Data from the

NATIONAL HEALTH SURVEY

Characteristicsof Visits to

Femaleand Male Physicians

The NationalAmbulatory

MedicalCare Survey

Unhlstates,1977

Based on data obtained from a national sample of office-based female and maIe physicians, statistics are presented on the patient and

clinical characteristics of ambulatory care office visits. The focus of

the report is on the utilization of medicai practitioners according to

the sex of the physician. Data are provided on the distribution of

visits by sex, race, and age of patients; and age and specialty of the

physician. Clinical aspects of the medical practices of female and

maIe physicians are compared.

DHHS Publication No. (PHS) 80-1710

Series 13

Number 49

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

Hyattsville, 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- Statistics. 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>siciansL’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] }02.1’1’097:3s

ISJ3N 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 ..............................................................................................................................................

Appendixes

I. 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 to

sex of the physician: United States, 1977 ....................................................................................

Number and percent of office visits to female and mrde physicians by female patients 15 years

and over, by age of the patient: United States, 1977 ..... ...... ........................................................

.

1

1

1

1

2

2

3

5

7

7

7

8

8

10

11

11

11

15

17

19

27

31

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 physician 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 the

physician: United States, 1977 ........................................... .........................................................

Number and percent distribution of office &.its by sex, age, and race of the patient, according to

sex and specialty of the physician: United States, 1977 ........................................................... ...

Number and percent distribution of office visits by principal reason for visit, according to sex and

specialty of the physician: United States, 1977 ...........................................................................

Number and percent of office visits, by selected reasons for visit, sex of the physician, and

selected diagnostic services ordered or provided: United States, 1977 .........................................

Number and percent of office visits to genend and family practitioners and internists, by sex of

the 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 principal diagnosis: United States, 1977 ............................................................................. ........ ........ ...

Number and percent of office visits to general and family practitioners and internists, by sex of

the 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 the

physician 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 and

age of the physician and selected diagnostic or therapeutic services ordered or provided: United

States, 1977 .................................................................................................................................

Number and percent distribution of office visits by selected visit characteristics, according to sex

and 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 physician, 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 the

physician: United States, 1977 ....................................................................................................

Mean contact duration of office visits by sex of the patient and sex and specialty of the physician: United States, 1977 ............................................................................................................

Average number of hours per week spent in direct patient encounter, by sex and specialty of the

physician: 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 of

reliability or precision ——-—.-—— *

iv

●
CHARACTERISTICS OF VISITS TO FEMALE AND

MALE PHYSICIANS

THE NATIONAL AMBULATORY MEDICAL CARE SURVEY

Beulah K. Cypress, Ph. D., Division of Health Resources Utilization Statistics

INTRODUCTION

Background

In 1967,4.9 percent of the nonfedera.lly employed physicians engaged in office-based patient care in the United States were women.1 A

decade later women constituted 6.2 percent of

this group.2 However, women candidates entering medical school increased from 9 percent of

the total enrollment in 1970 to 25 percent in

19773 portending an increased ratio of female

to male physicians in the next decade. Because

of the mounting interest in the performance and

productivity of women in traditionally maledominated professions, a retrospective examination was made of the utilization data collected

in the National Ambulatory Medical Care Survey, with the sex of the health provider as the

focal point. Previous reports based on data from

thk survey provided information on physician

utilization without regard to the sex of the

physician.

The data were collected in the National Ambulatory Medical Care Survey, which is a sample

survey conducted yearly by the Division of

Health Resources Utilization Statistics of the

National Center for Health Statistics. Detailed

information regarding the background and

methodology of the survey were published in

Vital and Health Statistics, Series 2, No. 61?

Summary data for 1977 were published in Vital

and Health Statistics, Series 13, No. 44.5

Data collection and processing for the 1977

National Ambulatory Medical Care Survey were

the responsibility of the University of Chicago’s

National Opinion Research Center. Sample selection was accomplished with the assistance of

the American Medical Association and American

Osteopathic Association.

Scope of the Survey

The basic sampling unit for the National

Ambulatory Medical Care Survey was the

physician-patient encounter or visit. The current scope of the National Ambulatory Medical

Care Survey included all office visits within the

conterrninous United States made by ambulatory patients to nonfederalIy employed officebased physicians classified by the American

Medical Association or the American Osteopathic Association. The National Ambulatory

Medical Care Survey physician universe excluded

physicians practicing in Alaska and Hawaii, anesthesiologists, pathologists, and radiolo@ts.

Visits to physicians principally engaged in teaching, research, or administration; telephone contacts; and visits conducted outside the physician’s office were also excluded.

The definitions for office, physician, patient,

and visit that were used to determine eligibility

for the National Ambulatory Medical Care Survey are presented in appendix 11.

Source and Limitations of the Data

The estimates in this report are based on information obtained from Patient Records (see

appendix III) for a sample of visits provided by a

1
national probability sample of office-based physicians. The sample for the 1977 National

Ambulatory Medical Care Survey (NAMCS) included 3,000 physicians, 507 of whom were not

eligible (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 appendix I). About 5 percent of the physician participants were women. (This is roughly the proportion of similarly described female physicians in

the universe.)

Sample physicians listed all office visits during a randomly assigned 7-day reporting period.

Information was recorded on the Patient Record

or encounter form, which supplied data on a systematic random sample of 51,044 visits. Female

physicians supplied 2,339 completed Patient

Record forms; male physicians provided 48,705.

Readers are urged to peruse the appendixes

to this report, which contain information necessary for proper understanding and interpretation

of the statistics presented. Appendix I contains a

general description of the survey methods, the

sample design, and the data collection and processing procedures. Methods of estimation and

imputation are also presented. The statistics in

this report are based on a sample of office visits

rather than on all visits and are subject to sampling errors. Therefore, particular attention

should be paid to the section on “Reliability of

Estimates” in appendix 1. Charts of relative

standard errors and instructions for their use are

also shown in appendix 1.

Definitions of the terms used in this report

and in the survey operations are presented in

appendix II. Facsimiles of survey materials, such

as the introductory letter and the Patient

Record and Induction Interview forms are furnished in appendix III.

PATIENT CHARACTERISTICS

Patient Sex, Race, and Age

Analyses of data for the past several years

have shown a clear pattern of proportionately

more visits to office-based physicians by females

than by males. The current analysis of patient

visits according to the sex of the physician

shows that not only is this pattern continuing,

but also that female patients tend to visit female

physicians for medical care proportionately

more than they visit male physicians, i.e., the

ratio of female to male patients visiting female

physicians is higher than that of patients visiting

male physicians. Table A shows that about 72

percent of the average female physician’s patient

load were females, compared with 60 percent of

that of the average male physician. Table B

shows that the tendency of women patients to

visit women physicians prevailed for women in

all age groups.

However, age-specific visit rates (the average

number of visits per 100 in the population) reTable A. Number and percent distribution of office visits by

sex, 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

Percent

distribution

100.0 I

100.0

T

71.5

28,6

81.3

18.7

26.9

8.0

9.4

8.2

8.8

4.9

4.1

5,,4

4,,2

5.8

4.5

3.9

6,1

60.1

39.9

90.7

9.3

17.8

6.9

8.1

8.2

7.0

5.4

5.1

5.9

6.5

6.7

6.1

5.7

10.7

2
veal an anomaly in the pattern of visits to female

physicians. Figure 1 shows that rates for both

female and male patients visiting male physicians increased with the advancing age group of

the patient, but the visit rates to female physicians shown in figure 2 were about the same regardless of patient age group.

When the race and age of the patient are

plotted, a similar result can be observed (figures

3 ~d 4). In this case, the proportion of visits to

female physicians by patients of black and

other races was about twice as high as the corresponding proportion of visits to male physicians

(table A).

Table A also shows that the largest share of

visits to all physicians included patients under

15 years of age, but female physicians were

more likely to serve this age group than men

were. About 27 percent of these visits were to

females, compared with about 18 percent that

were to males. Male physicizuis, however, tended

to care for proportionately more older patients

than female physicians did; 36 percent of the

visits made by patients over 50 years of age were

to male physicians, compared with about 25 percent to female physicians.

Physician and Patient Characteristics

The difference in proportions of visits by the

youngest patients was due, in part, to the distribution of visits by physician specialty. Although

general and farnily practice accounted for the

largest, and ahnost equal, proportions of visits

regardless of the sex of the physician, pediatricians had the second highest proportion of visits

to all female physicians (about 20 percent)

(table C). For male physicians, internal medicine

ranked second, and proportionately more visits

by patients over 50 years of age were made to

internists than to any other specialty.6 Dermatologists also ranked high on the distribution of

visits to women (about 16 percent).

No women in the NAMCS sample (selected

randomly by specialty) were in the specialties of

orthopedic surgery, cardiovascular diseases, urological surgery, and otoktryngology, which are

traditionally male-dominated fields. Relatively

few women in the sample were in the specialties

of general surgery, ophthalmology, and neurology-specialties rarely selected by women medical school graduates. Few women in the sample

represented 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 of

in female in female

thousands patients thousands patients

16,669

1,825

2,144

1,870

2,003

1,112

936

1,220

965

1,319

1,019

879

1,377

79.1

82.6

86.8

87.1

80.5

77.1

75.8

80.1

74.0

77.5

62.1

74.3

73.7

449,627

37,682

44,109

44,938

38,182

29,541

27,747

32,081

35,779

36,591

33,210

31,257

58,529

62.7

59.0

69.1

70.0

67.7

61.1

62.2

61.1

58.5

59.2

56.4

59.1

63.3

3
Female

J I I I I I I I

Less 1S24 25.34 3644 45.54 55.64 65.74 75

xhan and

15 PATIENT’SAGE IN YEARS ovel

White

Black and

all other

-1-

than am

15 we

PATIENT’S AGE IN YEARS

Figure 1. Annual rate of office visits to mele physicians by sex

and age of tha patient: Unitad States, 1977

Figure 3. Annual rate of office visits to male physicians by age

and rata of the patiant: United States, 1977

T

I

Less 15.24 25.34 35.44 45.54 55.e4

than

65.74 75

15

and

PATIENTS AGE IN YEARS over

Figure 2. Annual rate of office visits to female physicians by

sex and age of the patient: United States, 1977

neurology, which are also specialties selected by

relatively few women.

