Patterns of 

Ambulatory Care 

in Obstetrics 

and Gynecology: 

The National 

Ambulatory 

Medical Care 

Survey

United States, 

January 1980-

December 1981 

Data on the ambulatory medical care 

provided during office visits to obstetriciangynecologists are presented. Individual 

practice profiles are drawn for different age 

groups of physicians, for those in the four 

major geographic regions, for those in 

metropolitan and nonmetropolitan areas, 

and for those in solo and group practices. 

Patterns of medical care are also described 

according to the age of the patient and prior 

visit status. Descriptors of practice include 

patients’ reasons for visit and diagnoses 

rendered by physicians. Data on the 

utilization of patient management 

techniques include diagnostic services, 

medication therapy, and nonmedication 

therapy. 

Data From the National Health 

Sunfey 

Series 13, No. 76 .,..’ 

DHHS Publication No. (PHS) 84-1737 

U.S. Department of Health and Human 

Services . Public Health Service 

National Center for Health Statistics, 

Hyattsville, Md. 

February 1984 
Copyright Information 

All material appearing m this report is in the public domain and may be 

reproduced or copied without permission: citation as to source, however, IS 

appreciated. 

Suggested Citation 

National Center for Health Statlstlcs. 8. K. Cypress: Patterns of ambulatory 

care in obstetrics and gynecology. The National Ambulatory Medical Care 

Survey, United States, January 1980-December 1981. Viral and Health 

Sfafistics. Series 13, No. 76. DHHS Pub. No. (84) 1737. Public Health Serwce. 

Washington. US. Government Prlntmg Office, Feb. 1984. 

Library of Congress Cataloging in Publication Data 

Cypress, Beulah K. 

Patterns of ambulatory care in obstetrics and gynecology. 

(Vital 8 Health Statistics. Series 13. Data from the national health survey: 

no. 76) (DHHS publication: no. (PHS) 84-1737) 

Includes bibliographlcal references. 

Supt. of Dots. no.: HE 20.6209:13:76 

1. Obstetrics-United States-Statistics. 2. Gynecology-Unlted StatesStatistics. 3. Ambulatory medical care-Unlt&d States-Statistics. 4. PhysIcian 

services utilization-United States-Statistics. 5. Health surveys-United 

States. 6. United States-Statistics, Medical. I. National Center for Health 

Statistics (U.S.) II. Title. Ill. Series: Vital and health statistics. Series 13. Data 

from the national health survey: no. 76. IV. Series: DHHS publication; no. 

(PHS) 84-l 737. 

RG106.4.U6C96 1984 362.1’982’0973 83-600386 

ISBN &84064289-8 
National Center for Health Statistics 

Manning Feinleib, M.D., Dr.P.H., Director 

Robert A. Israel, Deputy Director 

Jacob J. Feldman, Ph.D., Associate Director for Analysis and 

Epidemiology 

Garrie J. Losee, Associate Director for Data Processing and 

Services 

Alvan 0. Zarate, Ph.D., Assistant Director for International 

Statistics 

E. Earl Bryant, Associate Director for Interview and Examination 

Statistics 

Robert L. Quave, Associate Director for Management 

Gail F. Fisher, Ph.D., Associate Director for the Cooperative 

Health Statistics System 

Monroe G. Sirken, Ph.D., Associate Director for Research and 

Methodology 

Peter L. Hurley, Associate Director for Vital and Health Care 

Statistics 

Alice Haywood, Information OfJicer 

Vital and Health Care Statistics Program 

Peter L. Hurley, Associate Director 

Gloria Kapantais, Assistant to the Director for Data Policy, 

Planning, and Analysis 

Division of Health Care, Statistic? 

W. Edward Bacdn; Ph.D., Director :t 

Joan F. Van Nostrand, Depkj ‘Director 

James E. Delozier, Chief, Ambulatory Care Statistics Branch 
Contents 

Introduction 

Background and purpose .............................................. 1 

Scope of the survey ................................................ 1 

Source and limitations of the data ........................................ 1 

Visits by specialty ................................................. 2 

Physicianandpracticecharacteristics 

Type and location of practice ........................................... 4 

Physician age and sex ............................................... 6 

Patientcharacteristics 

Age, race, and ethnicity .............................................. 10 

Visit rates ..................................................... 10 

Patientconditionandmanagement 

Patient age ..................................................... 11 

Male patients .................................................... 15 

Prior visit status .................................................. 16 

Reason for visit and diagnostic services ...................................... 17 

