-54 55 years35 years years and over 35 years years and over
Number in thousands
2,378 I 3,160 I 3,833 I 44,558 I 138,326 I 95,624
Percent ]
30.837.826.5“2.018.0●4.1●0.934.2
●5.5‘3.059.B●1.9●2.2*7.937.8*1.B*0.B
●2.462.224.5
●10.439.2
●12.1●7.152.7
*8.5*7.764.9
*12.3*1.925.7*1.4*5.9*7.3
●6.968.918.713.728.5
●4.3●1.166.5
●9.9*9.371.114.2*0.B16.0*2.3.*1.5*7.2
6.366.317.0
4.622.7
7.32.1
46.0
15.0“4.462.3
9.01.9
23.97.34.54.1
1Percents will not add to 100.0 because most patient visits required the provision of more than 1 se~ice.
an evaluation is often highly subjective and thedata should be viewed in this context.
Male physicians in general tended to assignvisits to the serious or very serious category pro-portionately more frequently than female physi-cians did (about 18 percent for visits to malephysicians and 14 percent for those to femalephysicians as shown in table N). This tendencywas most pronounced for psychiatrists.
Instructions to the patient to return at aspecified time was the most common dispositionof visits made by all physicians in the survey,but female physicians were more likely to so in-struct the patient than male physicians were(table N). Men were more likely than womenwere to make no followup plans. Women andmen did not differ significantly in the propor-tions of patients that they either referred toother physicians or admitted to the hospital; thelatter was a rare event for physicians of bothsexes.
9.261.620.5
3.824.5
9.56.2
45.3
15.54.8
64.48.70.6
25.41.7
,5.73.6
7.860.521.8
3.422.3
8.24.7
49.0
13.85.3
69.39.90.5
20.12.24.92.7
Table Q shows the proportions of visits es-timated in discrete time categories for selectedspecialties. Duration of the visit is the time spentin direct physician-patient encounter. Visitswhere only staff see the patient are recorded as“O” minutes. A higher proportion of visits tomale physicians than to female physicians con-sumed none of the physician’s time. The pro-portions of such visits shown in table Q mayberelated to staff availability; Estimates of staffingpatterns are not yet available in NAMCS, but afuture publication based on practice activity ofphysicians will report on an investigation of thisvariable. As expected, psychiatrists of both sexeshad the highest proportion of visits categorizedas 31 minutes or more.
Visit duration may also be compared byusing the mean contact duration. This durationis the average time spent by the physician in di-rect patient encounter. Visits in which thepatient did not see the physician are excluded
12
Table N. Number and percent distribution of office visits by selected visit characteristics, according to sex and speciakv of thephysician: United States, 1977
General and
Allfamily Obstetrics
specialties practice and Pediatrics and Dermatology Psychiatryinternal gynecology
medicine
Number in thousands
22,788 1] 9,371 [ 4,535 I 2,661 I 3,523 [ 1,319
Sex of physician and visit characteristic
FEMALE
All visitsl ..... ... .. ... .. .. ... . .. .... . .. ... .. . .... .. .
Percent distribution
Total .... .. ... ... .. ... .. .. .. ... .. .. ... .. .. .. .. .. .... . ..
Status of the visit
New patient .. .... . .... . .. ..... . . .... .. . ... .. .. .... .. . ... .. . ... .. ..Old patient, new problem .. ... . .... .. .. ... .. .. .. .. .. ... .. . .Old patient, old problem .. .... . . ..... . .. ... .. .. .. .. .. .... . . .
Seriousness of the Droblam
100.0 100.0 100.0 100.0 100.0 100.0
22.326.251.6
57.129.014.0
6.466.523.4
3.13.71.4
14.634.351.1
47.437.415.2
5.066.021.9
3.33.81.5
30.932.137.0
72.525.5
2.0
11.545.940.9
4.75.81.1
18.230.351.5
81.6●9.6●8.8
i.884.416.7
2.75.32.8
37.0*8.654.4
69.319.011.8
9.066.722.1
2.47.5
*14.6*3.182.3
*11.240.848.0
2.1
89.66.40.61.1
Not serious ... .. .. .... .. .. .. ... . .. .. .. . ... .. .. .... .. . ... .. .. ... . .. .Slightly wrious .. ..... . .. ... .. .. .... . . ... ... .. .. ... . .... .. . ... .. . .
Serious or very serious .. . ..... .. . .... .. . .... .. .. .. .. .. ... . .. .
Disposition 2
No followup planned .... .. .... ... ... .. ..... .. . ... ... . ... . .. ..Return at specified time .... ... .. ... . .. ... .. . .... . ... .. .. . ...Return if needed ... ... .... .. .. ... .. . .... . .. .... . .. .. .. .. ... .. . ..Telephone followup planned ..... .. . .... .. . ... .. ... .. . .. ..
Referred to another physician or agency . .. ... .. .. ..Admit to hospital . ... .... .. .. ... .. .. ... .. . .... .. . ... .. . .... .. ...
MALE
All visitsl ..... .. .. ... . .. .. .. .. .... .. ..... . . .... . .. ....
Number in thousands
547,264 [1 278,508 I 50,227 I 46,612 I 12,864 I 14,877
Percent distribution
Total ... ... ... .. ... .. . .... .. .. .... . . .... . .. .... .. . ... . .
Status of the visit
100.0
15.024.960.1
50.730.818.4
11.460.522.6
3.22.52.0
100.0 100.0 100.0 100.0 100.0
New patient . .... .. .. ... .. .. ... . ... ... . ... .. ... . ... .. .. ... .. .. ... . .Old patient, new problem .... .. . .. .. .. . .... .. .. ... .. .. ... . .Old patient, old problem .. ..... . .. ... . .. .... .. . ... .... . ... . .
Seriousness of the problem
Not ~rious .... . ... . ... ... .. .. .. ... . .... . . ..... . .. ... .. . ... .. . .... ..Slightly ~rious . . ... .... .. . ... .. .. ... .. .. ... .. .. ... . .. .... . .. ... ..Serious or very serious ... ... .... .. .. ... . .. .... .. . ... .. .. .. .. .
Disposition
11.731.656.7
48.334.017.7
12.456.525.9
3.1
3.0‘1.3
9.640.849.6
66.226.4
7.4
20.045.328.9
7.5
2.10.5
14.619.166.3
76.117.3
6.7
4.377.018.5
2.62.52.5
27.713.259.1
59.127.313.7
14.168.813.0
2.8
0.9
6.61.7
91.7
7.722.969.4
2.089.9
6.81.1
0,80.6
No followup planned .... ... .. ... . . .... .. .. ... .. .. ... .. . ... ...Return at specified time .. .. ... .. ... ... . .. ... ... . ... .. .. .. . ..Return if needed ..... . ... ... . . ..... . .. ... .. .. ... .. . ... ... . ... .. .Telephone followup planned .... .... .. .. ... .. . ... .. .. .. ...Referred to another physician or agency .... .. . ... . .Admit to hospital .... .. .. ... .. .. ... .. .. ... . .. .... .. . .... .. . ... ..
lviwit5 ww not add to total because sdl specialties are not shown in the table.@ercentstinotaddto 100. Obecausernore than 1 disposition was possible.
13
from this calculation. Mean contact duration bysex of the physician and by sex of the patientis shown in table R. Female physicians tended tosee patients longer than males did. The mean du-ration of all visits to women specialists was 17.8minutes, compared with 15.3 to male specialists,which was chiefly due to the average time usedby generaI and family practitioners (17.6 min-utes for females in this specialty, compared with12.7 for males in the same practice). Femalephysicians tended to spend more time, on theaverage, with female patients than with malepatients; while male physicians allotted aboutthe same time to both female and male patients.
Table O. Return visit rate by sex and specialty of the physician:United States, 1977
Physician specialty
I SexofI physician
Female Male
General and family practice andinternal medicine ... .. .. . .... .. .. .... .. .. ... .. .. .... ... .
Pediatrics . ... . ... ... .. .. .... .. . .... . ... ... .. ... .. ... .. .. .... . ..Obstetrics and gynecology ... ... .... .. .. ... ... . ..... . .Dermatology .... ... ... . .... .. .. .... .. .. .... . ... .... .. . ... ... .Psychiatry .... .. .. ... ... . .... .. ... .... . .. .... .. .. ... .. .. .... .. .
Return visitrate
5.86 7.542.24 9.414.49 5.831.70 2.61
5.86 14.13
Table C shows that female general and fam-ily practitioners had, on the average, 77 visitsper week, compared with 110 for males. Femaleinternists also had less weekly visits th,an malesdid. These visits included alI patient encountersin the scope of the survey, regardless of whetherthe patient saw the physician or only a staffmember (e.g., to have blood drawn by a techni-cian for a laboratory test). A more realisticestimate of physician-patient activity is the num-ber of hours per week spent in direct patient en-counter. This statistic was obtained by dividingthe total number of minutes the physician re-ported for encounters by 3,120 (60 minutes X52 weeks), and by the number of weighted phy-sicians in the sampIe. The results of this compu-tation are shown in table S. Women and men ingeneral and famiIy practice and internaI medi-cine spent about the same average number ofhours per week in direct patient care despite thefact that more visits per week were to the officesof the male specialists. However, table R revealsthat visits to female physicians Iastecl longerthan those to men did. This variation mayaccount for the difference in the number ofvisits; that is, female physicians saw fewer pa-tients in the same amount of time because thevisits were longer. As suggested previously, staffavailability may also have contributed to thesedifferences.
Table P. Percent of new patients seen by office-based physicians and percent referred by another physician, by sex and specialty of thephysician: United States, 1977
Sex of physicianPhysician specialty
Female Male Female Male
All specialties .. .. ..... .. .. ... .. . ...... .. .... .. ... ... . .. ..... .. .. ... ... . ... .. .. .... .. .. .... . .. .... .. . ..... . ... ... ... . .... .. ... ..