The average number of visits per week are

listed by sex and specialty of the physician in

table C. This rate is obtained by dividing the

total number of annual visits by 52 and then by

o~—L__J

Less 15.24 25.34 35.44 45.54 55.64 65-74 75

than and

15 PATIENT’S AGE IN YEARS over

Figure 4. Annual rate of office visits to female physicians by age

and race of the patient: United Statas, 1977

the weighted number of physicians in the sample. Except for dermatologists, male physicians

in all listed specialties saw more patients on a

weekly average than women did. These averages

may reflect the length of the practice-week and

workday 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 in

another section of this report. The length of the

practice-week and workday will be variables

used in a future publication based on the practice activity of physicians.

The specialty in which a physician practices

contributes more than any other variable to differences between physicians. Therefore, comparisons between female and male physicians in this

report are limited to contrasts within specialties

wherever possible. The primary care specialties

of generaI and family practice, internal medicine, pediatrics, and obstetrics and gynecology

constituted more than two-thirds of the visits to

both female and male physicians. Dermatology

and psychiatry are fields in which many female

physicians are active. Therefore, these specialties

were selected for analysis. As a matter of practicality all specialties are not shown in some

tables. Where a variable is not a significant factor

in a particular specialty, that specialty is not

shown. The reader should note the specialty

names (when they are shown) in the titles of the

tables.

Sex of physician

Both Female Male Female Male

sexes

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

39.1

11.4

9.6

6.3

8.6

3.5

1.1

2.9

2.0

2.8

4.7

0.5

2.8

4.7

100.0

34.9

6.2

19.9

●1.O

11.7

15,5

5,8

*1.O

*1.1

2.9

100.0 64.3

39.3 77.0

11.6 37.6

9.2 82.1

6.6 ●34.2

8.5 64.5

3.7

1.1

2.4 149.9

2.1

2.7 23.2

4.9 *45.7

0.5 ●

2.9

4.5 ---

74.5

110.0

58.5

108.0

47.8

71.9

65.4

33.6

120.1

52.3

31.5

79.5

27.5

82.5

. . .

Physician Specialty and Patient Age

The median visit age’ of patients in the offices of female physicians in all specialties was

28.6 years, which is significantly younger than

the median age of 36.8 years for visits to male

physicians (table D). However, when visit age is

adjusted for physician specialty, this statistic is

clearly influenced by the large proportion of

visits to women pediatricians where most patients are under 15 years of age. The median

visit age of patients visiting male general and

fardy practitioners is higher than that of patients visiting females in the same specialty, but

median visit ages are about the same for patients

seen by female and male internists, obstetriciangynecologists, and psychiatrists.

Table E provides detailed statistics on visits

to women and men specialists according to the

sex and age of the patient and the patient’s race.

aMedian visit age should not be confused with

median patient age. The median vs%itage is based on initial and return visits some of which maybe by the same

patient.

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 IMale

Physician specialty

Median Standard Median

visit error visit

age in of the age in

years median years

Standard

error

of the

median

All specialties ...................................................................................................

T17 28.6 1.53 36.8 0.34

33.9 2.38 39.1 0.66

56.0 4.28 56.0 0.66

5.0 0.95 4.4 0.21

28.9 1.74 28.8 0.36

33.2 2.21 33.9 0.74

General and family practice ...............................................................................................

Intarnal medicine ...............................................................................................................

Pediatrics .............................. .............................................................................................

Obstetrics and gynecology .................................................................... .............................

Psychiatry ..........................................................................................................................

1Includes 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 the

physician: United States, 1977

Sex and specialty of physician

Female I

Male

Sex, age, and race of patient General and

family

practice and

internal

medicine

General and

family

practice and

internal

medicine

Obstetrics

and Psychiatry

gynecology

Obstetrics

and

gynecology

Psychiatry

Number in thousands

1,319 I 278,508

Percent distribution

All visits ........................................... 9,37 2,661 I I 46,612 I 14,877

Total ................................................ 100.0 100.0 100.0 100.0

100.0

100.0

99.1

100.0

Sex and age

Female ...................................... ............ 74.7 ‘71.7 59.4 57.9

*2.5

8.7

31.9

13.3

1.5

42.1

Less than 15 years ............................................

15-24 years ......................................................

25J14 years ......................................................

45-84 years ......................................................

65 years and over .............................................

10.0

11.6

20.3

20.7

12.0

“0.9

34.6

47.6

●14.6

●2.4

*2.6

*11.1

48.4

*9.7

28.3

6.1

9.1

14.6

16.6

13.0

40.6

“0.4

29.1

52.9

13.8

2.9

Male ...................................................... 25.3 0.9

4.2

7.3

20.1

9.8

*0.7 .

Less than 15 years ............................................

15-24 years ......................................................

25-44 years ......................................................

45-64 years ......................................................

65 years and over .............................................

6.1

*3.4

5.7

6.5

*3.7

*4.O

*1.9

*1 8.8

*3.6

95.2

*4.8

5.9

5.6

9.4

12.1

7.6

88.2

*11.8

90.0

10.0

Race

White ...............................................................

Black and all other ...........................................

79.0

21.0

90.5

9.5

95.4

4.7

6
CLINICAL CHARACTERISTICS

Principal Reason for Visit

Information obtained in item 6 of the Patient Record form represents the reasons for visiting physicians’ offices. The physician records,

as nearly as possible in the patient’s own words,

the reason, complaint, or symptom that in his

judgment was the most important reason for the

patient visit. These data have been classified and

coded according to A Reason for Visit Classij?cation for Ambulato~ Care (RVC), which has

been published in Series 2, No. 78 of Vital and

Health Statistics. 7 Detailed tables showing a

summary of reasons for visit are included in

Series 13, No. 44.5 Similar tables by sex of the

patient (but not by sex of the physician) were

published in Series 13, No. 45.8

Proportionately more visits were classified in

the symptom module of the RVC to female physicians than to male physicians in the specialties

of general and family practice and internal medicine, and obstetrics and gynecology (table F).

The larger proportion of visits in the disease

module recorded by male general and family

practitioners and internists reflects their relatively high proportion of visits by elderly patients. (Visits by patients with prior diagnoses of

hypertension and heart disease, for example, are

likely to fall in this group.)

Male pediatricians were proportionately

more likely to see patients for diagnostic, screening, and preventive care (chiefly, well-baby examinations) than were female pediatricians.

Other differences in proportions of visits

shown in table F are not statistically significant.

Principal Reason for Visit and

Diagnostic Services

The kinds of diagnostic services ordered or

provided when patients presented different

types of symptoms are listed in table G. In this

table complaints constituting the major part of

the symptom module (S001-S999) are grouped

as general symptoms or symptoms referable to

selected body systems (e g., $400 -S499 represents symptoms referable to the respiratory

system only).

The clinical response of female and male

physicians to the presentation of these symptoms was about the same because the differences

in 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 and

RVC codel

All reasons for visit .... .... ....

Total .... .. ... ... .. .... .. ... . .... . .... .

Symptom module ., ... .. .. .. .. S001-S999

Disease module ............... DOOI-D999

Diagnostic, screening, and

preventive module .. ... .. . XI OO-X599

Treatment module ... ... ... .. TIOO-T899

Injuries and adverse effects

module .. . .. .. .... . .... .. ... . .... . JOO1-J999

Teat 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 14.4

4.6 ●5.4 ‘3.0

●1.5 “0.2 *4.2

●1.5 “2.2

4.4 +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 60.9

5.7 2.5

1

27.3 +2.0

7.7 32.5

2.3 “0.5

‘0.1 ‘0.0

1.9 ‘1.0

1.2 “0.5

lRea~on for “i~it ~roup~ and cOdes are based on A Reason for Vim-tCla@iCdOn for .4MWatocv ca~ (RvCh

21nclu,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 and

diagnostic 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

General

symptoms

Sool -s089

Symptoms Symptoms Symptoms

referable to referable to

the nervous

referable to

to the the digestive

system (except respiratory

sense organs) system

system

S200-S259 S400-S499 S500-S639

Symptoms

referable

to the

genitourinary

system

S640-S829

Symptoms

referable to

the musculoskeletal

system

S900-S999

2,091

‘9.4

56.7

28.9

‘ 5.4

22.6

32.0

41,643

8.7

57.2

25.8

1.6

26.5

41.7

705 I

+0.2

62.4

‘32.4

‘7.2

●28.3

65.7

18,545 I

7.4

58.1

25.6

●1.5

19.5

52.4

Number in thousands

2,870 I 1,161 I 1,611

Percentz

●3.9 ●1.3 ●2.6

70.4 63.3 56.4

23.1 ●31 .0 36.2

●0.9 ●11.9 331.0

21.8 35.5 52.8

27.4 43.0 61.7

Number in thousands

59,270 I 26,480 I 29,866

Percent2

6.8

68.9

19.5

‘0.1

16.5

26.7

5.2

59.3

26.9

2:::

37.3

in the table were not statistically significant. The

only statistically significant result showed that

female physicians were more likely to check

blood pressure during visits for symptoms referable to the genitourinary system than were men.

Principal Diagnosis

Conditions that were proportionately most

often diagnosed by female and male physicians

in the specialties of general and family practice

and internal medicine reflected the characteristics of the patients most likely to be seen by

them. According to the data shown in table H,

male physicians in these specialties treated proportionately more patients visiting principally

for diseases of the circulatory system than for

other diagnostic groups; female general and family practitioners and internists were more likely

to see patients with diseases of the genitourinary

5.2

61.0

23.1

416.7

46.1

35.4

1,614

38.2

43.5

15.8

‘0.3

●8.7

28.4

51,934

8.6

65.7

17,2

0.8

13.9

31.8

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 elderly

patients who presented symptoms typical of

that age group to male physicians; the latter

group reflects the younger female patients who

presented symptoms referable to the genitourinary system to female physicians. Other than

the differences in these two categories, the practices of female and male general and family

practitioners and internists were very similar in

the diseases they diagnosed.