Principal diagnosis and therapy, duration, disposition ............................... 17 

Conclusion 

Comparison with all specialties .......................................... 19 

Comparison with 1975 data ............................................ 19 

Hospital care .................................................... 20 

References....................................................... 21 

List of detailed tables ................................................ 22 

Appendixes 

I. Technical notes .................................................. 42 . 

II. Definitions of terms used in this report ...................................... 50 

III. Survey instruments ................................................ 53 

IV. American Hospital Formulary Service Classification system and therapeutic category codes .......... 62 

List of figures 

1. Percent distribution of office visits, by physician specialty: United States, January 1980-December1981 . . 

2. Percentdistribution of office visits by females 15-44 years of age, by physician specialty: United States, January 

1980-December1981 . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

3. Percentof office visits to obstetrician-gynecologists,by age of patient and age of physician: United States,January 

1980-DecemberI98 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

4. Percent of office visits to obstetrician-gynecologistsby ’ type of practice and age of physician: United States, 

January 1980-December1981 . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . 
5. Percent distribution of office visits, by selected diagnoses and physician specialty: United States, January 1980-December 

1981......... :......................................: ..‘..... 13 

6. Percent of office visits made by women that included a Pap test, by age of patient and physician specialty: 

United States, January 1980-December 1981 . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . 14 

7. Percent of office visits made by women that included a clinical laboratory test, by age of patient ‘and ‘physician 

specialty: United States, January 1980-December 198 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 

8. Percent of office visits made by women that included a blood pressure check, by age of patient and physician : 

specialty: United States, January 1980-December 1981 . . , . , . . . . . . . . . . . . . . . . . . . . . . . . ‘14 

List of text tables 

A. 

B. 

.c. 

- D. 

: E. 

F. 

G. 

H. 

J. 

K. 

L. 

M. 

Number of office visits to obstetrician-gynecologists by type of practice, and percent distribution by type ,of 

practice, according to location of physician’s practice: United States, January 1980-December 1981 ‘. . . . . 4 

Number of office visits to obstetrician-gynecologists, number and percent of drug visits, number of drug mentions, 

drug mention rate per visit, and drug intensity rate per drug visit, by type and location of physician’s practice: * 

United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . ‘5 

Average number of office visits per week and mean duration of visits to obstetrician-gynecologists, by age and ” 

sex of physician: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . 6 

Number of office visits to obstetrician-gynecologists, number and percent of drug visits, number of drug mentions, 

drug mention rate per visit, and drug intensity rate per drug visit, by age and sex of physician: United States, 

January 1980-December 198 1 . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

Percent distribution of office visits to obstetrician-gynecologists by type and location of physician’s practice, according 

to sex of physician: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . 7 

Number of office visits to obstetrician-gynecologists and percent of office visits, by selected principal diagnoses 

in supplementary classification and age of patient: United States, January 1980-December 198 1 . . . . . . . 12 

Number of drug mentions in office visits to obstetrician-gynecologists by age of patient, and percent of drug 

mentions by selected therapeutic categories and age of patient: United States, January 1980-December 198 1 . . 15 

Number of office visits to obstetrician-gynecologists, number and percent of drug visits, number of drug mentions, 

drug mention rate per visit, and drug intensity rate per drug visit, by selected characteristics: United States, 

January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘. . . 16 

Percent of office visits to obstetrician-gynecologists, by duration and status of visit: United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 

Mean duration of office visits to obstetrician-gynecologists by selected principal diagnoses and prior visit status: -

United States, January 1980-December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 

Percent of office visits to obstetrician-gynecologists and to all physicians by selected visit characteristics: United 

States, January 1980-December 198 1 . . , . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . 19 

Percent of office visits to obstetrician-gynecologists by selected visit characteristics: United States, 1975 and 1980-8 1 . . 20 
- - 

Symbols 

- Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than zero but less than 

0.05 

Z Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

l Figure does not meet standards of 

reliability or precision (more than 30-

percent relative standard error) 

# Figure suppressed to comply with 

confidentiality requirements 

. 
Patterns of Atibulatory 

Care in Obstetrics 

and Gynecology

The National Ambulatory 

Medical Care Survey 

by Beulah K. Cypress, Ph.D., Division of Health Care Statistics 

Introduction 

Background and purpose 

There were an estimated 109,035,OOO visits to officebased physicians in the practice of obstetrics and gynecology 

in the conterminous United States during the Zyear period 

1980-1981. Almost all of these visits were made by females 

(99 percent), and 87 percent of the patients were 15-44 

years of age. Thus, the characteristics of visits to these 

physicians form a pattern of medical care provided chiefly 

to women in the childbearing years. 