General and family practice and internal medicine . .. .... .. . ...... . . ..... . .. .... . ... .... .. . ... .. .. .... .. .. .... .. .. .... .. .. ..Pediatrics . ... .. ... ... .. ... ... . ... .. ... ... .. ... ... .. .. .... . ... .... .. . ... ... . .. .. ... . .... .. .. ... ... .. .... . .. ... .. ... ... .. .. .... .. . ..................
Obstetrics and gynecology .. ..... . .. .... .. .. .... .. .. .... .. .. ... ... . .... .. . .. ... . ... ... .. .. .... .. ..... . .. .... .. .. .... . ... ... .. .. .... .. ... .Dermatology ..... . ... .. .... ..... .. .. ... .. .. .... . ... .... .. .. .... . .. ... .. ... ... .. .. ..... . . .... .. .. ... .. .. .... .. .. .... . . ...... .. .. ... .. ...........Psychiatry ... . ..... .. .. .... . .. .... .. ... ... .. .. .... .. . .... ... ..... .. .. ... .. .. .... .. .. .... .. .. .... . .. ... .. .. .... .. . .... .. .. ... ... . .................
Percent ofnew patients
T22.3 15.0
14.6 11.730.9 9.618.2 14.637.0 27.714.6 6.6
Percentreferred by
anotherphysician
I20.2 , 26.2
16.5 10.59.7 20.8
20.0 19.228.9 35.240.8 47.4
14
Table Q. Percent distribution of office visits by duration of visit, according to sex and specialty of the physician: United States, 1977
Sex and specialty of physician
Duration of visitNumber
of visits inthousandsl
o 1-1o 11-15 15-30 31Total minutesz minutes minutes minutes minutes
or more
Percent distributionFemale
39.7 25.3All ~ecialties ............................ ................. 22,788 100.0 0.5 25.1 9.4
General and family practice .......................................Internal medicine .......................................................Pediatrics ...................................................................Obstetrics and gynecology ................ .........................Dermatology .................................................... ..........Psychiat~ ..................................................................
7,9551,4164,5352,6613,5231,319
100.0100.0100.0100.0100.0100.0
100.0
31.1●15.1
65.248.949.3+0.2
44.8
29.936.221.723.521.0●0.9
26.9
26.032.232.329.525.2
5.8
33.2●27.3
12.918.828.8
●17.0
20.3
16.327.012.924.222.116.6
5,8*20.7
●0.24.9
*0.981.9
5.7
1.69.21.82.8
*1.172.6
+0.7
3.9
2.4
Male
All specialties... ..................................... ..... 547,264
General and family practice., ........... ..........................Internal medicine .............. ..........................................Pediatrics ................................. .. ................................Obstetrics and gynecology ............... ..........................Dermatology ..............................................................Psychiat~ ..................................................................
214,95463,54450,22746,61212,86414.877
100.0100.0100.0100.0100.0100.0
2.82.23.81.2
●0. I
53.329.449.242.351.6
5.0
lvi~its WI not add to totals because aU specialties are not listed in the table.~Includes visits during which the patient was under the care of someone other than the physician and the form entry was “zero”
minutes,
Table R. Mean contact durationl of office visits by sex of thepatient and sex and specialty of the physician: UnitadStates, 1977
Table S. Average number of hours per week spent in directpatient encounter, by sex and specialty of the physician:United States, 1977
I Sax of patient I Sexof
Physician specialty
t--
physi
Female
:ian
Mala
Sex and specialty of physician
m
Female I Meandura ~tlon in minutes I Hours per week
All specialties........................
Ilr
17.8 18.3 16.5
General and family practice ............. 17.6 18.3 15.7Internal medicine ........................ .... 23.5 24.4 20.4Pediatrics......................................... 11.4 11.0 11.9Obstetrics and gynecology ............... 14.4 14.4 -Psychiatry ......... .............................. 48.3 48.0 49.4 -
General and family practice and internal20.922.617.426.923.0
Male— I -1-15.3 15.3All specialties........................ 15.3
General and family practice ............. 12.7Internal medicine ............................ 18.7Pediatrics......................................... 13.0Obstetrics and gynecology ............... 14.7Psychiatry ....................................... 43.9
DISCUSSION12.8 12.518.5 19.013.2 12.914.742.7 45.5
The NAMCS data on visits to office-basedphysicians do not reveal any startling differencesbetween the medical practices of women andmen. Results of other research suggest that somestatistically significant findings may be attrib-
lTime spent in face-to-face encounter between physician andpatient.
15
uted to sociocultural influences rather than tophysician behavior or judgment.
The American Medical Association reportedthat in 1977 office-based female physicianspracticed chiefly in the specialties of pediatrics,general and family practice, internal medicine,psychiatry, and obstetrics and gynecology (indescending order); however, female urologists,otolaryngologists, and neurologists (among otherspecialists) were rarely found.z The first groupof specialists were rated highest by female medi-cal students in a 1974 study of specialty prefer-ences, but the second group were preferredleast.10 It is no coincidence that in anotherstudy a group of male faculty physicians per-ceived the latter group as the least suitable forwomen entering medicine.1 1 These cultural in-fluences are reflected by the distribution ofvisits in the NAMCS.
Patient attitudes also tend to shape the char-acter of a practice. Although female physiciansencountered the full range of disease categoriesin office practice, examination of data on spe-cific diseases of the genitourinary systemshowed that men did not visit female generaland family practitioners and internists for malesex-related problems. However, women patientsmade visits to both female and male physiciansfor their uniquely feminine disorders.
Studies of the comparative productivity offemale and male physicians reported in 1957and 1969 showed that women tended to workfewer hours and saw fewer patients than mendid.12Js In the earlier study, 57 percent of themarried female physicians stated that they cur-tailed medical activity because of pregnancy andfamily problems; in the later study, 38 percentof married female physicians responded thatfamily responsibiIities limited their practices.This report has also shown that male physicianssaw more patients per week than women did,but that women and men devoted about anequal amount of time to direct patient care.Availability of adequate staff (perhaps limitedby economic resources of the physician, loca-tion, or type of practice) may be one factor inreporting physician productivity y. Therefore,societal expectations regarding the traditionalrole of women or economic conditions may alsobe involved in the differences between the medi-cal practices of women and men.
Although a comparison of the practice char-acteristics of female and male physicians is inev-itable, the primary objective of this report is toprovide baseline statistics for use in the conductof future research where the sex of the physicianis a required variable.
000
16
REFERENCES
1Theodore, C. N., and Haug, J. N.: Selected Charac-teristics of the Physician Population, 1963 and 1967.Special Statistical Series. Chicago. American MedicalAssociation, 1968.
2Center for Health Services Research and Develop-ment: Physician Distrt”bution and Medical Licensure iathe U.S., 1977. OP-054. Chicago. American MedicalAssociation, 1979.
3 Bureau of Health Manpower: Minorities & womenin the health fields. Health Manpower References.DHEW Pub. No. (HRA) 79-22. Health Resources Ad-ministration. Washington. U.S. Government PrintingOffice, Oct. 1978.
4National Center for Health Statistics: NationalAmbulatory Care Medical Care Survey: Background andmethodology, by J. B. Tenney et al. Vital and HealthStatistics. Series 2-No. 61. DHEW Pub. No. (HRA) 741335. Health Resources Administration. Washington.U.S. Government Printing Office, Apr. 1974.
5Nation~ Center for He~~ Statistics: The Nation~Ambulatory Medical Care Survey, 1977 Summary,United States, January-December 1977, by T. Ezzatiand T. McLemore. Vital and Health Statistics, Series 13-No. 44. DHEW Pub. No. (PHS) 80-1795. Public HealthService. Washington. U.S. Government Printing Office,Apr. 1980.
6Nation~ center for He~th Statistics: Office ~sits tointernists, The National Ambulatory Medical Care Sur-vey, United States, 1975, by B. K. Cypress. Vital andHealth Statistics. Series 13-No. 36. DHEW Pub. No.(PHS) 79-1787. Public Health Service. Washington. U.S.Government Printing Office, Dec. 1978.
7Natjon~ Center for He~th Statistics: A reason for
visit classification for ambulatory care, by D. Schneider,L. Appleton, and T. McLemore. Vital and Health Statis-tics. Series 2-No. 78. DHEW Pub. No. (PHS) 79-1352.Public Health Service. Washington. U.S. GovernmentPrinting Office, Feb. 1979.
8Nation~ center for He~th statistics: c)ffice ~sits
by women, The National Ambulatory Medical Care Sur-
vey, United States, 1977, by B. K. Cypress. Vital andHealth Statistics. Series 13-No. 45. DHEW Pub. No.(PHS) 80-1796. Public Health Service. Washington. U.S.Government Printing Office, Mar 1980.
9Nationfl Center for He~th Statistics: Ambulatorymedical care rendered in pediatricians’ offices during1975, by T. Ezzati. Advance Data j%om Vital andHealth Statzktics, No. 13. DHEW Pub. No. (HRA) 77-1250. Health Resources Administration. Hyattsville,Md., Ott 13, 1977.
10Gough, H. G.: Specialty preferences of physiciansand medical students. J. Med. Educ. 50:581-588,June 1975.
11Ducker, D. G.: Believed suitability of medical spe-cialties for women physicians. J. Am. Med. Women’sASSOC. 33 (1):25 -32, Jan. 1978.
12DykInzn, R. A., and Stalnaker, J. M.: Survey ofwomen physicians graduating from medical school 1925-1940. J. Med. Educ. 32 (pt. 2):3-38, Mar. 1957.
13 powers, L., pamelle, R. D., ad Wiesenfelder, H.:Practice patterns of women and men physicians. J. Med.Educ. 44:481 -491,June 1969.