Principal Diagnosis and Drug Therapy

Drugs were ordered or provided during physician visits more than any other form of therapy (54 percent of all visits).5 Table J shows the

percents of visits in which drug therapy was

indicated in the presence of the principal diagnoses. Because most differences in the proportions shown in the table are not statistically significant, 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 selected

principal diagnoses: United States, 1977

Principal diagnosis and ICDA codel

All visits ........................................................................................................................................ .............

Infective end parasitic diwaws .......................................... ................................ ............................................OW.l 36

Neoplasms ............................. ........................................................................... ............................................l4O.239

Endocrine, nutritional, and metabolic diseases .............................................................................................24O.279

Mental disorders ...........................................................................................................................................29O.3l 5

Diseases of the nervous system and sense organs ...........................................................................................32O.389

Diseases of the circulatory system ........ ........................................................................................................39O458

Diseeses of the respiratory system ................................................................................................................46O.5l9

Diseases of the digestive system ........................................................... .........................................................52O.577

Diseases of the genitourinary system .............................................................................. ..............................58O.629

Diseases of the skin and subcutaneous tissue ....... .........................................................................................68O.7O9

Diseases of the musculoskeletal s.y~em .........................................................................................................710-738

Symptoms and illdefined conditions .......................................................................................... ..................78O.796

Accidents, poisonings, and violence ..............................................................................................................8OO.999

Special conditions and examinations without sicknes$ ................................................................................ YOO-Y13

Sax of physician

EY-k.!L

Number in

thousands

9,371 I 278,508

Percent2

5.7 4.5

*1.O 1.6

4.9 6.5

*3.5 3.0

5.5 4.4

9.2 15.7

18.1 16.5

●2.5 4.3

10.2 5.0

4.6 4.2

6.9 7.5

4.4 5.0

8.9 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.l36

Neoplasms .............................................................................................l4O.239

Endocrine, nutritional, and metabolic diseases ........................ ..............240-279

Mental disorders .............................. ......................................................29O.3l 5

Diseases of the nervous system and sense organs ....................................32O-389

Diseases of the circulatory system .............................................. ...........39O458

Diseases of the respiratory system ................................... ......................46O.5l 9

Diseases of the digestive system .............................................................52O.577

Diseases of the genitourinary system .....................................................58O%29

Diseases of the skin and subcutaneous tissue .................................... .....680-709

Diseases of the musculoskeletal ~Sem ............. ........ .............................7l O-738

Symptoms and illdefined conditions .....................................................78O.796

Accidents, poisonings, and violence .......................................................8OO.999

SPecial conditions and examinations without sickness ......................... YOO-Y1 3

Sex of physician

Female

Number of

visits in

thousands

1,299

674

639

1,593

1,693

954

3,520

455

1,638

3,550

762

877

1,356

3,288

Percent of

visits with

drug

therapy

76.1

●24.6

67.3

33.1

81.8

81.3

85.1

70.8

67.8

74.6

62.6

47.2

35.4

18.6

Male

Number of

visits in

thousands

21,369

13,613

238647

22,930

46,598

53,749

78,946

17,996

34,835

28,360

32,221

24.818

42;404

92,720

Percent of

visits with

drug

therapy

72.4

28.6

64.5

47.8

53.1

73.1

79.5

57.6

62.4

65.1

62.2

48.9

35.1

18.4

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 differentially. Only when the principal diagnosis concerned diseases of the nervous system and sense

organs did female physicians use drug therapy

proportionately more than males seeing the

same conditions. This group of diseases included

otitis media, which is the most common specific

illness diagnosed by pediatricians.9

Clinical Services and Physician

Specialty

It was observed from the data, however, that

male psychiatrists prescribed drugs proportionately more often (33 percent of their visits) than

women psychiatrists did (17 percent). This tendency of male psychiatrists to prescribe drugs

was more pronounced with female patients (37

percent) than with male patients (28 percent)

(not shown in table J). Estimates of visits to

female psychiatrists were too small to determine

if this tendency was also significant for them.

When all diagnosed conditions were considered for the specialties of general and family

practice and internal medicine, both female and

male physicians ordered drugs in about two out

of three visits (table K).

The proportion of visits that includled physiotherapy was higher for female than for male

physicians, but the reverse was true of medical

counseling. Differences in other therapeutic services were not statistically significant.

Blood pressure checks and Pap tests were

used for diagnosis proportionately more often

by these women specialists than by men. Of the

approximately 7 million visits by women patients to female general and family practitioners

and internists, 13 percent included a Palp test; 6

percent of the approximately 165 million visits

by women patients to men in the same specialties included a Pap test. (Percents in table K are

based on visits by female and male patients.)

However, about one in three visits to female

and male obstetrician-gynecologists included a

Pap test (table L). Men in this specialty were

more likely than women were to take blood

pressure measurements and order laboratory

tests.

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 in

thousands

9,371 I 278,508

Percentl

11.4

59.2

22.7

9.6

29.5

6.9

*3.1

53.6

8.3

7.1

66.2

10.4

8.3

62.0

20.4

3.8

23.5

8.7

5.0

46.7

14.9

4.9

65.8

9.2

*1.5 0.8

17.2 23.3

11.0L2.8

*3.1 5.2

5.6 3.4

10
Table L. Number and percent of office visits made by women to obstetrician-gy necologists, by sax of the physician and selected

diagnostic 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 in

general and family practice and internal medicine were proportionately more likely to indicate that no diagnostic services were used during

visits (about 31 percent) than were women in

other age groups of physicians or men in the

same or other age groups. Therefore, most of the

percents of the selected diagnostic services detailed in table M are lower for this age group of

physicians than for others. The large amount of

physiotherapy (38 percent) provided by them,

however, is in marked contrast to the proportions of such therapy provided by other groups

of female and male physicians. (These data may

be related to the fact that dermatologists comprised the second largest group of female physicians under 35 years of age in the sample.)

Proportions of clinical services rendered by

male physicians did not vary appreciably among

the three age groups shown in table M.

Status of the Visit

Female physicians were more likely to encounter patients making initial visits (22 percent) than were males (15 percent). This reraFemale I Male

Numbw in

thousands

2,661 I 46,188

Percentl

6.5

62.7

29.1

34.5

31.8

55.1

40.5

39.3

●7.9

‘8.5

*1 5.4

●3.4

3.7

56.8

30.6

37.-1

44.0

66.6

34.9

36.9

6.5

11.1

22.4

5.5

tionship was true of all of the specialties listed in

table N-.

A return visit rate for selected medicaI specialties was obtained by dividing the number of

visits made by patients that the physician had

seen before by the number of new patients

(table O). Rates of return visits to male specialists are clearly higher than those to females.

These results are consistent with the increasing

visit rates to male physicians shown in figures 1

and 3.

Male physicians gained proportionately more

patients by referral than females did. Of the new

patients seen by women, 20 percent were referred by another physician; 26 percent of all

patients visiting male physicians for the first

time were referred. Variation in referd by specialty is shown in table P.

Seriousness of the Problem and

Disposition and Duration of Visit

Physicians were requested to judge the

seriousness of the patient’s problem based on

the extent of impairment that might result if no

care were available. A four-point scale ranging

from the categories of “not serious’” to “very

serious” 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 years

35 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 ]

30.8

37.8

26.5

“2.0

18.0

●4.1

●0.9

34.2

●5.5

‘3.0

59.B

●1.9

●2.2

*7.9

37.8

*1.B

*0.B

●2.4

62.2

24.5

●10.4

39.2

●12.1

●7.1

52.7

*8.5

*7.7

64.9

*12.3

*1.9

25.7

*1.4

*5.9

*7.3

●6.9

68.9

18.7

13.7

28.5

●4.3

●1.1

66.5

●9.9

*9.3

71.1

14.2

*0.B

16.0

*2.3

.*1.5

*7.2

6.3

66.3

17.0

4.6

22.7

7.3

2.1

46.0

15.0

“4.4

62.3

9.0

1.9

23.9

7.3

4.5

4.1

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 the

data should be viewed in this context.

Male physicians in general tended to assign

visits to the serious or very serious category proportionately more frequently than female physicians did (about 18 percent for visits to male

physicians and 14 percent for those to female

physicians as shown in table N). This tendency

was most pronounced for psychiatrists.

Instructions to the patient to return at a

specified time was the most common disposition

of visits made by all physicians in the survey,

but female physicians were more likely to so instruct the patient than male physicians were

(table N). Men were more likely than women

were to make no followup plans. Women and

men did not differ significantly in the proportions of patients that they either referred to

other physicians or admitted to the hospital; the

latter was a rare event for physicians of both

sexes.

9.2

61.6

20.5

3.8

24.5

9.5

6.2

45.3

15.5

4.8

64.4

8.7

0.6

25.4

1.7

,5.7

3.6

7.8

60.5

21.8

3.4

22.3

8.2

4.7

49.0

13.8

5.3

69.3

9.9

0.5

20.1

2.2

4.9

2.7

Table Q shows the proportions of visits estimated in discrete time categories for selected

specialties. Duration of the visit is the time spent

in direct physician-patient encounter. Visits

where only staff see the patient are recorded as

“O” minutes. A higher proportion of visits to

male physicians than to female physicians consumed none of the physician’s time. The proportions of such visits shown in table Q maybe

related to staff availability; Estimates of staffing

patterns are not yet available in NAMCS, but a

future publication based on practice activity of

physicians will report on an investigation of this

variable. As expected, psychiatrists of both sexes

had the highest proportion of visits categorized

as 31 minutes or more.