This report, based on visits to obstetrician-gynecologists 

(Ob-Gyn’s), is the third in a series of reports documenting 

the physician, organizational, and clinical characteristics of 

visits to various medical and surgical specialists. Previous 

publications highlighted the visit characteristics of general 

and family practice and pediatrics. ‘7’Like the first two reports, 

data from the National Ambulatory Medical Care Survey 

were used to develop the profile of health care. 

The data were gathered by the National Center for Health 

Statistics by means of the National Ambulatory Medical Care 

Survey, a sample survey of physicians’ office visits conducted 

annually through 1981 by the Division of Health Care Statistics. Data collection and processing for the 1980 and 1981 

National Ambulatory Medical Care Surveys were the responsibility of the National Opinion Research Center at the University of Chicago. Sample selection was accomplished with 

the assistance of the American Medical Association and the 

American Osteopathic Association. 

A brief report, based on 1975 estimates of visits to 

Ob-Gyn’s was published in Advance Data from Vital and 

Health Statistics No. 20.3 However, because the reason for’ 

visit coding system was revised in 1977 and the Ninth Revision 

of the International Classification of Diseases was introduced 

for coding diagnoses in 1979, data from that report may 

not be strictly comparable to those in this report. 

Detailed information on the background and methodology 

of the survey was published in Vital and Health Statistics, 

Series 2 No. 61 .4 A description of the 1980 and 198 1 surveys, 

including statistical design, data collection and processing, 

and estimation procedures, may be found in appendix I of 

this report. Technical details regarding reliability of estimates 

are also given in appendix I. Definitions of terms used in 

the survey are provided in appendix II. Facsimiles of survey 

instruments appear in appendix III. Prior to data presentation, 

the scope of the survey and limitations of the data are described 

briefly to assist the reader in interpreting the estimates. 

Scope of the survey 

The basic sampling unit for the National Ambulatory 

Medical Care Survey (NAMCS) is the physician-patient encounter or visit. The current scope of NAMCS includes 

all office visits within the conterminous United States made 

by ambulatory patients to nonfederally employed, office-based 

‘physicians as classified by the American Medical Association 

or the American Osteopathic Association. The NAMCS physician universe excludes anesthesiologists, pathologists, and 

radiologists, and physicians principally engaged in teaching, 

research, or administration. Telephone contacts and visits 

conducted outside the physician’s offtce also are excluded. 

Source and limitations of the data 

The data in this report are based on information obtained 

from a patient encounter form, the Patient Record (see appendix III), for a sample of visits provided by a national probability sample of office-based physicians. The combined samples 

for the 1980 and 1981 NAMCS included 5,805 physicians, 

1,124 of whom were ineligible because they were out of 

scope at the time of the survey. Of 4,681 eligible physicians, 

3,676 (78.5 percent) participated (see appendix I). There 

were 484 Ob-Gyn’s in the sample, of whom 71 were out 

of scope. Of 413 eligible Ob-Gyn’s, 350 participated (84.7 

percent). 

Sample physicians listed all office visits during a randomly assigned 7-day reporting period. During the 2-year 

period, information was recorded on Patient Records for 

a systematic random sample of 89,447 visits including 9,214 

visits to Ob-Gyn’s. 

The 1980 and 198 1 NAMCS were conducted in identical 

fashion using the same instruments, definitions, and procedures. The 2 years of data were combined to provide more 

reliable estimates. Therefore, the reader should note that 

estimates of numbers of visits and drug mentions contained 

in this report are for a 2-year period, but ratios and rates 

represent average annual estimates. 

The information in this report is derived from a complex 

sample survey, and the appendixes should be reviewed to 

\-
insure a proper understanding and interpretation of the statistical estimates presented. Since the statistics are based on 

a sample of office visits rather than on all visits, they are 

subject to sampling errors. Therefore, particular attention 

should be paid to the section entitled “Reliability of Estimates.” Charts on relative standard errors and instructions 

for their use are also given. 

Visits by specialty 

Obstetrics and gynecology ranked fourth among all specialties in the number of office visits, and accounted for 

about 9 percent of the total (figure I). However, obstetrics 

and gynecology ranked first among surgical specialties. When 

medical and surgical specialties are compared on the basis 

of visit volume, the customary setting of professional activity 

should be taken into consideration. The number of office 

encounters with surgical specialists may be less than those 

with medical specialists because a substantial portion of patient 

care rendered by the surgical specialist is done in a hospital. 