14National Center for Health Statistics: Eighth Revi-sion International Classification of Diseases, Adaptedfor Use in the United States. PHS Pub. No. 1693. PublicHealth Service. Washington. U.S. Government PrintingOffice, 1967.
15National. Center for HeaIth Statistics: Replication,An approach to the analysis of data from complex sur-veys, by P. J. McCarthy. Vital and Health Statistics. PHSPub. No. 1000-Series 2-No. 14. Public Health Service.Washington. U.S. Government Printing Office, Apr.1966.
16 National Center for Health Statistics: Pseudorepli-cation, Further evaluation and application of the bal-anced hidf-sarnple technique, by P. J. McCarthy. Vitaland Health Statistics. PHS Pub. No. 1000-Series 2-No.14. Public Health Service. Washington. U.S. GovernmentPrinting Office, Jan. 1969.
17
APPENDIXES
CONTENTS
L Technical Notes ............................................................................ .............. .............. .......................Statistical Design ........................... .......... ...... ................ ...... .......... ........ .............. .......... .............Data Collection and Processing ..................................................................................... .............Estimation Procedures .... ........................ ...................................... ...................... .......................Reliability of Estimates ................................................................................. .............................Tests of Significance ...................... ... ............ .......... ...................................................................Population Fi~res ............ ................ ....... .................................................... .. ............................Systematic Bi= ................. ............................ .... .... .. ...... ........ .................. .................. .................
II. Definition of Terms ............................................................................................ .............................Terms Relating to the Sumey ............ .........................................................................................Terms Relating to the Patient Record Form ......................................... .....................................
III. Suwey Insmuments ......... ........ .............................. .................................... ......................................Introductory Letter From Director, National Center for Health Statistics ... ....... .......................Patient Record and Patient Log ........................................................................... ......................Introduction Interview Fom .... ........................ ...................... ...... ................ ...... .......... ........ .....
LIST OF APPENDIX FIGURES
L Approximate relative standard errors for estimated numbers of office visits, 1977 NationalAmbulatory Medical Care Survey ....................................................................... ..........................
II. Approximate relative standard errors for percentages of estimated numbers of office visits, 1977National Ambulatory Medicaf Care Suwey ..... .. ........ ............ ........ ........ .......... ...... ........................
LIST OF APPENDIX TABLES
L Distribution of physicians in the 1977 National Arnbufatory Medical Care Survey sample andresponse rates, by sex and specialty of the physicim ....................................................................
IL Estimates of the civilian noninstitutionalized population of the United States, by age, race, andsex: United States, Jufy 1, 1977 ...................................... ......................... ...................................
1919212222252526
272728
31313233
23
24
20
25
18
APPENDIX I
TECHNICAL NOTESb
This report is based on data collected in the1977 National Ambulatory Medical Care Survey(NAMCS), an annual sample survey of office-based physicians conducted by the Division ofHealth Resources Utilization Statistics of theNational Center for Health Statistics.
Statistical Design
Scope of the survey. –The target populationof NAMCS encompasses office visits within theconterminous United States made by ambula-tory patients to nonfederally employed physi-cians who are principally engaged in officepractice, but not in the specialties of anesthesi-ology, pathology, or radiology. Telephone con-tacts and nonoffice visits are excluded.
Sample des@z. –The NAMCS utilizes a mul-tistage probability design that involves probabil-ity samples of primary sampling units (PSU’s),physician practices within PSU’S, and patientvisits within practices. The first-stage sample of87 PSU’S was selected by the National OpinionResearch Center (NORC) of the University ofChicago, the organization responsible forNAMCS field and data processing operationsunder contract to the National Center for HealthStatistics. A PSU is a county, a group of ad-jacent counties, or a standard metropolitanstatistical area (SMSA). A modified probability -proportional-to-size procedure using separatesampling frames for SMSA’S and for nonmetro-politan counties was employed. After sortingand stratifying by size, region, and demographiccharacteristics, each frame was divided intosequential zones of 1 million residents, and a
bPreP~ed by Thomas McLemore, M.S.P.H., Divisionof Health Resources Utilization Statistics.
random number was drawn to determine whichPSU came into the sample from each zone.
The second stage consisted of a probabilitysample of practicing physicians selected fromthe master files maintained by the AmericanMedical Association (AMA) and the AmericanOsteopathic Association (AOA) who met thefollowing criteria:
Office-based, as defined by AMA and AOA.
Principally engaged in patient care activities.
NonfederalIy empIoyed.
Not in the specialties of anesthesiology,pathology, clinical pathology, forensic path-ology, radiology, diagnostic radiology, pedi-atric radiology, or therapeutic radiology.
The 1977 NAMCS physician universe included188,690 doctors of medicine and 10,010 doc-tors of osteopathy.
Within each PSU, alI eligible physicians werearranged by nine specialty groups: general andfamily medicine, internal medicine, pediatrics,other medicaI specialties, general surgery, obstet-rics and gynecology, other surgical specialties,psychiatry, and alI other specialties. Then,within each PSU, a systematic random sample ofphysicians was selected in such a way that theoverall probability y of selecting any physician inthe United States was approximately constant.
The 1977 NAMCS physician sample in-cluded 3,000 physicians. SampIe physicians werescreened at the time of the survey to ensure thatthey Inet the aforementioned criteria; 507 physi-cians did not meet all the criteria and weretherefore ruled out of scope (ineligible) for thestudy. The most common reasons for being out
19
Table 1. Distribution of physicians in the 1977 National Ambulatory Medical Care Survey sample and response rates, by sex and
specialty of the physician
Sex and specialty of physician
Femala
All ~ecialties .... ... .. ... . ... .... . .. ... .. .. .... . .. .... . ... .... ... .... . .. .... ..
General and family practice .. .... .. . ..... . ... .... . . .... .. ... .. ... .. ... . .. .... .. .. ... ..
Medical specialties .... ... .. .. .... . .. ..... . . .... .. .. ... .. . .... .. .. ... ... .. ... .. . .... .. . .... .Internal medicine ...... . .. .... . .. .... . .. .... .. . ..... .. .... .. .. .... . .. .... . .. .....<.....
Pediatrics .. .. .. .... .. .. .... .. . .... . .. .... . ... .... .. .. .. .. .. ... ... .. ... .. . .... . .. .... .. .. ...Other medical specialties .. .. ... ... .. .... .. .. ... . .. .... .. .. ... .. .. ... .. .. .... .. .. ..
Surgical specialties .. .. .. .... .. .. ... . .. .... .. .. .... . . .... .. .. ... ... . .... .. .. ... .. .. .... . . ...General surge~ . .. .... ... .. .. ... . .. .... ... . .... . .. .... . . ..... .. .. .... . .. ... .. .. .... .. . ..Obstetrics and gynecology . ... .... . .. .... .. .. ... .. .. ... .. . ..... .. .. .. ... .. ... . .. ..Other surgical specialties ... ... .. .... . .. ... .. .. .... . .. ... .. .. .... . .. ..... . .. .... . .. .
Other specialties .. ..... . .. .. ... .. . ... ... .. .... . . ..... . .. ... . .. .... .. .. ... .. .. .. ... .. ... .. . ..Psychiatry ..... .. .. ... .. .. ..... . .. ... .. .. .... . .. .... .. .. .. ... . ... . ... ... .. .. ... ... . .... .. ..Other specialties ... .. .. ... .. .. .... .. . .... . .. ... .. .. ... ... . .... . .. ... .. .. .... .. . .... . .. .
Male
All specialties . ... ... . . .... .. . .... . .. .... . .. ... ... . ... .. .. ... .. .. .... . .. .... . ..
General and family practice .. . .... .. . .... ... .. .. .. .. ... .. .. ... .. . .... .. .. ... . ... ... .. .
Medical specialties ... .... .. .. .... . .. ... .. .. ... ... .. ... .. . ... .. ... .. . .. ..... . .. ... .. .. .... ..Internal madicine .... .. .. .... . .. .... .. . ... ... .. ... . .. .... . .. ... .. .. ... ... . .... . .. .... . .Pediatrics .. .. . . .... .. .. .... .. .... .. . .... . ... ... .. .. .... . . .... . ... .. .. .. . ... .. . .... . ... ... ..Other medical specialties . .. .... .. . .... .. .. .... . .. ... .. .. ... .. . .... . ... ... .. . ... ...
Surgical specialties .. ... ... .. .. .... ... .... . .. ... .. . .... .. .. ... ... . ... .. .. .... .. . ... .. .. ... ..General surge~ .. ... .... .. . .... . . ..... . .. .... . .. .... .. . .. .. .. . ... .. .. .... . . .... .. .. ... ..Obstetrics and gynecology .. .... .. .. ... .. .. ... . .. .... . .. ... ... .. ... . .. ... .. .. ... ..Other surgical specialties .. .. .. ... .. .. ... .. .. ... . .. ... .. .. .... . .. ... .. . .... .. .. ... ..
Other specialties. ... .. ... .... . .. .... . .. ... .... . .. .. .. ... .. . ... ... . .... . ... .. .. .. .... . .. ... ..Psychiatry .. .. . ..... . .. ... .. .. .... .. .. ... .. .. ... .. .. .... . .. .. .. .. ... .. ... ... . . .... .. .. .. .. .
Other specialties .... .... . . .... .. .. ... .. .. ... .. .. ... .. . ... .. .. ... .. .. .... .. .... .. .. ... ..
of scope were that the physician was retired,deceased, or employed in teaching, research oradministration. Of the 2,387 in-scope (eligible)male physicians, 1,846 (77.3 percent) partici-pated in the study. Of the 106 in-scope femalephysicians, 86 participated (81.1 percent). Ofthe participating physicians, 265 physicians sawno patients during their assigned reportingperiod because of vacations, illnesses, or otherreasons for being temporarily not in practice.The physicians sample size and response data byphysician specialty and sex are shown in table I.