Visit duration may also be compared by

using the mean contact duration. This duration

is the average time spent by the physician in direct patient encounter. Visits in which the

patient 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 the

physician: United States, 1977

General and

All family Obstetrics

specialties practice and Pediatrics and Dermatology Psychiatry

internal 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

22.3

26.2

51.6

57.1

29.0

14.0

6.4

66.5

23.4

3.1

3.7

1.4

14.6

34.3

51.1

47.4

37.4

15.2

5.0

66.0

21.9

3.3

3.8

1.5

30.9

32.1

37.0

72.5

25.5

2.0

11.5

45.9

40.9

4.7

5.8

1.1

18.2

30.3

51.5

81.6

●9.6

●8.8

i.8

84.4

16.7

2.7

5.3

2.8

37.0

*8.6

54.4

69.3

19.0

11.8

9.0

66.7

22.1

2.4

7.5

*14.6

*3.1

82.3

*11.2

40.8

48.0

2.1

89.6

6.4

0.6

1.1

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

15.0

24.9

60.1

50.7

30.8

18.4

11.4

60.5

22.6

3.2

2.5

2.0

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

11.7

31.6

56.7

48.3

34.0

17.7

12.4

56.5

25.9

3.1

3.0

‘1.3

9.6

40.8

49.6

66.2

26.4

7.4

20.0

45.3

28.9

7.5

2.1

0.5

14.6

19.1

66.3

76.1

17.3

6.7

4.3

77.0

18.5

2.6

2.5

2.5

27.7

13.2

59.1

59.1

27.3

13.7

14.1

68.8

13.0

2.8

0.9

6.6

1.7

91.7

7.7

22.9

69.4

2.0

89.9

6.8

1.1

0,8

0.6

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 by

sex of the physician and by sex of the patient

is shown in table R. Female physicians tended to

see patients longer than males did. The mean duration of all visits to women specialists was 17.8

minutes, compared with 15.3 to male specialists,

which was chiefly due to the average time used

by generaI and family practitioners (17.6 minutes for females in this specialty, compared with

12.7 for males in the same practice). Female

physicians tended to spend more time, on the

average, with female patients than with male

patients; while male physicians allotted about

the 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 Sexof

I physician

Female Male

General and family practice and

internal medicine .......................................

Pediatrics ......................................................

Obstetrics and gynecology ............................

Dermatology .................................................

Psychiatry .....................................................

Return visit

rate

5.86 7.54

2.24 9.41

4.49 5.83

1.70 2.61

5.86 14.13

Table C shows that female general and family practitioners had, on the average, 77 visits

per week, compared with 110 for males. Female

internists also had less weekly visits th,an males

did. These visits included alI patient encounters

in the scope of the survey, regardless of whether

the patient saw the physician or only a staff

member (e.g., to have blood drawn by a technician for a laboratory test). A more realistic

estimate of physician-patient activity is the number of hours per week spent in direct patient encounter. This statistic was obtained by dividing

the total number of minutes the physician reported for encounters by 3,120 (60 minutes X

52 weeks), and by the number of weighted physicians in the sampIe. The results of this computation are shown in table S. Women and men in

general and famiIy practice and internaI medicine spent about the same average number of

hours per week in direct patient care despite the

fact that more visits per week were to the offices

of the male specialists. However, table R reveals

that visits to female physicians Iastecl longer

than those to men did. This variation may

account for the difference in the number of

visits; that is, female physicians saw fewer patients in the same amount of time because the

visits were longer. As suggested previously, staff

availability may also have contributed to these

differences.

Table P. Percent of new patients seen by office-based physicians and percent referred by another physician, by sex and specialty of the

physician: United States, 1977

Sex of physician

Physician specialty

Female Male Female Male

All specialties ......................... .........................................................................................

General and family practice and internal medicine ..........................................................................

Pediatrics .................................................... .....................................................................................

Obstetrics and gynecology ...................................................................... .........................................

Dermatology ............... ................................................................................................ ....................

Psychiatry .................................................. .....................................................................................

Percent of

new patients

T

22.3 15.0

14.6 11.7

30.9 9.6

18.2 14.6

37.0 27.7

14.6 6.6

Percent

referred by

another

physician

I

20.2 , 26.2

16.5 10.5

9.7 20.8

20.0 19.2

28.9 35.2

40.8 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 visit

Number

of visits in

thousandsl

o 1-1o 11-15 15-30 31

Total minutesz minutes minutes minutes minutes

or more

Female Percent distribution

All ~ecialties ............................................. 22,788 100.0 0.5 39.7 25.3 25.1 9.4

General and family practice .......................................

Internal medicine .......................................................

Pediatrics ...................................................................

Obstetrics and gynecology .........................................

Dermatology ..............................................................

Psychiat~ ..................................................................

7,955

1,416

4,535

2,661

3,523

1,319

100.0

100.0

100.0

100.0

100.0

100.0

100.0

31.1

●15.1

65.2

48.9

49.3

+0.2

44.8

29.9

36.2

21.7

23.5

21.0

●0.9

26.9

26.0

32.2

32.3

29.5

25.2

5.8

33.2

●27.3

12.9

18.8

28.8

●17.0

20.3

16.3

27.0

12.9

24.2

22.1

16.6

5,8

*20.7

●0.2

4.9

*0.9

81.9

5.7

1.6

9.2

1.8

2.8

*1.1

72.6

+0.7

3.9

2.4

Male

All specialties............................................. 547,264

General and family practice., .....................................

Internal medicine ........................................................

Pediatrics ...................................................................

Obstetrics and gynecology .........................................

Dermatology ..............................................................

Psychiat~ ..................................................................

214,954

63,544

50,227

46,612

12,864

14.877

100.0

100.0

100.0

100.0

100.0

100.0

2.8

2.2

3.8

1.2

●0. I

53.3

29.4

49.2

42.3

51.6

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 the

patient and sex and specialty of the physician: Unitad

States, 1977

Table S. Average number of hours per week spent in direct

patient 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 15.7

Internal medicine ............................ 23.5 24.4 20.4

Pediatrics......................................... 11.4 11.0 11.9

Obstetrics and gynecology ............... 14.4 14.4 -

Psychiatry ....................................... 48.3 48.0 49.4 -

General and family practice and internal

20.9

22.6

17.4

26.9

23.0

—Male I

-1- All specialties........................ 15.3 15.3 15.3

General and family practice ............. 12.7

Internal medicine ............................ 18.7

Pediatrics......................................... 13.0

Obstetrics and gynecology ............... 14.7

Psychiatry ....................................... 43.9

DISCUSSION

12.8 12.5

18.5 19.0

13.2 12.9

14.7

42.7 45.5

The NAMCS data on visits to office-based

physicians do not reveal any startling differences

between the medical practices of women and

men. Results of other research suggest that some

statistically significant findings may be attriblTime spent in face-to-face encounter between physician and

patient.

15
uted to sociocultural influences rather than to

physician behavior or judgment.

The American Medical Association reported

that in 1977 office-based female physicians

practiced chiefly in the specialties of pediatrics,

general and family practice, internal medicine,

psychiatry, and obstetrics and gynecology (in

descending order); however, female urologists,

otolaryngologists, and neurologists (among other

specialists) were rarely found.z The first group

of specialists were rated highest by female medical students in a 1974 study of specialty preferences, but the second group were preferred

least.10 It is no coincidence that in another

study a group of male faculty physicians perceived the latter group as the least suitable for

women entering medicine.1 1 These cultural influences are reflected by the distribution of

visits in the NAMCS.

Patient attitudes also tend to shape the character of a practice. Although female physicians

encountered the full range of disease categories

in office practice, examination of data on specific diseases of the genitourinary system

showed that men did not visit female general

and family practitioners and internists for male

sex-related problems. However, women patients

made visits to both female and male physicians

for their uniquely feminine disorders.

Studies of the comparative productivity of

female and male physicians reported in 1957

and 1969 showed that women tended to work

fewer hours and saw fewer patients than men

did.12Js In the earlier study, 57 percent of the

married female physicians stated that they curtailed medical activity because of pregnancy and

family problems; in the later study, 38 percent

of married female physicians responded that

family responsibiIities limited their practices.

This report has also shown that male physicians

saw more patients per week than women did,

but that women and men devoted about an

equal amount of time to direct patient care.

Availability of adequate staff (perhaps limited

by economic resources of the physician, location, or type of practice) may be one factor in

reporting physician productivity y. Therefore,

societal expectations regarding the traditional

role of women or economic conditions may also

be involved in the differences between the medical practices of women and men.

Although a comparison of the practice characteristics of female and male physicians is inevitable, the primary objective of this report is to

provide baseline statistics for use in the conduct

of future research where the sex of the physician

is a required variable.

000

16
REFERENCES

1Theodore, C. N., and Haug, J. N.: Selected Characteristics of the Physician Population, 1963 and 1967.

Special Statistical Series. Chicago. American Medical

Association, 1968.

2Center for Health Services Research and Development: Physician Distrt”bution and Medical Licensure ia

the U.S., 1977. OP-054. Chicago. American Medical

Association, 1979.

3Bureau of Health Manpower: Minorities & women

in the health fields. Health Manpower References.

DHEW Pub. No. (HRA) 79-22. Health Resources Administration. Washington. U.S. Government Printing

Office, Oct. 1978.

4National Center for Health Statistics: National

Ambulatory Care Medical Care Survey: Background and

methodology, by J. B. Tenney et al. Vital and Health

Statistics. Series 2-No. 61. DHEW Pub. No. (HRA) 74

1335. 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. Ezzati

and T. McLemore. Vital and Health Statistics, Series 13-

No. 44. DHEW Pub. No. (PHS) 80-1795. Public Health

Service. Washington. U.S. Government Printing Office,

Apr. 1980.

6Nation~ center for He~th Statistics: Office ~sits to

internists, The National Ambulatory Medical Care Survey, United States, 1975, by B. K. Cypress. Vital and

Health 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 Statistics. Series 2-No. 78. DHEW Pub. No. (PHS) 79-1352.

Public Health Service. Washington. U.S. Government

Printing Office, Feb. 1979.

8Nation~ center for He~th statistics: c)ffice ~sits

by women, The National Ambulatory Medical Care Survey, United States, 1977, by B. K. Cypress. Vital and

Health 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: Ambulatory

medical care rendered in pediatricians’ offices during

1975, by T. Ezzati. Advance Data j%om Vital and

Health Statzktics, No. 13. DHEW Pub. No. (HRA) 77-

1250. Health Resources Administration. Hyattsville,

Md., Ott 13, 1977.

10Gough, H. G.: Specialty preferences of physicians

and medical students. J. Med. Educ. 50:581-588,

June 1975.