For example, it was reported in a study conducted by the 

Division of Research in Medical Education of the University 

of Southern California School of Medicine that 24 percent 

of all patient encounters by Ob-Gyn’s were in the hospital, 

compared with I4 percent of those by general practitioners, 

and 49 percent of those by general surgeons.5-7 

Of all visits by women 15-44 years of age, 30 percent 

were to obstetrician-gynecologists (figure 2). This proportion 

was exceeded only by the 32 percent of such visits made 

to general and family practitioners. 

All other 

Psychiatry I 

:ral and family 

or:actice Other surgical 

specialties 

General -+ 

surgery 

Obstetrics 

gynecology and 0 

medicine 

Figure 1. Percent distribution of office visits, by phisician specialty: United States, January 1986December 1981 
. . . .. -- . , .- . 

All other specialties 

/ General and family practice 

Internal medicine 

T

Obstetrics and gynecology 

Figure 2. Percent distribution of office visits by females 154.4 years of age, by physician specialty: United States, January 1980-December 1981 

:3 

1-
Physician and 

practice characteristics 

Type and location of practice 

There were proportionately fewer visits to Ob-Gyn’s in 

solo practice (45 percent) than to those in other types of 

practice (55 percent) (table A). However, in contrast to the 

growing trend toward group” practice reported by the American 

Medical Associaton,’ the proportion of visits to Ob-Gyn’s 

in solo practice’ in 1980-81 represents an increase from the 

39 percent reported in 1975.3 In this respect Ob-Gyn’s differed 

from the first three leading specialists where visits to physicians in solo practice decreased between 1975 and 1980-8 1. ‘-

In the Northeast and North Central Regions proportions 

of visits to multiple practice organizations exceeded those 

to solo practices, but in the West Region the reverse was 

true. There were also proportionately more visits to solo 

practices in the South Region, but the difference was not 

statistically significant. 

Similar to the distribution of all visits to Ob-Gyn’s, 

the majority of visits in metropolitan areas were to multiplemember practices (58 percent). However, more than half 

(55 percent) of the visits in nonmetropolitan areas were to 

solo practice. 

Visits to Ob-Gyn’s in solo practice and other types of 

practice are distributed by selected characteristics in table 

1. In this table, and others, statistics on “all” visits provide 

a general pattern of care by Ob-Gyn’s. However, other statistics in the tables are based on specific variables such as 

type or location of practice. 

Patients were typically females in the childbearing ages 

of 15-44 years, and this pattern did not vary appreciably 

by practice organization. There were proportionately more 

visits by patients 45 years and over to physicians in solo 

practice (14 percent) than to others (11 percent). This may 

be related to the tendency of older patients to consult older 

physicians, who are more likely to practice alone. This relationship is discussed in the section “Physician characteristics.” 

About 71 percent of the visits to Ob-Gyn’s were made 

by patients the physician had seen before returning for treatment of continuing problems, regardless of the type of practice. Only 12 percent were new patients. For Ob-Gyn’s, 

the ratio of return visits to initial visits was higher than 

the NAMCS average for all specialties. 

‘The American Medical Association defines group practice as the provision 

of medical services by three or more physicians. In this reportthe terms 

“group” and “multiple” practice are used to describe provision of medical 

services by more than one physician. 

Table A. Number of office visls to obstetrician-gynecologists by type of 

practice, and percent distribution of office visits by type of practice,

according to location of practice: United States, January 1980-

December 1981 

Number of Type of practice 

Location of visits in 

practice thousands Total Solo Other’ 

Percent distribution 

All visits 109,035 100.0 44.5 55.5 

Geographic region 

Northeast . . . 26,365 100.0 41 .I 56.9 

North Central 26,935 100.0 33.5 66.5 

South . . . . . . . 30,921 100.0 51.3 46.7 

West . . . . . . 22,794 100.0 53.1 46.9 

Area 

Metropolitan . . . . . 69,110 100.0 42.2 57.6 

Nonmetropolitan . . 19,925 100.0 54.6 45.2 

‘Includes parhership. 9roup, and other types of practice. 