The final stage was the selection of patientvisits within the annual practices of the sample
Grosstotal
172
40
6715
3913
293
179
3627
9
2,828-
700
759415164180
1,033299232502
336194142
out ofscope
66
17
294
196
7151
1385
441
123
103611527
105401649
1103971
Nettotal
106
23
3811
207
222
128
2319
4
2.387-
577
656354149153
928259216453
226155
71
Non-respondents
20
5
52
3
7
34
33
541
157
164973136
180445185
402911
Respond-ents
86
18
339
177
15294
2016
4
1,846
420
492257118117
748215165368
186126
60
lResponserata
81.1
78.3
86.8
81.8
85.0100.0
68.2100.0
75.050.0
87.084.2
100.0
77.3
72.8
75.072.679.276.5
80.683.076.481.2
82.381.384.5
.
physicians. This involved two steps. First, thetotal physician sample was divided into 52random subsampIes of approximately equal size,and each subsample was randomly assigned to 1of the 52 weeks in the survey year. Second, asystematic random sample of visits was selectedby the physician during the assigned week. Thesampling rate varied for this final step from a100-percent sample for very small practices to a20-percent sample for very large practices. Themethod by which the sampling rate was deter-mined is described later in this appendix and inthe Induction Interview form in appendix 111.During 1977, 51,044 usable Patient Record
20
forms were completed by physicians partici-pating in NAMCS (2,339 by female physicians~d 48,705 by males).
Data Collection and Processing
Field procedures. –Both mail and telephonecontacts were used to enlist sample physiciansfor NAMCS. Physicians received introductoryletters from NCHS (see appendix III) and AMAor AOA. When appropriate, a letter from thephysician’s specialty organization, endorsing thesurvey and urging his participation, was enclosedwith the NCHS letter. A few days later, a fieldrepresentative telephoned the physician to ex-plain briefly the study and arrange an appoint-ment for a personal interview. A physician whodid not respond initially was generally recon-tacted via a telephone call or special explanatoryletter requesting him to reconsider participationin the study.
During the personal interview the field repre-sentative determined the physician’s eligibility,ascertained his cooperation, delivered surveymaterials with verbal and printed instructions,and assigned a predetermined Monday-Sundayreporting period. A short interview concerningbasic practice characteristics, such as type ofpractice and expected number of office visits,was conducted. Office staff who were to assistwith data collection were invited to attend theinstruction session or were offered separateinstruction sessions.
Before the beginning of and again during theweek assigned for data collection, the inter-viewer telephoned the sample physician toanswer questions that might have arisen and toensure that procedures were going smoothly. Atthe end of the survey week, the participatingphysician mailed the finished survey materials tothe interviewer, who edited the forms forcompleteness before transmitting them for cen-tral data processing. Problems of missing orincomplete data were resolved at this stage byinterviewer telephone followup to the samplephysician; if there were no problems, fieldprocedures were complete with respect to the ‘sample physician’s participation in NAMCS.After the end of the survey year, each samplephysician was sent a thank-you letter fromNCHS along with one of the survey’s statisticalreports.
Data collection. –The actual data collectionfor NAMCS was carried out by the physician,aided by his office staff when possible. Two datacollection forms were employed by the physi-cian: the Patient Log and the Patient Record(appendix III). The Patient Log is a sequentiallisting of patients seen in the physician’s officeduring his assigned reporting week. This listserved as the sampling frame to indicate thevisits for which data were to be recorded. Aperforation between the patient names andpatient visit characteristics permitted the physi-cian to remove and retain the patient names,thus protecting the confidentiality of thepatients.
Based on the physician’s estimate of theexpected number of office visits, each physicianwas assigned a patient sampling ratio. Theseratios were designed so that about 30 PatientRecord forms were completed during the as-signed reporting week. Physicians expecting 10or fewer visits each day recorded data for allvisits, those expecting more than 10 visits perday recorded data for every second, third, orfifth visit, based on the predetermined samplinginterval. These procedures minimized the datacollection workload and maintained approxi-mately equal reporting levels among samplephysicians regardless of practice size. For physi-cians assigned a patient sampling ratio, a randomstart was provided on the first page of the log, sothat predesignated sample visits recorded oneach succeeding page of the log provided asystematic random sample of patient visits dur-ing the reporting period.
Data processing. –In addition to complete-ness checks made by the field staff, clerical editswere performed upon receipt of the data forcentral processing. These procedures provedquite efficient, reducing the item nonresponserates to a negligible amount-2 percent or lessfor all items.
Information contained in item 6 (patient’sproblem or reason for visit) of the Patient Ret-’ord was coded according to A Reason for VisitClassification for Ambulatory Care.7 Diagnosticinformation (item 8 of the Patient Record) wascoded according to the Eighth Revision Interna-tional Classification of Diseases, Adapted for
NOTE: A list of references follows the text.
21
Use in the United States. 14 A maximum ofthree entries were coded from each of theseitems. Quality control in the medical codingoperation involved a two-way independent veri-fication procedure with 100-percent verification.Coding differences were adjudicated at theNational Center for Health statistics.
Information from the Induction Interviewand Patient Record forms was keypunched, with100-percent verification, and converted to com-puter tape. At this point, extensive computerconsistency and edit checks were performed. In-complete items were imputed by assigning avalue from a Patient Record with similar charac-teristics; physician specialty and broad diag-nostic categories were used as the basis for theseimputations.
Estimation Procedures
Statistics from the 1977 National Ambula-tory Medical Care Survey were derived by amultistage estimation procedure, which pro-duces essentially unbiased national estimates andhas three basic components: (1) inflation byreciprocals of the probabilities of selection, (2)adjustment for nonresponse, and (3) a ratioadjustment to fixed totals. Each component isdescribed briefly.
Inflation by reciprocals of sampling pro ba-bilites. –Since the survey utilized a three-stagesample design, there were three probabilities ofselection: (1) the probability of selecting thePSU, (2) the probability of selecting a physicianwithin the PSU, and (3) the probability y ofselecting a patient visit within the physician’spractice. The last probability was defined to bethe exact number of office visits during thephysician’s specified reporting week divided bythe number of Patient Records completed. Allweekly estimates were inflated by a factor of 52to derive annual estimates.
A djustrnent for nonresponse. —Estimatesfrom the NAMCS data were adjusted to accountfor sample physicians who did not participate inthe study. This was done in such a manner as tominimize the impact of nonresponse on finalestimates by imputing to nonresponding physi-cians the practice characteristics of similar re-
NOTE: A list of references follows the text.
spending physicians. For this purpose, physi-cians were judged similar if they had the samespecialty designation and practiced in the samePsu.
Ratio adjustment. –A poststratification ad-justment was made within each of nine physi-cian specialty groups. The ratio adjustment wasa multiplication factor of which the numeratorwas the number of physicians in the universe ineach physician specialty group and the denomi-nator the estimated number of physicians in thatparticular specialty group. The numerator wasbased on figures obtained from the AMA-AOAmaster files, and the denominator was based ondata from the sample.
Reliability of Estimates
Since the statistics presented in this reportare based on a sample, they differ somewhatfrom the figures that would be obtained if acomplete census had been taken using the sameforms, instructions, and procedures. However,the probability design of NAMCS permits thecalculation of sampling errors. The standarderror is primarily a measure of sampling variabil-ity that occurs by chance because only a samplerather than the entire population is surveyed.The standard error, as calculated in this report,also reflects part of the variation that arises inthe measurement process. It does not includeestimates of any systematic biases that may bein the data. The chances are about 68 out of 100that an estimate from the sample WOUIC1differfrom a complete census by less than the stand-ard error. The chances are about 95 out of 100that the difference would be less than twice thestandard error, and about 99 out of 100 that itwould be less than 2Y2 times as large.
The relative standard error of an estimate isobtained by dividing the standard error by theestimate itself and is expressed as a percent ofthe estimate. For this report, an asterisk (*)precedes any estimate with more than a 30-percent relative standard error.
Estimates of sampling variability were calcu-lated using the method of half-sample replica-tion. This method yields overall vati.abilitythrough observation of variability among ran-dom subsamples of the total sample. A descrip-tion of the development and evaluation of the
22
replication technique for error estimation hasbeen published.ls>lG
Approximate relative standard errors for ag-gregates and percentages are presented in figuresI and II. In order to derive error estimates thatwould be applicable to a wide variety of statis-tics and could be prepared at moderate cost,several approximations were required. As a re-sult, the relative standard errors shown in figures
Estimates of aggregates. –Approximate rela-tive standard errors (in percent) for aggregatestatistics, such as the number of office visitswith a given characteristic, are obtained fromthe curve in figure I or calculated by theformula:
RSE (x) = J 0.00160725 +41.31046
“ 100.xI and H should be interpreted as approxi-mate
.-
rather than exact for any specific estimate. where x is the aggregate of interest in thousands.Directions for determining approximate relative Estimates of percentages. —Approximatestandard errors from the figures follow. relative standard errors (in percent) for estimates
of this type can be calculated from the curve inNOTE: A list of references follows the text. figure I as follows. Obtain the relative standard
Figure 1. Approximate relative standard arrors for estimated numbers of offica visits, 1977 National Ambulatory Medical Care Survey
100 10090 90
80 80
70 70
60 611
50 50
40 40
30 30
20 20
10 109 9
8 s
7 7
6 6
5 5
4 4
3 3
2 2
1
A 2 ‘456789A 2 3456789A 2 2456789A 2 34’’ 78’A1100 1,000 10,000 100,000 1,000,000
SIZE OF ESTIMATE (IN THOUSANDS)
Example of use of this chart: An estimate of 10 million office visits (read from scale at bottom ofchart) has a re_lative skndard error of 7.6 percent (read from scale at left side of chart) or a standarderror of 760,000 office visits (7.6 percent of 10 million visits).