11Ducker, D. G.: Believed suitability of medical specialties for women physicians. J. Am. Med. Women’s

ASSOC. 33 (1):25 -32, Jan. 1978.

12DykInzn, R. A., and Stalnaker, J. M.: Survey of

women 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 Revision International Classification of Diseases, Adapted

for Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U.S. Government Printing

Office, 1967.

15National. Center for HeaIth Statistics: Replication,

An approach to the analysis of data from complex surveys, by P. J. McCarthy. Vital and Health Statistics. PHS

Pub. No. 1000-Series 2-No. 14. Public Health Service.

Washington. U.S. Government Printing Office, Apr.

1966.

16 National Center for Health Statistics: Pseudoreplication, Further evaluation and application of the balanced hidf-sarnple technique, by P. J. McCarthy. Vital

and Health Statistics. PHS Pub. No. 1000-Series 2-No.

14. Public Health Service. Washington. U.S. Government

Printing 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 National

Ambulatory Medical Care Survey .................................................................................................

II. Approximate relative standard errors for percentages of estimated numbers of office visits, 1977

National Ambulatory Medicaf Care Suwey ...................................................................................

LIST OF APPENDIX TABLES

L Distribution of physicians in the 1977 National Arnbufatory Medical Care Survey sample and

response rates, by sex and specialty of the physicim ....................................................................

IL Estimates of the civilian noninstitutionalized population of the United States, by age, race, and

sex: United States, Jufy 1, 1977 ..................................................................................................

19

19

21

22

22

25

25

26

27

27

28

31

31

32

33

23

24

20

25

18
APPENDIX I

TECHNICAL NOTESb

This report is based on data collected in the

1977 National Ambulatory Medical Care Survey

(NAMCS), an annual sample survey of officebased physicians conducted by the Division of

Health Resources Utilization Statistics of the

National Center for Health Statistics.

Statistical Design

Scope of the survey. –The target population

of NAMCS encompasses office visits within the

conterminous United States made by ambulatory patients to nonfederally employed physicians who are principally engaged in office

practice, but not in the specialties of anesthesiology, pathology, or radiology. Telephone contacts and nonoffice visits are excluded.

Sample des@z. –The NAMCS utilizes a multistage probability design that involves probability samples of primary sampling units (PSU’s),

physician practices within PSU’S, and patient

visits within practices. The first-stage sample of

87 PSU’S was selected by the National Opinion

Research Center (NORC) of the University of

Chicago, the organization responsible for

NAMCS field and data processing operations

under contract to the National Center for Health

Statistics. A PSU is a county, a group of adjacent counties, or a standard metropolitan

statistical area (SMSA). A modified probability -

proportional-to-size procedure using separate

sampling frames for SMSA’S and for nonmetropolitan counties was employed. After sorting

and stratifying by size, region, and demographic

characteristics, each frame was divided into

sequential zones of 1 million residents, and a

bPreP~ed by Thomas McLemore, M.S.P.H., Division

of Health Resources Utilization Statistics.

random number was drawn to determine which

PSU came into the sample from each zone.

The second stage consisted of a probability

sample of practicing physicians selected from

the master files maintained by the American

Medical Association (AMA) and the American

Osteopathic Association (AOA) who met the

following 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 pathology, radiology, diagnostic radiology, pediatric radiology, or therapeutic radiology.

The 1977 NAMCS physician universe included

188,690 doctors of medicine and 10,010 doctors of osteopathy.

Within each PSU, alI eligible physicians were

arranged by nine specialty groups: general and

family medicine, internal medicine, pediatrics,

other medicaI specialties, general surgery, obstetrics and gynecology, other surgical specialties,

psychiatry, and alI other specialties. Then,

within each PSU, a systematic random sample of

physicians was selected in such a way that the

overall probability y of selecting any physician in

the United States was approximately constant.

The 1977 NAMCS physician sample included 3,000 physicians. SampIe physicians were

screened at the time of the survey to ensure that

they Inet the aforementioned criteria; 507 physicians did not meet all the criteria and were

therefore ruled out of scope (ineligible) for the

study. 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 or

administration. Of the 2,387 in-scope (eligible)

male physicians, 1,846 (77.3 percent) participated in the study. Of the 106 in-scope female

physicians, 86 participated (81.1 percent). Of

the participating physicians, 265 physicians saw

no patients during their assigned reporting

period because of vacations, illnesses, or other

reasons for being temporarily not in practice.

The physicians sample size and response data by

physician specialty and sex are shown in table I.

The final stage was the selection of patient

visits within the annual practices of the sample

Gross

total

172

40

67

15

39

13

29

3

17

9

36

27

9

2,828

-

700

759

415

164

180

1,033

299

232

502

336

194

142

out of

scope

66

17

29

4

19

6

7

1

5

1

13

8

5

441

123

103

61

15

27

105

40

16

49

110

39

71

Net

total

106

23

38

11

20

7

22

2

12

8

23

19

4

2.387

-

577

656

354

149

153

928

259

216

453

226

155

71

Nonrespondents

20

5

5

2

3

7

3

4

3

3

541

157

164

97

31

36

180

44

51

85

40

29

11

Respondents

86

18

33

9

17

7

15

2

9

4

20

16

4

1,846

420

492

257

118

117

748

215

165

368

186

126

60

lResponse

rata

81.1

78.3

86.8

81.8

85.0

100.0

68.2

100.0

75.0

50.0

87.0

84.2

100.0

77.3

72.8

75.0

72.6

79.2

76.5

80.6

83.0

76.4

81.2

82.3

81.3

84.5

.

physicians. This involved two steps. First, the

total physician sample was divided into 52

random subsampIes of approximately equal size,

and each subsample was randomly assigned to 1

of the 52 weeks in the survey year. Second, a

systematic random sample of visits was selected

by the physician during the assigned week. The

sampling rate varied for this final step from a

100-percent sample for very small practices to a

20-percent sample for very large practices. The

method by which the sampling rate was determined is described later in this appendix and in

the Induction Interview form in appendix 111.

During 1977, 51,044 usable Patient Record

20
forms were completed by physicians participating in NAMCS (2,339 by female physicians

~d 48,705 by males).

Data Collection and Processing

Field procedures. –Both mail and telephone

contacts were used to enlist sample physicians

for NAMCS. Physicians received introductory

letters from NCHS (see appendix III) and AMA

or AOA. When appropriate, a letter from the

physician’s specialty organization, endorsing the

survey and urging his participation, was enclosed

with the NCHS letter. A few days later, a field

representative telephoned the physician to explain briefly the study and arrange an appointment for a personal interview. A physician who

did not respond initially was generally recontacted via a telephone call or special explanatory

letter requesting him to reconsider participation

in the study.

During the personal interview the field representative determined the physician’s eligibility,

ascertained his cooperation, delivered survey

materials with verbal and printed instructions,

and assigned a predetermined Monday-Sunday

reporting period. A short interview concerning

basic practice characteristics, such as type of

practice and expected number of office visits,

was conducted. Office staff who were to assist

with data collection were invited to attend the

instruction session or were offered separate

instruction sessions.

Before the beginning of and again during the

week assigned for data collection, the interviewer telephoned the sample physician to

answer questions that might have arisen and to

ensure that procedures were going smoothly. At

the end of the survey week, the participating

physician mailed the finished survey materials to

the interviewer, who edited the forms for

completeness before transmitting them for central data processing. Problems of missing or

incomplete data were resolved at this stage by

interviewer telephone followup to the sample

physician; if there were no problems, field

procedures were complete with respect to the ‘

sample physician’s participation in NAMCS.

After the end of the survey year, each sample

physician was sent a thank-you letter from

NCHS along with one of the survey’s statistical

reports.

Data collection. –The actual data collection

for NAMCS was carried out by the physician,

aided by his office staff when possible. Two data

collection forms were employed by the physician: the Patient Log and the Patient Record

(appendix III). The Patient Log is a sequential

listing of patients seen in the physician’s office

during his assigned reporting week. This list

served as the sampling frame to indicate the

visits for which data were to be recorded. A

perforation between the patient names and

patient visit characteristics permitted the physician to remove and retain the patient names,

thus protecting the confidentiality of the

patients.

Based on the physician’s estimate of the

expected number of office visits, each physician

was assigned a patient sampling ratio. These

ratios were designed so that about 30 Patient

Record forms were completed during the assigned reporting week. Physicians expecting 10

or fewer visits each day recorded data for all

visits, those expecting more than 10 visits per

day recorded data for every second, third, or

fifth visit, based on the predetermined sampling

interval. These procedures minimized the data

collection workload and maintained approximately equal reporting levels among sample

physicians regardless of practice size. For physicians assigned a patient sampling ratio, a random

start was provided on the first page of the log, so

that predesignated sample visits recorded on

each succeeding page of the log provided a

systematic random sample of patient visits during the reporting period.

Data processing. –In addition to completeness checks made by the field staff, clerical edits

were performed upon receipt of the data for

central processing. These procedures proved

quite efficient, reducing the item nonresponse

rates to a negligible amount-2 percent or less

for all items.

Information contained in item 6 (patient’s

problem or reason for visit) of the Patient Ret-’

ord was coded according to A Reason for Visit

Classification for Ambulatory Care.7 Diagnostic

information (item 8 of the Patient Record) was

coded according to the Eighth Revision International Classification of Diseases, Adapted for

NOTE: A list of references follows the text.

21
Use in the United States. 14 A maximum of

three entries were coded from each of these

items. Quality control in the medical coding

operation involved a two-way independent verification procedure with 100-percent verification.

Coding differences were adjudicated at the

National Center for Health statistics.

Information from the Induction Interview

and Patient Record forms was keypunched, with

100-percent verification, and converted to computer tape. At this point, extensive computer

consistency and edit checks were performed. Incomplete items were imputed by assigning a

value from a Patient Record with similar characteristics; physician specialty and broad diagnostic categories were used as the basis for these

imputations.

Estimation Procedures

Statistics from the 1977 National Ambulatory Medical Care Survey were derived by a

multistage estimation procedure, which produces essentially unbiased national estimates and

has three basic components: (1) inflation by

reciprocals of the probabilities of selection, (2)

adjustment for nonresponse, and (3) a ratio

adjustment to fixed totals. Each component is

described briefly.