Nonillness care occupies a prominent place in the ObGyn’s practice as evidenced by the 62 percent of visits in 

which the physician selected that category as the major reason 

for the visit. The same proprotion (62 percent) was found 

for the diagnostic, screening, and preventive module when 

the physician selected this category as the patients’ principal 

reason for visit. In NAMCS, patients’ reasons for visit, expressed as closely as possible in the patients’ own words, 

are recorded by the physician in item 6 of the Patient Record 

form. The reason given by the patient, which in the physician’s 

judgment is most responsible for the visit, is the first-listed 

or principal reason for the visit. Reasons for visit are coded 

and grouped in eight modules according to a classification 

system that is detailed in A Reasonfor Visit Classification 

for Ambulatory Care (RVC). lo These modules are listed in 

table 1. (Specific reasons for visit are discussed in the section 

“Patient condition and management.“) 

Practice profiles varied somewhat based on the major 

reason for visit. Although nonillness care was preeminent 

in all types of practice, visits to physicians in multiple practice 

were more likely to be for nonillness care (64 percent) than 

those to physicians in solo practice were (59 percent). On 

the other hand, physicians in solo practice treated more cases 

of routine chronic problems (10 percent) than physicians, 

in multiple practice did (7 percent). These results may be 

related to the larger proportion of visits by patients 45 years 

of age and over to solo practice physicians, because the 

4 

2.9 
type of care rendered is also related to patient age. This 

is discussed in the section “Patient characteristics.” 

As expected, proportions of visits with certain diagnostic 

services were higher for Ob-Gyn’s than for the average of 

all physicians in NAMCS. Forty-three percent of Ob-Gyn’s 

visits included clinical laboratory tests, 29 percent included 

Pap tests, and 68 percent included blood pressure checks; 

in contrast to the NAMCS averages of 22 percent, 7 percent, 

and 34 percent, respectively. Ob-Gyn’s also exceeded the 

average in their proportion of visits with family planning 

services (16 percent of Ob-Gyn’s visits as opposed to 2 

percent overall). 

Except for the limited history and/or examination that 

physicians in multiple practice were more likely to include 

in their visits than solo physicians were, differences in proportions of diagnostic services and nonmedication therapy did 

not differ significantly by type of practice. 

Probably because of the high rate of visits for nonillness 

care, Ob-Gyn’s had the lowest rate of medication therapy 

of the four leading specialties.” Ob-Gyn’s had 9 percent 

of all NAMCS visits but only 5 percent of all drug mentions. 

‘It was the only one of the leading specialties in which no 

medication was indicated in the majority of visits (58 percent). 

Physicians in multiple-member practice (who also had proportionately more nonillness care visits) were more likely to 

prescribe no medication (62 percent) than physicians in solo 

practice were (54 percent). When medication was mentioned 

in office visits, no more than one drug was named in 30 

percent of all visits. Physicians in solo practice prescribed 

a single drug proportionately more often (33 percent of visits) 

than other physicians did (29 percent). 

Estimates of drug utilization in NAMCS are based on 

the physicians’ entries on the Patient Record form. These 

entries may be brandb or generic names of prescription or 

bathe use of brand or trade names is for identification purpose only and 

does not imply endorsement by the Public Health Service or the U.S. 

Department of Health and Human Services. 

over-the-counter drugs, or a therapeutic effect. Drug mentions 

include all new or continued drugs listed in item 11. Physicians 

may make up to eight such entries. The methodology used 

to collect and process this drug information is described 

in Vital andHealth Sstatistics, Series ~-NO. 90. I2 

In addition to counting the number of drugs prescribed 

during a visit and the percent of visits in which one or 

more drugs were ordered (drug visits), drug utilization may 

be measured by two utilization rates (table B). The drug 

mention rate is the number of drug mentions divided by 

all visits. The drug intensity rate is the number of drug 

mentions divided by the number of drug visits. Differences 

in drug mention rates and drug intensity rates by type of 

practice were not statistically significant. 

Drug mentions are listed by the therapeutic effects they 

are intended to produce in table 2. Therapeutic categories 

are based on the American Hospital Formulary Service classification system (AHFS) (see appendix IV).13 In the NAMCS 

drug file each drug entry was assigned to one AHFS category, 

although for some drugs more than one therapeutic effect 

is possible. The range of drugs used by Ob-Gyn’s is narrower 

than the average use in NAMCS. Five categories constituted 

61 percent of all mentions. Hormones and synthetic substitutes 

(26 percent), skin and mucous membrane preparations (11 

percent), vitamins (19 percent), and blood formation and 

coagulation (5 percent) were mentioned proportionately more 

often by Ob-Gyn’s than by all other physicians. Anti-infective 

agents (16 percent) were used in about the same proportion 

in Ob-Gyn’s visits as in those of all other physicians, but 

other classes of drugs were used less frequently than average. 