23
Figure II. Approximate relative standard errors for percentages of estimated numbers of office visits, 1977 National AmbulatorMedic;l Care Survey
(Base of percentage shown on curves in millions)
100908070
60
50
40
30
20
10987
6
5
4
3
2
1,9,8,7
,6
,5
,4
,3
,2
.1
A’34’6789A23 456789A
-100:;70
. 60
$0
40
30
20
- 109
- 87
6
5
4
3
2
- 1
- ::- ,7
- .6
- ,5
,4
- ,3
- .2
-.1
1 10 100
ESTIMATED PERCENTAGE
Example of use of this chart: An estimate of 20 percent (read at bottom of chart) based on anestimate of 10 million office visits has a relative standard error of 12.9 percent (read from scale at leftof chart) or a standard error of 2.6 percentage points (12.9 percent of 20 percent).
error of the numerator and denominator. Squareeach of the relative standard errors, subtract theresulting value for the denominator from the re-sulting value for the numerator, and extract thesquare root. This calculation has been made forseveral percents and bases and is presented infigure II. Alternatively, the formula
Wf4=-.loo.can be used to calculate the RSE(p) and base (x, in thousands).
24
for any percent
Estimates of rates where the numerator isnot a subclass of the denominator. —Approxi-mate relative standard errors for rates in whichthe denominator is the total U.S. population orone or more of the age-sex-race groups of thetotal population are equivalent to the relativestandard error of the numerator that cm-i be ob-tained from figure 1.
Estimates of differences between two sta-tistics. —The relative standard errors shown inthis appendix are not directly applicable to dif-ferences between two sample estimates. Thestandard error of a difference is approximately
the square root of the sum of the squares ofeach standard error considered separately. Thisformula represents the standard error quiteaccurately for the difference between separate
‘“and uncorrelated characteristics, although it isonly a rough approximation in most other cases.
In addition to sampling error, survey resultsare subject to reporting and processing errorsand biases due to nonresponse or incompleteresponse. There is no way to compute the mag-nitude of these errors. However, they were keptto a minimum by procedures built into the sur-vey operation. Careful attention and extensivepretesting were given to the phrasing of thequestions and the terms (and their definitions)employed in order to eliminate ambiguities andencourage uniformity of reporting. The stepstaken to reduce nonresponse bias are discussedin the sections on field procedures and data col-lection. Quality control procedures and consist-ency and edit checks, discussed in the data proc-essing section, reduced errors in data coding andprocessing.
Tests of Significance
In this report, the determination of statisti-cal inference is based on the t-test with a criticalvalue of 1.96 (O.05 level of significance). Termsrelating to differences, such as “higher,” “less,”etc., indicate that the differences are statisticallysignificant. Terms such as “similar” or “no dif-ference” mean that no statistical significanceexists between the estimates being compared. Alack of comment regarding the difference be-tween any two estimates does not mean that thedifference was tested and found to be notsignificant.
Population Figures
The base population used in computingannual visit rates is presented in table II. The fig-ures are based on provisional estimates for thecivilian noninstitutionalized population of theUnited States as of July 1, 1977, provided bythe U.S. Bureau of the Census. Because NAMCSincluded data for only the conterminous United
Table II. Estimates of the civilian non institutionalized population of the United States, 1 by age, race, and sax: United States, July 1,1977
[ Used in the calculation of rates for this report]
Age
Race and sexAllages Under 15-24 25-34 35-44 4!X4 55-64 6S74 75 years
15 years years years years years years years and over
Number in thousands
All races .. .. . .. .. ... . ..... . .. .. .. .. . 210,843 51,186 39,425 31,947 22,846 23,075 20,065 14,217 7,983
Male . .. .. ... .. .. .. .... ... .. .. .. .. .... . .. .... . .. ... .. .. 101,745 26,110 19,350 15,499 11,021 11,126 9,471 6,178 2,991Female ..... ... . ... ... .. ... ... . .... .. .. ... .. . ... .. .. . 109,098 25,076 20,075 16,448 11,925 11,950 10,584 8,039 4,882
White ... ..... .. .... . .. .. .. . . .. .. ... . .. .. .. 182,781 42,495 33,646 27,878 20,059 20,469 18,129 12,836 7,267
Male .... .. . .... .. .. .. .. .. .. .... . .. ... . .. .... . ... .... . . 88,607 21,734 16,639 13,703 9,754 9,926 8,582 5,567 2,701Female .. . ... ... . ... ... .. ... .. .. .... .... .. .. ... .... . . 94,174 20,761 17,010 14,175 10,305 10,643 9,546 7,269 4,565
Black . .. . .. ... .. . ... .. .. . ... ... . ... .. . .... . 24,970 7,761 5,262 3,458 2,467 2,311 1.767 1,280 664
Male .. . ... .. ... ... ... .... .. .. ... . .. ... .. .. .... . .. .... . 11,610 3,911 2,465 1,512 1,060 1,038 807 556 259Female ... .. ... ... .. . .... .. .... .. .. ... .. .. ... . .. .... . 13,360 3,850 2,797 1,945 1,407 1,273 959 724 405
All other races .. .. .. .... .. .. .. ... . .. .. 3,093 930 514 611 420 295 170 100 52
Male . ... .. .. .. .... .. . .... .. . ..... .. . .. . .. .. ... . .. ... .. 1,529 464 246 284 207 161 82 55 31Female .... .. .... ... . .... . .. ... ... . ... ... . .... . . ..... 1,564 466 268 328 213 135 88 46 21
lExcludes Alaska and Hawaii.
25
States, the original census estimates were modi-fied to account for the exclusion of Alaska andHawaii from the study. For this reason the pop-ulation estimates should not be consideredofficial and are presented here solely to providedenominators for rate computations.
Systematic Bias
There have been no attempts to determinesystematic bias on the data reported here. Thereare several factors, however, which the user ofthese data should understand, that indicate thatthese data underrepresent the total number ofoffice visits to office-based physicians. Some ofthe factors are:
1. The sampling frame for the 1977NAMCS included all nonfederally em-
ployed, “office-based, patient care phy-cians on the AMA-AOA master files.There are certainly physicians not soclassified who, at the time of survey,would have met the criteria for thatclassification. Visits to these physiciansare not represented here.
2. Physicians who participated in NAMCSdid a thorough and conscientious jobin keeping the Patient Log; however, theprobability that a patient visit was acci-dentally omitted from the survey ismuch greater than the probability that apatient was included who did not make avisit. This factor also introduces an un-known bias into the data.
000
26
APPENDIX II
DEFINITION OF TERMS
Terms Relating to the Survey
Office(s). –Premises identified by the physi-cian as locations for his ambulatory practice.The responsibility over time for patient care andprofessional services rendered there generallyresides with the individual physician rather thanwith any institution.
Ambulatory patient.–An individual seekingpersonal hezdth services, who is neither bedrid-den nor currently admitted to any health careinstitution on the premises.
Physician. –Classified as either:
AZ scope: All duly Iicensed doctors of medi-cine and doctors of osteopathy currently inpractice who spend some time in caring forambulatory patients at an office location.
Out of scope: Those physicians who treatpatients only indirectly, including special-ists in anesthesiology, pathology, forensicpathology, radiology, therapeutic radiology,and diagnostic radiology, and the followingphysicians:
Physicians in military service.
Physicians who treat patients only in aninstitutional setting (e.g., patients innursing homes and hospitals).
Physicians employed full time by an in-dustry or institution and having no pri-vate practice (e g., physicians who workfor the Veterans Administration, theFord Motor Company, etc.).
Physicians who spend no time seeingambulatory patients (e g., physicianswho only teach, are engaged in research,or are retired).
Patients. –Classified as either:
In scope: All patients seen by the physi-cian or a member of his staff in his office(s).
Out of scope: Patients seen by the physicianin a hospital, nursing home, or other ex-tended care institution, or the patient’shome. [Note: If the physician has a privateoffice (fitting the definition “office”) lo-cated in a hospital, the ambulatory patientsseen there are considered in scope.] The fol-lowing types of patients are considered outof scope:
Patients seen by the physician in an insti-tution (including outpatient clinics ofhospitals) for whom the institution hasthe primary responsibilityy over time.
Patients who telephone and receive ad-vice from the physician.
Patients who come to the office only toleave a specimen, pick up insuranceforms, or pay their bills.
Patients who come to the office only topick up medications previously pre-scribed by the physician.
Visit.–A direct, personal exchange betweenan ambulatory patient and a physician (or mem-bers of his staff) for the purpose of seeking careand rendering health services.
Physician specialty .–Principal specialty (in-cluding generaI practice) as designated by thephysician at the time of the survey. Those physi-cians for whom a specialty was not obtainedwere assigned the principal specialty recorded inthe master physician fdes maintained by the
27
American Medical Association or the American diagnosis represents the physician’s best judg-Osteopathic Association. ment at the time of the visit and may be tenta-
tive, provisional, or definitive.Terms Relating to the Patient Other significant current diagnosis. —TheRecord Form diagnosis of any other condition known to exist
Age. –The age calculated from date of birthwas the age at last birthday on the date of visit.
Color or t-ace. -On the Patient Record, coloror race includes four categories: white, Negro/black, other, and unknown. The physician wasinstructed to mark the category which in hisjudgment was most appropri~te -for the patientbased on observation and/or prior knowledgeof the patient. “Other” was restricted to Ori-ental people, American Indians, and persons ofother nonwhite, non-Negro races.
Was patient referred for this visit by anotherphysician ?–Referrals are any visits that aremade because of the advice or direction of aphysician other than the one being visited. Theinterest is in referrals for the current visit andnot in referrals for any prior visit.