Inflation by reciprocals of sampling pro babilites. –Since the survey utilized a three-stage

sample design, there were three probabilities of

selection: (1) the probability of selecting the

PSU, (2) the probability of selecting a physician

within the PSU, and (3) the probability y of

selecting a patient visit within the physician’s

practice. The last probability was defined to be

the exact number of office visits during the

physician’s specified reporting week divided by

the number of Patient Records completed. All

weekly estimates were inflated by a factor of 52

to derive annual estimates.

A djustrnent for nonresponse. —Estimates

from the NAMCS data were adjusted to account

for sample physicians who did not participate in

the study. This was done in such a manner as to

minimize the impact of nonresponse on final

estimates by imputing to nonresponding physicians the practice characteristics of similar reNOTE: A list of references follows the text.

spending physicians. For this purpose, physicians were judged similar if they had the same

specialty designation and practiced in the same

Psu.

Ratio adjustment. –A poststratification adjustment was made within each of nine physician specialty groups. The ratio adjustment was

a multiplication factor of which the numerator

was the number of physicians in the universe in

each physician specialty group and the denominator the estimated number of physicians in that

particular specialty group. The numerator was

based on figures obtained from the AMA-AOA

master files, and the denominator was based on

data from the sample.

Reliability of Estimates

Since the statistics presented in this report

are based on a sample, they differ somewhat

from the figures that would be obtained if a

complete census had been taken using the same

forms, instructions, and procedures. However,

the probability design of NAMCS permits the

calculation of sampling errors. The standard

error is primarily a measure of sampling variability that occurs by chance because only a sample

rather than the entire population is surveyed.

The standard error, as calculated in this report,

also reflects part of the variation that arises in

the measurement process. It does not include

estimates of any systematic biases that may be

in the data. The chances are about 68 out of 100

that an estimate from the sample WOUIC1differ

from a complete census by less than the standard error. The chances are about 95 out of 100

that the difference would be less than twice the

standard error, and about 99 out of 100 that it

would be less than 2Y2 times as large.

The relative standard error of an estimate is

obtained by dividing the standard error by the

estimate itself and is expressed as a percent of

the estimate. For this report, an asterisk (*)

precedes any estimate with more than a 30-

percent relative standard error.

Estimates of sampling variability were calculated using the method of half-sample replication. This method yields overall vati.ability

through observation of variability among random subsamples of the total sample. A description of the development and evaluation of the

22
replication technique for error estimation has

been published.ls>lG

Approximate relative standard errors for aggregates and percentages are presented in figures

I and II. In order to derive error estimates that

would be applicable to a wide variety of statistics and could be prepared at moderate cost,

several approximations were required. As a result, the relative standard errors shown in figures

Estimates of aggregates. –Approximate relative standard errors (in percent) for aggregate

statistics, such as the number of office visits

with a given characteristic, are obtained from

the curve in figure I or calculated by the

formula:

RSE (x) = J0.00160725 +

41.31046

“ 100

.x

I 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. —Approximate

standard errors from the figures follow. relative standard errors (in percent) for estimates

of this type can be calculated from the curve in

NOTE: 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

100 100

90 90

80 80

70 70

60 611

50 50

40 40

30 30

20 20

10 10

9 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’A1

100 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 of

chart) has a re_lative skndard error of 7.6 percent (read from scale at left side of chart) or a standard

error 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 Ambulator

Medic;l Care Survey

(Base of percentage shown on curves in millions)

100

90

80

70

60

50

40

30

20

10

9

8

7

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

- 8

7

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 an

estimate of 10 million office visits has a relative standard error of 12.9 percent (read from scale at left

of chart) or a standard error of 2.6 percentage points (12.9 percent of 20 percent).

error of the numerator and denominator. Square

each of the relative standard errors, subtract the

resulting value for the denominator from the resulting value for the numerator, and extract the

square root. This calculation has been made for

several percents and bases and is presented in

figure 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 is

not a subclass of the denominator. —Approximate relative standard errors for rates in which

the denominator is the total U.S. population or

one or more of the age-sex-race groups of the

total population are equivalent to the relative

standard error of the numerator that cm-i be obtained from figure 1.

Estimates of differences between two statistics. —The relative standard errors shown in

this appendix are not directly applicable to differences between two sample estimates. The

standard error of a difference is approximately
the square root of the sum of the squares of

each standard error considered separately. This

formula represents the standard error quite

accurately for the difference between separate

‘“and uncorrelated characteristics, although it is

only a rough approximation in most other cases.

In addition to sampling error, survey results

are subject to reporting and processing errors

and biases due to nonresponse or incomplete

response. There is no way to compute the magnitude of these errors. However, they were kept

to a minimum by procedures built into the survey operation. Careful attention and extensive

pretesting were given to the phrasing of the

questions and the terms (and their definitions)

employed in order to eliminate ambiguities and

encourage uniformity of reporting. The steps

taken to reduce nonresponse bias are discussed

in the sections on field procedures and data collection. Quality control procedures and consistency and edit checks, discussed in the data processing section, reduced errors in data coding and

processing.

Tests of Significance

In this report, the determination of statistical inference is based on the t-test with a critical

value of 1.96 (O.05 level of significance). Terms

relating to differences, such as “higher,” “less,”

etc., indicate that the differences are statistically

significant. Terms such as “similar” or “no difference” mean that no statistical significance

exists between the estimates being compared. A

lack of comment regarding the difference between any two estimates does not mean that the

difference was tested and found to be not

significant.

Population Figures

The base population used in computing

annual visit rates is presented in table II. The figures are based on provisional estimates for the

civilian noninstitutionalized population of the

United States as of July 1, 1977, provided by

the U.S. Bureau of the Census. Because NAMCS

included 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 sex

All

ages 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 2,991

Female ............................................. . 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 2,701

Female ............................. ............... .. 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 1,038 807 556 259

Female .................. ............................ 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 31

Female .... .. ........................................ 1,564 466 268 328 213 135 88 46 21

lExcludes Alaska and Hawaii.

25
States, the original census estimates were modified to account for the exclusion of Alaska and

Hawaii from the study. For this reason the population estimates should not be considered

official and are presented here solely to provide

denominators for rate computations.

Systematic Bias

There have been no attempts to determine

systematic bias on the data reported here. There

are several factors, however, which the user of

these data should understand, that indicate that

these data underrepresent the total number of

office visits to office-based physicians. Some of

the factors are:

1. The sampling frame for the 1977

NAMCS included all nonfederally employed, “office-based, patient care phycians on the AMA-AOA master files.

There are certainly physicians not so

classified who, at the time of survey,

would have met the criteria for that

classification. Visits to these physicians

are not represented here.

2. Physicians who participated in NAMCS

did a thorough and conscientious job

in keeping the Patient Log; however, the

probability that a patient visit was accidentally omitted from the survey is

much greater than the probability that a

patient was included who did not make a

visit. This factor also introduces an unknown bias into the data.

000

26
APPENDIX II

DEFINITION OF TERMS

Terms Relating to the Survey

Office(s). –Premises identified by the physician as locations for his ambulatory practice.

The responsibility over time for patient care and

professional services rendered there generally

resides with the individual physician rather than

with any institution.

Ambulatory patient.–An individual seeking

personal hezdth services, who is neither bedridden nor currently admitted to any health care

institution on the premises.

Physician. –Classified as either:

AZscope: All duly Iicensed doctors of medicine and doctors of osteopathy currently in

practice who spend some time in caring for

ambulatory patients at an office location.

Out of scope: Those physicians who treat

patients only indirectly, including specialists in anesthesiology, pathology, forensic

pathology, radiology, therapeutic radiology,

and diagnostic radiology, and the following

physicians:

Physicians in military service.

Physicians who treat patients only in an

institutional setting (e.g., patients in

nursing homes and hospitals).

Physicians employed full time by an industry or institution and having no private practice (e g., physicians who work

for the Veterans Administration, the

Ford Motor Company, etc.).

Physicians who spend no time seeing

ambulatory patients (e g., physicians

who only teach, are engaged in research,

or are retired).

Patients. –Classified as either:

In scope: All patients seen by the physician or a member of his staff in his office(s).

Out of scope: Patients seen by the physician

in a hospital, nursing home, or other extended care institution, or the patient’s

home. [Note: If the physician has a private

office (fitting the definition “office”) located in a hospital, the ambulatory patients

seen there are considered in scope.] The following types of patients are considered out

of scope:

Patients seen by the physician in an institution (including outpatient clinics of

hospitals) for whom the institution has

the primary responsibilityy over time.

Patients who telephone and receive advice from the physician.

Patients who come to the office only to

leave a specimen, pick up insurance

forms, or pay their bills.

Patients who come to the office only to

pick up medications previously prescribed by the physician.

Visit.–A direct, personal exchange between

an ambulatory patient and a physician (or members of his staff) for the purpose of seeking care

and rendering health services.

Physician specialty .–Principal specialty (including generaI practice) as designated by the

physician at the time of the survey. Those physicians for whom a specialty was not obtained

were assigned the principal specialty recorded in

the master physician fdes maintained by the

27
American Medical Association or the American diagnosis represents the physician’s best judgOsteopathic Association. ment at the time of the visit and may be tentative, provisional, or definitive.

Terms Relating to the Patient Other significant current diagnosis. —The

Record Form diagnosis of any other condition known to exist

Age. –The age calculated from date of birth

was the age at last birthday on the date of visit.

Color or t-ace.-On the Patient Record, color

or race includes four categories: white, Negro/

black, other, and unknown. The physician was

instructed to mark the category which in his

judgment was most appropri~te -for the patient

based on observation and/or prior knowledge

of the patient. “Other” was restricted to Oriental people, American Indians, and persons of

other nonwhite, non-Negro races.

Was patient referred for this visit by another

physician ?–Referrals are any visits that are

made because of the advice or direction of a

physician other than the one being visited. The

interest is in referrals for the current visit and

not in referrals for any prior visit.