The distribution of therapeutic categories by type of practice 

were similar. Specific drugs are discussed in the section 

“Patient condition and management.” 

The limited use of drug therapy by Ob-Gyn’s is a reflection of the 63 percent of visits with principal diagnoses 

in the supplementary classification, which consists mainly 

of health services and examinations where medication is not 

Table B. Number of office visits to obstettician-gynecologists, number and percent of drug visits, number of drug mentions, drug mention rate per visit, 

and drug intensity rate per drug visit, by type and location of physician’s practice: United States, January 1980-December 1981 

Number of Drug Drug 

Number of Drug Percent dnrs mention intensity 

visits in visits in drus mentions in rate rate per 

Type and location of practice thousands thousands’ visits thousands per visit 2 drug visit 3 

Type of practice 

All types of practice. . . . . . . . . . . . . . . . 109.035 45,369 41.6 61,204 0.56 1.35 

Solo....................... 48,512 22,528 46.4 31,373 0.65 1.39 

Othe? . . . . . . . . . . . . . . . . . . . . . 60,522 22,840 37.7 29,632 0.49 1.31 

Geographic region 

Northeast . . . . . . . . . . . . . . . . . . . . . 26,385 9,756 37.0 12,063 0.46 1.24 

North Central . . . . . . . . . . . . . . . . . . . 26,935 11,024 36.1 13,926 0.48 1.26 

South . . . . . . . . . . . . . . . . . . . . . . . 30,921 15,970 51.7 23,425 0.76 1.47 

West . . . . . . . . . . . . . . . . . . . . . . . 22,794 8,618 37.8 11,791 0.52 1.37 

Area 

Metropolitan . . . . . . . . . . . . . . . . . . . . 89,110 36,188 40.6 48,576 0.55 1.34 

Nonmetropolitan . . . . . . . . . . . . . . . . . 19,925 9,181 46.1 12,626 0.63 1.38 

‘A visit in which 1 or more drugs were prescribed.

2Drcg mentions divided by number of visits. 

%rug mentions divided by number of drug visits. 

%?cludes parb?ership,group. and other types of practice. 

5 
generally indicated. This is in contrast to the 18 percent 

of all physicians’ visits in this category. The principal (firstlisted) diagnoses rendered by physicians during visits are 

listed by categories based on the International Classification 

of Diseases, 9th Revision, Clinical Modification (ICD-9-

CM)i4 in table I. Consistent with the pattern of visits based 

on the reason for visit, diagnoses in the supplementary classification group were more commonly rendered in multiple practice situations than in solo practices. Diseases of the genitourinary system was the second ‘largest category of diagnoses 

treated by Ob-Gyn’s (I9 percent) and this exceeded the national average of 6 percent. Proportions of this category 

were similar for all types of practice. 

In about 3 percent of all NAMCS visits, the duration 

of the visit was shown as 0 minutes, indicating that the 

patient was seen by a member of the physician’s staff rather 

than by the physician. However, for Ob-Gyn’s, less than 

1 percent of the visits were so recorded. When patients 

were seen by the physician, the average encounter lasted 

13.9 minutes. The mean duration varied by the patient’s 

visit status and diagnosis, but not by the type of practice 

visited. Mean duration in terms of diagnosis and visit status 

is explored in the section “Patient condition and management.” 

A higher than average number of Ob-Gyn’s visits culminated with appointments for return visits (76 percent, compared with the NAMCS average of 61 percent). This disposition, together with the high proportion of return visits and 

the large number of visits for preventive care, suggests careful 

patient surveillance by Ob-Gyn’s as well as patient compliance. This pattern was evident regardless of type of practice. 

Patterns of care did not vary appreciably among geographic regions. There were proportionately fewer visits to 

Ob-Gyn’s in the West Region than in other regions, which 

is consistent with the NAMCS average for all specialties. 

Less visits to Ob-Gyn’s (and to all physicians) in the West 

Region (excluding Alaska and Hawaii) may be expected because statistics of the American Medical Association indicate 

proportionately fewer office-based physicians in that area 

than in the other three regions. ” 

Physicians in metropolitan areas treated proportionately 

more patients 25-44 years of age (58 percent) than physicians 

in nonmetropolitan areas did (50 percent). But the latter 

saw more patients 15-24 years of age (36 percent) than 

the former (30 percent). These differences may be due to 

the distribution of the population in these areas, or to a 

tendency ,of women in metropolitan areas to delay childbearing 

because prenatal care is a large part of the Ob-Gyn’s practice. 

Visits by diagnoses are discussed in the section “Patient 

condition and management.” 