Patient’s complaint, symptom(s), or otherreason(s) for this visit (in patient’s own words). —The patient’s principal problem, complaint,symptom, or other reason for this visit as ex-pressed by the patient. Physicians were in-structed to record key words or phrases verbatimto the extent possible, listing that problem firstwhich, in the physician’s judgment, was mostresponsible for the patient’s visit.
Time since onset of complaint/symptom initem 6a. —Physicians were instructed to checkthe category corresponding to the length of timesince the known beginning of the patient’s mostimportant problem. “Not applicable” was usedwhen the reason for visit was not a complaintor symptom (e.g., annual and well-baby exami-nations). For postoperative visits, “onset” refersto the length of time since the surgery. Forroutine prenatal visits, onset refers to the lengthof time since conception. For a flareup of achronic condition (e g., arthritis), onset refersto the length of time since the flareup, not theonset of the original condition.
Pn”ncipal diagnoses. –The physician’s diag-nosis of the patient’s principal problem, com-plaint, or symptom. In the event of multiplediagnoses, the physician was instructed to listthem in order of decreasing import ante; “prin-cipal” refers to the first-listed diagnosis. The
for the patient at the time of the visit. Otherdiagnoses may or may not be related to the rea-son for that visit.
Seriousness of problem in item 8a. –Thisitem includes four categories: very serious, seri-ous, slightly serious, and not serious. The physi-cian was instructed to check one of the fourcategories according to his own evaluation of theseriousness of the patient’s problem causing thisvisit. Seriousness refers to the physician’s clini-cal judgment as to the extent of the impairmentthat might result if no care were given.
Diagnostic services this visit. —Physicianswere instructed to check any of the followingservices that were ordered or provided duringthe current visit:
Limited exam/history: History and/orphysical examination which is limited to aspecific body site or system, or which isconcerned primarily with the patient’s chiefcomplaint, for example, pelvic examinationor eye examination.
General exam/history: History and/orphysical examination of a comprehensivenature, including all or most body systems.
Pap test: Papanicolaou test, self-explanatory.
Clinical lab test: One or more laboratoryprocedures or tests, including examinationof blood, urine, sputum, smears, exudates,transudates, feces, and gastric conte:nt, andincluding chemistry, serology, bacteriology,and pregnancy test (excludes Pap test).
X-ray: Any single or multiple X-ray exami-nation for diagnostic or screening purposes.Radiation therapy is not included in thiscategory.
EKG: Electrocardiogram, self-explanatory.
Vision test: Visual acuity test.
Endoscopy: Examination of the interior ofany body cavity, except ear, nose, andthroat, by means of an endoscope.
Blood pressure check: Self-explanatory.
28
Other: All other diagnostic services ordered supportive materials for fractures andor provided that are not included in the pre- sprains, and all irrigations, aspirations, dila-ceding categories. tations, and excisions.
Therapeutic services this visit.–Physicians Psych o t herapy~tiierapeutic listening: Allwere instructed to check any of the following treatments designed to produce a mentzd orservices that were ordered or provided during emotionaI response through suggestion, per-the current visit: suasion, reeducation, reassurance, or sup-
Immunization/desensitization: Administra-tion of any immunizing, vaccinating, or de-sensitizing agent or substance by any route,for example, syringe, needle, oral, gun, orscarification.
Drugs (prescrzption or nonprescrt~ tion)Drugs, vitamins, hormones, ointments, sup-positories, or other medications ordered orprovided, except injections and immuni-zations. Includes both prescription andnonprescription (over-the-counter) medi-cation.
Diet counseling: Instructions, recommenda-tions, or advice regarding diet or dietaryhabits.
Family planning: Services, counseling, or ad-vice that might enable patients to determinethe number and spacing of their children.Includes both contraception and infertilityyservices.
Medical counseling: Instructions and recom-mendations regarding any health problem,including advice or counsel about change ofhabit or behavior. Physicians were instructedto check this category only if the medicalcounseling was a significant part of thetreatment. (Excludes diet and family plan-ning counseling.)
Physiotherapy: Any form of physical ther-apy ordered or provided, including any treat-ment using heat, light, sound, or physicalpressure or movement, for example, ultra-sonic, ultraviolet, infrared, whirlpool, dia-thermy, coId therapy, and manipulativetherapy.
Office surgery: Any surgical procedure per-formed in the office this visit, includingsuture of wounds, reduction of fractures,
port, including psychological counseling,hypnosis, psychoanalysis, and transactionaltherapy.
Other: Treatments ordered or providedwhich are not included in the preceding cate-gories.
Disposition this visit. –Eight categories areprovided to describe the physician’s dispositionof the case as foIlows:
No followup planned: No return visit ortelephone contact was scheduled for the pa-tient’s problem.
Return at specified time: Patient was told toschedule an appointment or was instructedto return at a particular time.
Return if needed, RR.N.: No future appoint-ment was made, but the patient was in-structed to make an appointment with thephysician if the patient considered it nec-essary.
Telephone follo wup planned: Patient wasinstructed to telephone the physician on aparticular day to report on his progress, orif the need arose.
Referred to other physician: Patient wasinstructed to consult or seek care fromanother physicizm. The patient may or maynot return to this physician at a later date;
Returned to refem”ng physician: Patient wasreferred to this physician and was now in-structed to consult again with the physicianwho referred him.
Admit to hospital: Patient was instructedthat further care or treatment would be pro-vided in a hospital. No further office visitswere expected prior to that admission.
application and/or removal of casts, incision Other: Any other disposition of the case notand draining of abscesses, application of included in the above categories.
29
Duration of this visit. –Time the physician ence of the physician, and time spent reviewingspent with the patient, not including the time records, tests results, etc. In the event a patientthe patient spent waiting to see the physician, was cared for by a member of the physician’stime the patient spent receiving care from sorne- staff but did not see the physician during theone other than the physician without the pres- visit, the duration of visit was recorded ajszero.
000
30
APPENDIX II 1
SURVEY INSTRUMENTS
Introductory Letter From Direotor, National Center for Health Statistics
@
#“ ‘%,
( ~-)-)DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
~ ,,. PUBLIC HEALTH SERVICE
NATIONAL CENTER FOR Ht!ALTH STATISTICSI.IYATTSVILLE, MARYLAND 207S2
lindorsing Organizations
American Academyof Dermatology
American Academv of
Famllv Physicians
American Academv
of Neurology
American Academy ofOrthopaed!c Surgeons
Amer!can Academy
of Pedtatrtcs
Amertcan Assoc8atmn Of
Neurolog,c?.1 Surgeons
American Cd Iege of
Obstetrlctans ●nd
Gvnecologm;s
Amertcan Collegeof Physic,am
American C011e9e of
Preventive Med#c#ne
American Osteopathic
Auocmtton
Amer, can Proctologic
Soc!etv
American PsychiatricAssoc iat mn
American Society of
Internal Medicine
American Society ofPlastic and Reconstructive
Surgeons, Inc.
American UrologicAssociation
Association of American
Medical Colleges
National Medical
NATIONAL AMBULATORY
Mk?O1cAL cARESURV15Y
Dear Dr.
The National Center for Health Statistics, as part of itscontinuingprogram to provide information on the healthstatus of the American people, is conducting a NationalAmbulatory Medical Care Survey (NAMCS).
The purpose of this survey ia to collect informationabout ambulatory patients, their problems, and theresources used for their care. The resulting publishedstatisticswill help your profession plan for moreeffective health services, determine health manpowerrequirements,and improve medical education.
Since practicing physicians are the only reliable sourceof this information,we need your assistance in the NAMCS.As one of the physicians selected in our national sample,your participation is essential to the success of thesurvey. Of course, all information that you provide isheld in strict confidence.
Many organizationsand leaders in the medical professionIaveexpressed their support for this survey, includingthose shown to the left. They join me in urging yourcooperation in this important research.
Within a few days, a survey representativewill telephoneyou for an appointment to discuss the detaila of yourparticipation. We greatly appreciate your cooperation.
Sincerely yours,
Dorothy P. RiceDirector
.
31
ASSURANCE OF CONFIDENTIALITY–AI! information which wo.ldperrnit identification of an individual,a pracri.e, or an establishment will be held .Onfidend al, will be us$jdonly by persons engaged i. and for
z
Ihe purposes of th. s.mey and will not be disclosed Orreleasad to. mha persons o, used for any other pwpos%1+-.m~
1. DATE OF VISIT PATlENT RECORDd. L. NATIONAL AMBULATORY MEDICAL CARE SURVEY
g. PATIENT LOGMo/’Day i Y,
2. DATE OF BIRTH 3. SEX 4. COLOR OR 5. WAS PATIENTRACE REFERREO FOR
THIS VISIT BY/, 1 ❑ WHITE I ANOTHER
o6. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER a.
REASON(S) FOR THIS VISIT(In patient’sown words)
m3Q
A$, ahpwen, ar,, ves <word name .“d,,ln,01 ,,s,! on ,he log below Fo, [he Pakn( enfeted on lane *S, also complere the Dahentrecordm the qht
=;*I ❑ FEMALE SLACK I PHYSICIAN?, ❑ NEGRO/
, ❑ MALE 3 ❑ YES3 ❑ OTHER
a. MOSTimportant __ — g
PATl ENT’S NAME I ‘lfl:l+?F
‘
=.b. OTHER –—–__–—–— m
3P+
10. SERIOUSNESS OFCONDITION IN F
mITEM Ba (Check one)
1 ❑ VERY SERIOUS
, ❑ SERIOUS
,0 SLIGHTLYSERIOUS
+ ❑ NOT SERIOUS
7. TIME SINCE ONSET
OF COMPLAINTISYMPTOM IN ITEM @
(Check one)
, Q LESS THAN 1 DAY
, ❑ 1.6 DAYS
, ❑ 1-3 WEEKS
4 ❑ 1-3 MONTHS
SnMORE THAN3 MONTHS
* ❑ NOT APPLICABLE
~. PHYSICIAN’S OIAGNOSES 3. HAVE YOU SEEN
PATlENT BEFORE?