Patient’s complaint, symptom(s), or other

reason(s) for this visit (in patient’s own words). —

The patient’s principal problem, complaint,

symptom, or other reason for this visit as expressed by the patient. Physicians were instructed to record key words or phrases verbatim

to the extent possible, listing that problem first

which, in the physician’s judgment, was most

responsible for the patient’s visit.

Time since onset of complaint/symptom in

item 6a. —Physicians were instructed to check

the category corresponding to the length of time

since the known beginning of the patient’s most

important problem. “Not applicable” was used

when the reason for visit was not a complaint

or symptom (e.g., annual and well-baby examinations). For postoperative visits, “onset” refers

to the length of time since the surgery. For

routine prenatal visits, onset refers to the length

of time since conception. For a flareup of a

chronic condition (e g., arthritis), onset refers

to the length of time since the flareup, not the

onset of the original condition.

Pn”ncipal diagnoses. –The physician’s diagnosis of the patient’s principal problem, complaint, or symptom. In the event of multiple

diagnoses, the physician was instructed to list

them in order of decreasing import ante; “principal” refers to the first-listed diagnosis. The

for the patient at the time of the visit. Other

diagnoses may or may not be related to the reason for that visit.

Seriousness of problem in item 8a. –This

item includes four categories: very serious, serious, slightly serious, and not serious. The physician was instructed to check one of the four

categories according to his own evaluation of the

seriousness of the patient’s problem causing this

visit. Seriousness refers to the physician’s clinical judgment as to the extent of the impairment

that might result if no care were given.

Diagnostic services this visit. —Physicians

were instructed to check any of the following

services that were ordered or provided during

the current visit:

Limited exam/history: History and/or

physical examination which is limited to a

specific body site or system, or which is

concerned primarily with the patient’s chief

complaint, for example, pelvic examination

or eye examination.

General exam/history: History and/or

physical examination of a comprehensive

nature, including all or most body systems.

Pap test: Papanicolaou test, self-explanatory.

Clinical lab test: One or more laboratory

procedures or tests, including examination

of blood, urine, sputum, smears, exudates,

transudates, feces, and gastric conte:nt, and

including chemistry, serology, bacteriology,

and pregnancy test (excludes Pap test).

X-ray: Any single or multiple X-ray examination for diagnostic or screening purposes.

Radiation therapy is not included in this

category.

EKG: Electrocardiogram, self-explanatory.

Vision test: Visual acuity test.

Endoscopy: Examination of the interior of

any body cavity, except ear, nose, and

throat, by means of an endoscope.

Blood pressure check: Self-explanatory.

28
Other: All other diagnostic services ordered supportive materials for fractures and

or provided that are not included in the pre- sprains, and all irrigations, aspirations, dilaceding categories. tations, and excisions.

Therapeutic services this visit.–Physicians Psych o therapy~tiierapeutic listening: All

were instructed to check any of the following treatments designed to produce a mentzd or

services that were ordered or provided during emotionaI response through suggestion, perthe current visit: suasion, reeducation, reassurance, or supImmunization/desensitization: Administration of any immunizing, vaccinating, or desensitizing agent or substance by any route,

for example, syringe, needle, oral, gun, or

scarification.

Drugs (prescrzption or nonprescrt~ tion)

Drugs, vitamins, hormones, ointments, suppositories, or other medications ordered or

provided, except injections and immunizations. Includes both prescription and

nonprescription (over-the-counter) medication.

Diet counseling: Instructions, recommendations, or advice regarding diet or dietary

habits.

Family planning: Services, counseling, or advice that might enable patients to determine

the number and spacing of their children.

Includes both contraception and infertilityy

services.

Medical counseling: Instructions and recommendations regarding any health problem,

including advice or counsel about change of

habit or behavior. Physicians were instructed

to check this category only if the medical

counseling was a significant part of the

treatment. (Excludes diet and family planning counseling.)

Physiotherapy: Any form of physical therapy ordered or provided, including any treatment using heat, light, sound, or physical

pressure or movement, for example, ultrasonic, ultraviolet, infrared, whirlpool, diathermy, coId therapy, and manipulative

therapy.

Office surgery: Any surgical procedure performed in the office this visit, including

suture of wounds, reduction of fractures,

port, including psychological counseling,

hypnosis, psychoanalysis, and transactional

therapy.

Other: Treatments ordered or provided

which are not included in the preceding categories.

Disposition this visit. –Eight categories are

provided to describe the physician’s disposition

of the case as foIlows:

No followup planned: No return visit or

telephone contact was scheduled for the patient’s problem.

Return at specified time: Patient was told to

schedule an appointment or was instructed

to return at a particular time.

Return if needed, RR.N.: No future appointment was made, but the patient was instructed to make an appointment with the

physician if the patient considered it necessary.

Telephone follo wup planned: Patient was

instructed to telephone the physician on a

particular day to report on his progress, or

if the need arose.

Referred to other physician: Patient was

instructed to consult or seek care from

another physicizm. The patient may or may

not return to this physician at a later date;

Returned to refem”ng physician: Patient was

referred to this physician and was now instructed to consult again with the physician

who referred him.

Admit to hospital: Patient was instructed

that further care or treatment would be provided in a hospital. No further office visits

were expected prior to that admission.

application and/or removal of casts, incision Other: Any other disposition of the case not

and 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 reviewing

spent with the patient, not including the time records, tests results, etc. In the event a patient

the patient spent waiting to see the physician, was cared for by a member of the physician’s

time the patient spent receiving care from sorne- staff but did not see the physician during the

one 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 STATISTICS

I.IYATTSVILLE, MARYLAND 207S2

lindorsing Organizations

American Academy

of Dermatology

American Academv of

Famllv Physicians

American Academv

of Neurology

American Academy of

Orthopaed!c Surgeons

Amer!can Academy

of Pedtatrtcs

Amertcan Assoc8atmn Of

Neurolog,c?.1 Surgeons

American Cd Iege of

Obstetrlctans ●nd

Gvnecologm;s

Amertcan College

of Physic,am

American C011e9e of

Preventive Med#c#ne

American Osteopathic

Auocmtton

Amer, can Proctologic

Soc!etv

American Psychiatric

Assoc iat mn

American Society of

Internal Medicine

American Society of

Plastic and Reconstructive

Surgeons, Inc.

American Urologic

Association

Association of American

Medical Colleges

National Medical

NATIONAL AMBULATORY

Mk?O1cAL cARESURV15Y

Dear Dr.

The National Center for Health Statistics, as part of its

continuing program to provide information on the health

status of the American people, is conducting a National

Ambulatory Medical Care Survey (NAMCS).

The purpose of this survey ia to collect information

about ambulatory patients, their problems, and the

resources used for their care. The resulting published

statisticswill help your profession plan for more

effective health services, determine health manpower

requirements,and improve medical education.

Since practicing physicians are the only reliable source

of 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 the

survey. Of course, all information that you provide is

held in strict confidence.

Many organizations and leaders in the medical profession

Iave expressed their support for this survey, including

those shown to the left. They join me in urging your

cooperation in this important research.

Within a few days, a survey representativewill telephone

you for an appointment to discuss the detaila of your

participation. We greatly appreciate your cooperation.

Sincerely yours,

Dorothy P. Rice

Director

.

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 RECORD

d. L. NATIONAL AMBULATORY MEDICAL CARE SURVEY g

. PATIENT LOG

Mo/’Day i Y,

2. DATE OF BIRTH 3. SEX 4. COLOR OR 5. WAS PATIENT

RACE REFERREO FOR

THIS VISIT BY

/, 1 ❑ WHITE I ANOTHER

o

6. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER a.

REASON(S) FOR THIS VISIT

(In patient’sown words) m

3

Q

A$, ahpwen, ar,, ves <word name .“d,,ln,

01,,s,! on ,he log below Fo, [he Pakn( en

feted on lane *S, also complere the Dahent

recordm the qht

=;* I ❑ FEMALE SLACK I PHYSICIAN? , ❑ NEGRO/

, ❑ MALE 3 ❑ YES

3 ❑ OTHER

a. MOST

important __ — g

PATl ENT’S NAME I ‘lfl:l+?F

‘

=.

b. OTHER –—–__–—–— m

3

P+

10. SERIOUSNESS OF

CONDITION IN F

m

ITEM Ba (Check one)

1 ❑ VERY SERIOUS

, ❑ SERIOUS

,0 SLIGHTLY

SERIOUS

+ ❑ NOT SERIOUS

7. TIME SINCE ONSET

OF COMPLAINTI

SYMPTOM IN ITEM @

(Check one)

, Q LESS THAN 1 DAY

, ❑ 1.6 DAYS

, ❑ 1-3 WEEKS

4 ❑ 1-3 MONTHS

Sn MORE THAN

3 MONTHS

* ❑ NOT APPLICABLE

~. PHYSICIAN’S OIAGNOSES 3. HAVE YOU SEEN

PATlENT BEFORE?

, ❑ YES IONO

+

IF YES. FOR THE

CONDITION IN

ITEM S,?

I ❑ YES IQNO

. . PRINcIPAL DIAGNOs Is/P f106LEM AS50cl ATED WITH

ITEM 6,

-----

b. OTHER SIGNIFICANT CURRENT DIAGNOSES

I

p,m

l––am

2

I

pm

am

3

p.m

*.m

4

pm

—

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)

R A-3 4-2

12. THERAPEUTIC SERVICES THIS

VISIT (Check all ordersd or provided)

, ❑ NONE

2 ❑ lMMUNIZATl ON/

DESENSITIZATION

~ ❑ DRUGS (PRESCRIPTION/

NoNPRESCRIPTION)

4 ❑ DIET COUNSELING

5 ❑ FAMILY PLANNING

● ❑ MEDICAL COUNSELING

7 ❑ PHYSIOTHERAPY

a ❑ OFFICE SURGERY

* ❑ PSYCHOTHERAPY/

THERAPEUTIC LISTENING

, 0 ❑ OTHER (Spscify)

14.DURATION OF

THIS VISIT

(Time scfually

spent with

physician)

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 REFERRING

PHYSICIAN

7 ❑ ADMIT To HDSPITAL

“ ❑ OTHER (Specify)

Record Items 1-14 for th!s pat[ent

pm

I

_ MINuTES

CONTINUE LISTING PATIENTS

ON NEXT PAGE

OEpARTMENT OF HEALTH, EDUCATII AND WELFARE

PUBLIC HEALTH SERV

HEALTH RESOURCES AD MINI:

NATIONAL CENTER FOR HE ALT}

o. f.te. %8-R1498

REV. 9-76

;ATION

TAT ISTICS
1nduction Interview Form

CONFIDENTIAL*

NORC-4233

FOR OFFICE USE

ONLY:

m

5-6/

m

7-10/

BEGIN DECK 3

Form Approved

OMB No. 68R1498 I

NATIONAL AMBULATORY MZDICAL CARE SURVEY

INDUCTION I~ERVIEW

BEFORE STARTING INTERVIEW

1. ENTER PHYSICIAN I.D. NUMBER IN BOX TO

RIGHT.