Management of patients in metropolitan and nonmetropolitan areas varied for only one diagnostic service used 

by Ob-Gyn’s, and for some forms of therapy provided. Compared with physicians in nonmetropolitan areas, those in 

metropolitan locations performed proportionately more Pap 

tests (31 ,percent, compared with 23 percent) and provided 

more family planning therapy (17 percent, compared with 

13 percent) (table 3). Physicians in nonmetropolitan areas 

were more likely to provide medical counseling (31 percent, 

compared with 24 percent), and to prescribe drugs (46 percent 

were drug visits, compared with 41 percent for metropolitan 

physicians). 

Relatively short visits (less than I1 minutes) were more 

likely in nonmetropolitan offices (63 percent) than in metropolitan offices (46 percent). Relatively long visits (16 minutes 

and longer) were proportionately more numerous in metropolitan offices. 

Physician age and sex 

The relationship of the physician’s age and sex to the 

organization and content of practice is explored in this section. 

On the average, Ob-Gyn’s had 68.5 patient visits per week 

(table C). Except for physicians 65 years of age and over 

who had 40.6 visits per week, the age of the physician 

had little observable effect on the number of visits. Like 

female general and family practitioners and pediatricians’ v2, 

female Ob-Gyn’s saw fewer patients in an average workweek 

(49.0 office visits) than their male counterparts did (69.5). 

The mean duration of visits for physicians up to 64 years 

of age hovered around the average of 13.9 minutes, but 

for those 65 years and over the average visit lasted 17.9 

minutes. Similar to female physicians in general and family 

practice and pediatrics, female Ob-Gyn’s also had longer 

visits on the average than males did. 

Characteristics of visits to Ob-Gyn’s are shown for physician age groups in table 3. Drug mentions are listed by 

therapeutic category and physician age groups in table 4. 

The reader will note that in previous tables the rounded 

total of visits was about 109.0 million and the number of 

drug mentions was about 61.2 million. However, in tables 

3 and 4 the comparable totals are 107.2 million and 60.1 

million, respectively. This is because tables relating to the 

age of the physician do not include visits to doctors of 

osteopathy, because data on the age of these physicians were 

unavailable. It is not likely that the distribution of visits 

with the omission of the 1.8 million visits to doctors of 

osteopathy would differ significantly from the distribution 

that includes them. Tabulations are not shown separately 

Table C. Average number of office visits per week and mean duration of 

visits to obstetrician-gynecologists, by age and sex of physician:

United States, January 1980.December 1981 

Age and sex of physician’ 

Age 

All ages ................ 

Under 35 years ........... 

35-44 years. ............ 

45-54 years ............. 

55-64 years .............. 

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

Sex 

Female ................ 

Mele .................. 

‘Does not include doctors of osteopathy. 

Average Mean 

number of duration 

visits per of visit 

physician in 

per week minutes 

66.5 13.9 

66.1 12.0 

72.3 14.6 

72.1 13.2 

66.4 13.6 

40.6 17.9 

49.0 17.1 

69.5 13.8 

6 
Table D. Number of office visits to obstetrician-gynecologists, number and percent of drug visits, number of drug mentions, drug mention rate per visit, 

and drug intensity rate per drug visit, by age and sex of physician: United States, January 1980-December 1981 

Drug Dw Drug 

All visits Drug Percent mentions mention intensi~ 

Age and sex in visits in drug in rate rate per 

of ohvsician’ thousands thousand8 visits thousands per visit 3 visit 4 

All ages _ . . . . . . ...... 107,263 44,701 41.7 60,i 12 0.56 1.34 

Under 35 years . . ...... . . 7,876 3,690 46.9 4,434 0.56 1.20 

35-44 years. . . . ...... 37,760 14,389 38.1 19,038 0.50 1.32 

45-54 years. . . . ...... 37,354 15,168 40.6 19,545 0.52 1.29 

55-64 years. . . : ...... 18,565 7,625 41 .o II ,002 0.59 1.44 

65 years and over ...... 5,668 3,630 67.6 6,093 1.07 1.59 

Sex 

Female . . . . . . . . . . . . . . . . . . 3,969 2,072 52.2 3,149 0.79 1.52 

Male. . . . . . .’ . . . . . . . . . . . . . 103,295 42,629 44.8 56,964 0.55 1.34 

‘Does not include doctors of osteopathy.

2A visit in which 1 or more drugs were prescribed. ‘Drug mentions divided by number of visits. ‘Drug mentions divided by number of drug visits. 