, ❑ YES IONO
+IF YES. FOR THECONDITION IN
ITEM S,?
I ❑ YES IQNO
. . PRINcIPAL DIAGNOs Is/P f106LEM AS50cl ATED WITHITEM 6,
-----
b. OTHER SIGNIFICANT CURRENT DIAGNOSES
I p,m
l––am
2I pm
am
3p.m
*.m
4pm
—11. DIAGNOSTIC SERVICES THIS
VISIT {Check all ordersd or provided)
, ❑ NONE
I •l LIMITED EXAM/HISTORY
3 ❑ GENERAL EXAM/HISTORY
. ❑ PAP TEST
, ❑ CLINICAL LAB TEST
6 ❑ X-RAY
7 ❑ EKG
8 ❑ VISION TEST
, ❑ ENDOSCOPY
,, ❑ BLOOO PRESSURE CHECK
I I ❑ 0TH E R (Specify)
RA-3 4-2
12. THERAPEUTIC SERVICES THISVISIT (Check all ordersd or provided)
, ❑ NONE
2 ❑ lMMUNIZATl ON/
DESENSITIZATION~ ❑ DRUGS (PRESCRIPTION/
NoNPRESCRIPTION)
4 ❑ DIET COUNSELING
5 ❑ FAMILY PLANNING● ❑ MEDICAL COUNSELING
7 ❑ PHYSIOTHERAPYa ❑ OFFICE SURGERY
* ❑ PSYCHOTHERAPY/THERAPEUTIC LISTENING
, 0 ❑ OTHER (Spscify)
14.DURATION OFTHIS VISIT(Time scfuallyspent withphysician)
13. DISPOSITION THIS VISIT(Check all that appfy)
1 ❑ NO FOLLOW-UP PLANNED
2 ❑ RETURN AT SPECIFIED TIME
3 ❑ RETURN IF NE EOEO, P.R. N.
5‘ ❑ TELEPHDNE FOLLOW-UP PLANNEO
‘ ❑ REFERRED TO OTHER PHYSICIAN
‘ ❑ ‘ETURNEDTO REFERRINGPHYSICIAN
7 ❑ ADMIT To HDSPITAL
“ ❑ OTHER (Specify)
Record Items 1-14 for th!s pat[entpm
I
_ MINuTES
CONTINUE LISTING PATIENTS
ON NEXT PAGEAND WELFAREOEpARTMENT OF HEALTH, EDUCATII
PUBLIC HEALTH SERVHEALTH RESOURCES AD MINI:
NATIONAL CENTER FOR HE ALT}
o. f.te. %8-R1498REV. 9-76
;ATIONTAT ISTICS
1nduction Interview Form
CONFIDENTIAL*NORC-4233
FOR OFFICE USEONLY:
m5-6/
m7-10/
BEGIN DECK 3
Form ApprovedOMB No. 68R1498 I
NATIONAL AMBULATORY MZDICAL CARE SURVEYINDUCTION I~ERVIEW
BEFORE STARTING INTERVIEW
1. ENTER PHYSICIAN I.D. NUMBER IN BOX TORIGHT.
2. ENTER DATES OF ASSIGNED REPORTING WEEK INQ. 2, P. 2.
- ‘m1-4/
.=
Doctor, before I begin, let me take a minute to give you a little background aboutthis survey.
*
The National Ambulatory Medical Care Survey is authorized byCongress in Public Law 93-353, section 308. It is a voluntarystudy and there are no penalties for refusing to answer anyquestion. All information collected is confidential and willbe used only to prepare statistical summaries. No informationwhich will identify an individual or a physician’s practicewill be released.
Although ambulatory medical care accounts for nearly 90 per cent,of all medical carereceived in the United States, there is no systematic information about the charac-teristics and problems of people who consult physicians in their offices. This kindof informationhas been badly needed by medical educators and others concerned withthe medical manpower situation.
In response to increasing demands for this kind of information, the National Centerfor Health Statistics, in close consultation with representativesof the medicalprofession, haa developed the National Ambulatory Medical Care Survey.
Your own taak in the survey is simple, carefully designed, and should not take muchof your time. Essentially, it consists of your participation during a specified7-day period. During this period, you simply check off a minimal amount of informa-tion concerning patients that you see.
Now, before we get into the actual procedures, I have a few questions to ask aboutyour practice. The answers you give me will be used only for classification and ~analysis, and of course all information you provide is held in strict confidence.
1. First, you are a IS that right?(ENTER SPECIALTY FROM CODE ON FACE SHEET LABEL.)*
Yes . . . . . . . . . , . .XNo... .(ASKA) . . ..Y
A. IF NO: What is your specialty (includinggeneral practice)?
1’111(Name of Specialty) 11-13/
33
●
-2-
2. Now, doctor, this study will be concerned with the ambulatorypatients you willsee in your office during the week of (READ REPORTING DATES ENTERED BELOW).
Kre
A.
(that’s a (that’s ar Monday) through I Sunday)
month date month date
you likely to see ~ ambulatory patients in your office during that week?
Yes. . . . . .(GO TOQ. 3). . x
No . . . . . . (ASKA) . . . . Y
IF NO: my is that? RECORD VERBATIM, THEN READ PARAGRAPH BELOW
Since it’s very important, doctor, that we include any ambulatory patientsthat you ~ happen to see in your office during that week, I’d like toleave these forms with you anyway--just in case your plans change. I’llplan to check back with your office just before (STARTINGDATE) to makesure, and I can explain them in detail then, if necessary.
GIVE DOCTOR THE ~ PATIENT RECORD FORMS AND GO TO Q. 9, P. 6.
34
-3-
3. A. At what office location will you be7-day period? RECORD UNDER A BELOW
B. FOR EACH OFFICE LOCATION ENTERED IN
IN SCOPE (Yes)
Private officesFree-standing clinics
(non-hospital based)Groups, partnershipsKaiser, HIP, Mayo ClinicNeighborhood Health CentersPrivately operated clinics
(except family planning)
IN CASE OF DOUBT, ASK: Is that
Is that
seeing ambulatoryAND THEN CODE B.
A, CODE YES OR NO
patients during
TO “IN SCOPE.”
that
10UT OF SCOPE (No)[
Hospital emergency roomsHospital outpatient departmentsCollege or university infirmariesIndustrial outpatient facilitiesFamily planning clinicsGovernment-operated clinics
(VD, maternal & child health, etc.)
(clinic/facility/institution)hospital based?
(clinic/facility/institution)governmentoperated?
c. Is that Q of the office locations at which you expect to see ambulatorypatients during that week?
Yes. . . . . . . . . . . XNo . . . . . . , ., . .Y
IF NO: OBTAIN ADDITIONAL OFFICE LOCATION(S), EIKCERIN “A” BELOW, AND REPEAT.
A. B.
Office Location In Scope?
YesI
No
(1) x Y
(2) x Y
(3) x Y
(4) x Y
IF ALL LOCATIONS ARE OUT OF SCOPE, THANK THE DOCTOR AND LEAVE.
35
-4- DECK 3
4. A. During that week (RIIPEATDATES), how many ambulatory patients do you expectto see in your office practice? (DO NOT couNT PATIENTS SEEN AT [OUT-OF-SCOPELOCATIONS] CODED IN 3-B.)
ENTER TOTAL UNDER “A” BELOW AND CIRCLE ON APPROPRIATE LINE,
B. And during those seven days (REPEAT DATES IF NECESSARY), on how many ~ doyou expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOREXPECTS TO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION.
ENTER TOTAL UNDER “B” BELOW AND CIRCLE NUMBER IN APPROPRIATE COLUMN.
DETERMINE PROPER PATIENT LOG FORM FROM CHART BELOW. READ ACROSSON “TOTAL PATIENTS” LINE UNDER “A” AND CIRCLE LETTER IN APPROPRIATE
“DAYS” COLUMN UNDER “B.”
THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS (A, B, C, D)SHOULD BE USED BY THIS DOCTOR.
LOG FORM DESCRIPTION
A--Patient Record is to becompleted for ALLpatients Iiste=n Log. 14-16/
,B--PatientRecord is to becompleted for everySECOND patient listedon Log.
C--Patient Record is to becompleted for everyTHIRD patient listedon Log.
‘*D--PatientRecord is to becompleted for everyFIFTH patient listedon Log.
A. I B. i
26- 39 “ I CBA AAAL4
40- 52 “ CBBAAAA—
53- 65 “ ID C B B AAA
66- 79 “ lDc’BBBA,A
80- 92 “ ID DC BBB:B
93-105 “ ID DC BBBB
106-118 “ DDCCBB :B
119-131 “ DDCCBBB
132-145 “ DDDCCBB—
146-158 “ DDDCCBB—
159-171 “ D“D D C ~ C IF
172-184 “ ID DDC CCC
I 185-197 “ ID D D D D II II
1198-210’’ lDDDDDDD
211+ “ DDDDDDD
*In the rare instance the physician will see more than 500 patients during his
assigned reporting week, give him two D Patient Log Folios and instruct him to corn..plete a patient record form for only every tenth patient. Then you are to draw am Xthrough the Patient Record on every other page of the two folio pads, starting withpage 1 of the pad. The physician then completes the Patient Log on every page, butcompletes the Patient Record on every second page.
36
.
DECK 3
5. FIND LOG FOLIO WITH APPROPRIATEOF THE FORM AND NUMBER OF LINESFORMS (if no lines are stamped,
-5-
LETTER AND CIRCLESTAMPED “BEGIN ONenter “O”) BELOW.
LETTER, ENI’ERFIRST FOURNEXT LINE” FOR THE B-C-D
FOLIONo. Lines FOR OFFICE USE ONLY
Stamped “BEGIN Number patient recordLetter Number ON NEXT LINE” forms Completed.