2. ENTER DATES OF ASSIGNED REPORTING WEEK IN

Q. 2, P. 2.

- ‘m

1-4/

.=

Doctor, before I begin, let me take a minute to give you a little background about

this survey.

*

The National Ambulatory Medical Care Survey is authorized by

Congress in Public Law 93-353, section 308. It is a voluntary

study and there are no penalties for refusing to answer any

question. All information collected is confidential and will

be used only to prepare statistical summaries. No information

which will identify an individual or a physician’s practice

will be released.

Although ambulatory medical care accounts for nearly 90 per cent,of all medical care

received in the United States, there is no systematic information about the characteristics and problems of people who consult physicians in their offices. This kind

of informationhas been badly needed by medical educators and others concerned with

the medical manpower situation.

In response to increasing demands for this kind of information, the National Center

for Health Statistics, in close consultation with representativesof the medical

profession, haa developed the National Ambulatory Medical Care Survey.

Your own taak in the survey is simple, carefully designed, and should not take much

of your time. Essentially, it consists of your participation during a specified

7-day period. During this period, you simply check off a minimal amount of information concerning patients that you see.

Now, before we get into the actual procedures, I have a few questions to ask about

your 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 . . . . . . . . . , . .X

No... .(ASKA) . . ..Y

A. IF NO: What is your specialty (including general practice)?

1’111

(Name of Specialty) 11-13/

33

●
-2-

2. Now, doctor, this study will be concerned with the ambulatorypatients you will

see in your office during the week of (READ REPORTING DATES ENTERED BELOW).

Kre

A.

(that’s a (that’s a

r 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 patients

that you ~ happen to see in your office during that week, I’d like to

leave these forms with you anyway--just in case your plans change. I’ll

plan to check back with your office just before (STARTINGDATE) to make

sure, 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 be

7-day period? RECORD UNDER A BELOW

B. FOR EACH OFFICE LOCATION ENTERED IN

IN SCOPE (Yes)

Private offices

Free-standing clinics

(non-hospital based)

Groups, partnerships

Kaiser, HIP, Mayo Clinic

Neighborhood Health Centers

Privately operated clinics

(except family planning)

IN CASE OF DOUBT, ASK: Is that

Is that

seeing ambulatory

AND THEN CODE B.

A, CODE YES OR NO

patients during

TO “IN SCOPE.”

that

10UT OF SCOPE (No) [

Hospital emergency rooms

Hospital outpatient departments

College or university infirmaries

Industrial outpatient facilities

Family planning clinics

Government-operated clinics

(VD, maternal & child health, etc.)

(clinic/facility/institution)hospital based?

(clinic/facility/institution)government

operated?

c. Is that Q of the office locations at which you expect to see ambulatory

patients during that week?

Yes. . . . . . . . . . . X

No . . . . . . , ., . .Y

IF NO: OBTAIN ADDITIONAL OFFICE LOCATION(S), EIKCERIN “A” BELOW, AND REPEAT.

A. B.

Office Location In Scope?

Yes

I

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 expect

to see in your office practice? (DO NOT couNT PATIENTS SEEN AT [OUT-OF-SCOPE

LOCATIONS] 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 ~ do

you expect to see any ambulatory patients? COUNT EACH DAY IN WHICH DOCTOR

EXPECTS 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 ACROSS

ON “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 be

completed for ALL

patients Iiste=n Log. 14-16/

,B--PatientRecord is to be

completed for every

SECOND patient listed

on Log.

C--Patient Record is to be

completed for every

THIRD patient listed

on Log.

‘*D--PatientRecord is to be

completed for every

FIFTH patient listed

on Log.

A. I B. i

26- 39 “ ICBA 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 X

through the Patient Record on every other page of the two folio pads, starting with

page 1 of the pad. The physician then completes the Patient Log on every page, but

completes the Patient Record on every second page.

36

.
DECK 3

5. FIND LOG FOLIO WITH APPROPRIATE

OF THE FORM AND NUMBER OF LINES

FORMS (if no lines are stamped,

-5-

LETTER AND CIRCLE

STAMPED “BEGIN ON

enter “O”) BELOW.

LETTER, ENI’ERFIRST FOUR

NEXT LINE” FOR THE B-C-D

FOLIO

No. Lines FOR OFFICE USE ONLY

Stamped “BEGIN Number patient record

Letter Number ON NEXT LINE” forms Completed.

A

B

c

NuMBERS

LOG

17-21/

22-24/

6. HAND DOCTOR HIS FOLIO AND EXPLAIN HOW FORMS ARE TO BE FILLED OUT. SHOW DOCTOR

INSTRUCTIONS ON THE POCKET OF FOLIO, ITEMS 11 AND 12 DEFINITIONS ON CARD IN POCKET

OF FOLIO AND ITEM DEFINITIONS ON THE BACK OF FOLIO, TO WHICH HE CAN REFER AFTER

YOU LEAVE.

EMPHAST.2ETHAT EVERY PATIENT VISIT EXCEPT ADMINISTRATIVE PURPOSE ONLY IS TO BE

RECORDED ON,THE LOG FOR ENTIRE REPORTING PERIOD. FOR EXAMPIZ, IF A MEDICAL

ASSISTANT GAVE THE PATIENT AN INOCULATION, OR A TECHNICIANADMINISTERED AN

ELECTROCARDIOGRAMAND THE PATIENT DID N~-SEE THE DOCTOR, THIS VISIT IS TO BE

LISTED 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 LOCATION

DURING 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 NEXT

LINE” FOR THE B-C-D LOG FOR THOSE LOCATIONS BELOW, BEFORE DELIVERING FORM(S).

FOLIO No. Lines FOR OFFICE USE ONLY:

Location Stamped “BEGIN Number patient record

Letter 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 help

you 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 IPOSITION

—

I

LOCATION

PERSONALLY BRIEF EACH PERSON LISTED ABOVE.

EMPHASIZE THAT EVERY PATIENI VISIT DURING THE ENTIRE WEEK IS TO BE RECORDED ON THE

LOG EXCEPT “ADMINISTRATIVEPURPOSE ONLY.”

9. Do you have a solo practice, or are you associatedwith other physicians in a

partnership, in a group practice, or in some other way?

solo. . . . . (GO TO,Q. 10) . . 1 49/

Partnership . . (ASK A-C) . . . 2

Group . . . ..(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 cent

No . . . . . . . . . .2

of patients are

prepaid? per cent 51-53/

How many other physicians are

associated with you? NUMBER OF PHYSICIANS: 54-56/

What are the specialties of the other physicians associated with you?

(How many of these are there?)

Specialty Number of Physicians

(1)

(2)

(3)

(4)

(5)

38
10. NOW I have just

IN LARGE GROUP,

one

THE

-7- BEGIN DECK4

more question about your practice. (NOTE: IF DOCTOR PRACTICES

FOLLOWING 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 NECESSARY

AND 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 NECESSARY

AND RECORD NUMBER OF EACH IN COLUMN B.)

t I A. I B. I

Employees 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 14dical

Bmminers through the Certification Exam for Assistant to the Primary Care Physician.

BEFORE YOU LEAVE, AGAIN STRESS THAT EACH AND EVERY AMBULATORY PATIENT SEEN BY THE

DOCTOR OR HIS STAFF DURING THE 7-DAYyRIOD AT ALL IN-SCOPE OFFICE LOCATIONS (mEAT

THEM) 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’ll

call yg on Monday morning of your survey week just to remind YOU.

11. TIME INTERVIEW ENDED . . . . . . . . AM

PM

12. DATEOFINTERVIEW . . . . . . . . . . . . . . .

I HI

(Month) (Day) (Year)

39
-8-

COMMENTS :

IN!JERVIEWERNUM8ER

111111

INTERVIEWER‘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 National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessan for understanding the data.

Series 2 Data Evaluation and Methods Research.–Studics of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, 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 health

statistics, 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] and

health statistics and documents such as recommended model vital registration laws and revised birth

and death certificates.

Series 10. Data From the Health Interuieul Suruey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dentd, and other services, and other health-related topics, afl based on data collected

in a continuing national household interview survey.

.%rics 11. Data From the Health Examination Suroey and the Health and Arutrition Examination Survey. –Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Sen”es 12. Data From the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources .Wi[ization. –Statistics on the utilization of health manpower and facilities

providing 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 distribution, and characteristics of health resources including physicians, dentists, nurses, other heaIth

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in rewl=’ ~nual or monthW

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics cm characteristics of deaths not available from the vital records based on

sample surveys of those records.

Series 21. Data on Natality, Marriage, und Diuorct. –\~3rious statistics on natality, marriage, and divorce other

thao 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 not

available 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 reports

from 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 dissolution, family planning, and related maternal and infant health topics derived from a biennial survey

of 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 Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Lid. 20782
NCHS

US DEPARTMENT OF HEALTH AND HUMAN SERVICES

“., mEP/l RTMk NT “, H.+

HH53

P13’5TAGE AND FEES PRID

.5.

Publ,c Health Service

96

Of f#c. of Health Ressarch, Statimcs, and Technology

I

A

Nmcmal Genter for Heakh Stalmcs

a

37~ EamWesi Hi@way

L

Hyanswlle, Mawland 20782

THIRD CLASS

OFFICIAL BuSINESS

PENALTY FOR PRIVATE uSE, $300 I !(), oub],cal, om ,n the 1