A
B
c
NuMBERSLOG
17-21/
22-24/
6. HAND DOCTOR HIS FOLIO AND EXPLAIN HOW FORMS ARE TO BE FILLED OUT. SHOW DOCTORINSTRUCTIONSON THE POCKET OF FOLIO, ITEMS 11 AND 12 DEFINITIONS ON CARD IN POCKETOF FOLIO AND ITEM DEFINITIONS ON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTERYOU LEAVE.
EMPHAST.2ETHAT EVERY PATIENT VISIT EXCEPT ADMINISTRATIVE PURPOSE ONLY IS TO BERECORDED ON,THE LOG FOR ENTIRE REPORTING PERIOD. FOR EXAMPIZ, IF A MEDICALASSISTANT GAVE THE PATIENT AN INOCULATION, OR A TECHNICIANADMINISTERED ANELECTROCARDIOGRAMAND THE PATIENT DID N~-SEE THE DOCTOR, THIS VISIT IS TO BELISTED ON THE LOG.
RECORD VERBATIM BELOW ANY CONCERN, PROBLEMS OR QUESTIONS THE DOCTOR RAISES.
7. IF DOCTOR EXPECTS TO SEE AMBULATORY PATIENTS AT MORE THAN ONE IN-SCOPE LOCATIONDURING ASSIGNED WEEK, TELL HIM YOU WILL DELIVER THE FORMS TO THE OTHER LOCATION(S).ENTER THE FORM LETTER AND NUMBER(S) AND NUMBER OF LINES STAMPED “BEGIN ON NEXTLINE” FOR THE B-C-D LOG FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING FORM(S).
FOLIONo. Lines FOR OFFICE USE ONLY:
Location Stamped “BEGIN Number patient recordLetter Number ON NEXT LINE” forms completed
25-29/30-32/33-37/38-40/41-45/46-48/
37
-6- DECK 3
8. During the survey week (REPEATEXACT DATES), will anyone be available to helpyou in filling out these records (at each IN-SCOPE location)?
Yes . . . .(ASKA). ..X
No . . . . . . . . . . .Y
A. IF YES: klhowould that be?
RECORD NAME, POSITION AND LOCATION.
NAME I POSITION—
I LOCATION
PERSONALLY BRIEF EACH PERSON LISTED ABOVE.
EMPHASIZE THAT EVERY PATIENI VISIT DURING THE ENTIRE WEEK IS TO BE RECORDED ON THELOG EXCEPT “ADMINISTRATIVEPURPOSE ONLY.”
9. Do you have a solo practice, or are you associatedwith other physicians in apartnership, in a group practice, or in some other way?
solo. . . . . (GO TO,Q. 10) . . 1 49/
Partnership . . (ASK A-C) . . . 2Group . . . ..(ASKA-C) . ..3
<--- Other (SPECIFYAND ASK A-C) . . 4
IF PARTNERSHIP.GROUP. OR OTHER:
A.
B.
c.
Is this a prepaid group practice? Yes . . (ASK [l]) . . . 1 50/
[1] IF YES TO A: What per centNo . . . . . . . . . .2
of patients areprepaid? per cent 51-53/
How many other physicians areassociatedwith you? NUMBER OF PHYSICIANS: 54-56/
What are the specialties of the other physicians associatedwith you?(How many of these are there?)
Specialty Number of Physicians
(1)
(2)
(3)
(4)
(5)
38
10. NOW I have justIN LARGE GROUP,
one
THE
-7- BEGIN DECK4
more question about your practice. (NOTE: IF DOCTOR PRACTICESFOLLOWING INFORMATIONCAN BE OBTAINED FROM SOMEONE ELSE.)
A. What is the total number of full-time (35 hours or more per week) employees of your (partnership/group) practice? Include persons regularly employed who-are now on vacation, temporarily ill, -etc. Do not include other physician. RECORD ON BOTTOM LINB OF COLU3X4A BELLW.
(1) Ho=anyof these full-time employees are a . . . (READ CATEGORIES BELCWAS NECESSARYAND RSCORD NUMBER OF EACH IN COLUMN A.)
B. AU6 what is the total number of part-time (leas than 35 hours per week) employees of your(partnerahip/group) practice? Again, include persons regularly employed who are now on vacation,ill, etc. Do not include other physicians. RJICOSDON BOTTOM LINE OF COLOWN B BELOW.
(1) Howmsnyof these part-time employees are a . . . (READ CATEGORIES BELOW AS NECESSARYAND RECORD NUMBER OF EACH IN COLUMN B.)
t I A. I B. IEmployees Pull-time Part-time
(35 or more hourslweek) (Less than 35 hours/week) I
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Registered Nurse . . . . . . . . . . . 11-13/
Licensed Practical Nurse . . . . . . . 14-16/
Nursing Aide. . . . . . . . . . . . . 17-19/
Physician Assistant* . . . . . . . . . 20-22/
Technician. . . . . . . . . . . . . . 23-25/
Secretary or Receptionist . . . . . . 26-28/
Other (SPECIFY) 29-31/
35-37/
38-40/
41-43/
44-46/
47-49/
50-52/
53-55/
TIYIXL: 56-58/
*Physician Aaaiatant must be a graduate of an accredited training program for physician
Assistants (Physician Extenders, Medex, etc. ) or certified by the National Board of 14dicalBmminers through the Certification Exam for Assistant to the Primary Care Physician.
BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EVERY AMBULATORY PATIENT SEEN BY THEDOCTOR OR HIS STAFF DURING THE 7-DAYyRIOD AT ALL IN-SCOPE OFFICE LOCATIONS (mEATTHEM) IS TO BE INCLUDED IN THE SURVEY, THAT EAC=ATIENT IS TO BE RECORDED ON THE LOG,AND ONLY THE APPROPRIATE NUM8ER OF PATIENT RECORDS COMPLETED.
Thank you for your time, Dr. If you have any (more) questions,please feel free to call me. l& phone num;er is written in the folio. I’llcall yg on Monday morning of your survey week just to remind YOU.
11. TIME INTERVIEWENDED . . . . . . . . AMPM
12. DATEOFINTERVIEW . . . . . . . . . . . . . . .I HI
(Month) (Day) (Year)
39
-8-
COMMENTS:
IN!JERVIEWERNUM8ER
111111INTERVIEWER‘S SIGNATURE
No. of
40
FOR OFFICE USE ONLY:
Patients Seen:Un “-’1’
W.S. GOVERNMENT PRINTING OFHCE: 1980 311.240/21 1-3
VITAL AND HEALTH STATISTICS Series
Series 1. Programs and Collection Procedures. –Reports which describe the general programs of the NationalCenter for Health Statistics and its offices and divisions and data collection methods used and includedefinitions and other material necessan for understanding the data.
Series 2 Data Evaluation and Methods Research.–Studics of new statistical methodology including experi-mental tests of new survey methods, studies of vital statistics collection methods, new analyticaltechniques, objective evaluations of reliability of collected data, and contributions to statisticzd theory.
Series 3. Analytical Studies. –Reports presenting analytical or interpretive studies based on vital md healthstatistics, carrying the analysis further than the expositow types of reports in the other series.
Series 4. Documents and Committee Reports. – Final reports of major committees concerned with vita] andhealth statistics and documents such as recommended model vital registration laws and revised birthand death certificates.
Series 10. Data From the Health Interuieul Suruey. –Statistics on illness, accidental injuries, disability, use ofhospital, medical, dentd, and other services, and other health-related topics, afl based on data collectedin a continuing national household interview survey.
.%rics 11. Data From the Health Examination Suroey and the Health and Arutrition Examination Survey. –Datafrom direct examination, testing, and measurement of national samples of the civilian noninstitu-tionalized population provide the basis for two types of reports: (1) estimates of the medically definedprevalence of specific diseases in the United States and the distributions of the population with respectto physical, physiological, and psychological characteristics and (2) analysis of relationships among thevarious measurements without reference to an explicit finite universe of persons.
Sen”es 12. Data From the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports fromthese surveys will be in Series 13.
Series 13. Data on Health Resources .Wi[ization. –Statistics on the utilization of health manpower and facilitiesproviding long-term care, ambulato~ care. hospitaI care, and family planning services.
Series 14. Data on Health Resources: ,Ilanpo rcer and Facilities. –Statistics on the numbers, geographic distri-bution, and characteristics of health resources including physicians, dentists, nurses, other heaIthoccupations, hospitals, nursing homes, and outpatient facilities.
Series 20. Data on Mortality. –Various statistics on mortality other than as included in rewl=’ ~nual or monthWreports. Special analyses by cause of death, age, and other demographic variables; geographic and timeseries analyses; and statistics cm characteristics of deaths not available from the vital records based onsample surveys of those records.
Series 21. Data on Natality, Marriage, und Diuorct. –\~3rious statistics on natality, marriage, and divorce otherthao as included in re%ular annual or monthly reports. Special analyses by demographic variab!es;geographic and time series analyses: studies of fertility; and statistics on characteristics of births notavailable from the vital records based on sample sumeys of those records.
Series 22. Data From the Arationa[ Mortality and Natality Surwys.- Discontinued effective I ~ 75. Future reportsfrom these sample surveys based on vita] records \vill be included in Series 20 and 21, respecti~’ely.
Series 23. Data From the National Suruey of Family Grou’th. –Statistics on fertility, family formation and dis-solution, family planning, and related maternal and infant health topics derived from a biennial surveyof a nationwide probability sample of ever-married women 15-W years of age.
For a list of titles of reports published in these series, ~vrite to: Scientific and Technical Information BranchNational Center for Health StatisticsPublic Health ServiceHyattsville, Lid. 20782
NCHSUS DEPARTMENT OF HEALTH AND HUMAN SERVICES
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