Table E. Percent distribution of office visits to obstetrician-gynecologists

by type and locatiin of physician’s practice, according to sex of 

physician: United States, January 1980-December 

I

1981 . 

Sex of physic/an 

Type and location Both 

of physician’s practice sexes Female Male 

Percent distribution 

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

Type of practice 

Solo . . . . . . . . . . . . . . 44.5 63.5 43.8 

Other’ _ _ _ . . . . . . . . . . 55.5 36.5 56.2 

Geographic region 

Northeast . . . . . . . . . . . 24.2 27.7 24.1 

North Central . _ . . . . . . . 26.5 31.9 26.3 

South . . . . . . . . . . . . . 28.4 27.1 28.4 

West . . . . . . . . . . . . . 20.9 13.3 21.2 

Area 

Metropolitan . . . . . . . . . . 61.7 96.0 81.2 

Nonmetropolitan . . . . . . . 18.3 4.0 18.8 

‘Includes partnership, group, and other types of practice. 

for female and male physicians in tables 3 and 4, because 

detailed analysis of the relatively small number of visits 

to female physicians (about 4.0 million, compared with 105.1 

million to males) would not provide reliable statistics in 

all areas of concern. However, table D contains information 

on medication therapy by sex of the physician. The statistics 

on type and location of practice in table E are also shown 

separately for female and male physicians. 

The’relationship between the age of the physician and 

the age of the patient that was demonstrated in the two 

previous specialty profiles’,2 persisted for obstetrics and 

gynecology. Although the patient load of all Ob-Gyn’s is 

dominated by patients 15-44 years of age, the proportion 

of visits by patients in that age group decreased with the 

advancing age group of the physician. Concomitantly, proportions of visits by patients 45 years and over increased. This 

phenomenon can be seen in figure 3. Another characteristic 

that appears to be related to the age of Ob-Gyn’s, as well 

as of pediatricians and general and family practitioners, is 

the type of practice. As illustrated in figure 4, proportions 

of visits of physicians in solo practice increased from the 

age group 45-54 years on. Proportions of multiple-practice 

visits are likely to be higher at younger ages. This is consistent 

with projections made by the American Medical Association.’ 

That is, as young physicians enter the practice of medicine, 

they tend to join group practices. 

When the age group of patients changes in accordance 

with the age group of the physician, as shown in figure 

3, the clinical characteristics of the visits change in tandem. 

Nonillness care (principally prenatal care and gynecological 

examinations) constituted 75 percent of the visits to physicians 

under 35 years of age in stark contrast to the 47 percent 

for the same purposes to physicians 65 years of age and 

over. Except for a plateau between 35 and 54 years, the 

proportion of visits for nonillness care decreased from one 

age group to the next older, as did principal reasons for 

visit in the diagnostic, screening, and preventive module. 

On the other hand, physicians over 65 years of age were 

more likely to see patients who presented symptoms or complaints (40 percent) than younger physicians were (26 percent 

of visits to those in age group 55-64 years, and 16 percent 

to those under 35 years). 

Although a one-to-one association between the principal 

reason for visit and the principal diagnosis is not expected 

in NAMCS, it is clear that they are highly correlated within 

specific physician age groups. For the youngest age group 

of physicians the supplementary classification constituted 75 

percent of the visits. For the oldest group the comparable 

proportion was 33 percent. Thus, the relationship demonstrated 

among physician age group, the major reason for the visit 

assigned by the physician, and the principal reason for the 

visit given by the patient was preserved. Furthermore, proportions of visits with diagnoses in the category of diseases 

of the genitourinary system increased with the increasing 

age group of the physician, suggesting also an association 

between such diagnoses and the age of the patient. Patient 

1 

7 
Patients 15-44 

60 

/ / /’ 

Patients 45 years / 

and over / 

/ 

/ 

,’ 

,, yy , , , 

Under 35-44 45-54 55-64 65 years 

35 and over 

Age of physician in years 

NOTE: Does not include doctors of osteopathy 

Fgure 3. Percent of office visits to obstetrician-gynecologists by age of 

patient and age of physician: United States, January 1980-December 

1981 

age and diagnosis are discussed in the section “Patient condition and management.” 

Physicians over the age of 44 years were less likely 

to use the limited history and/or examination for diagnosis 

than younger physicians were, but they were more likely 

to give Pap tests. Probably because they saw proportionately 

more’patients over 44 years of age, physicians over 54 years 

of age were less likely to provide family planning therapy 

than younger physicians whose patients were chiefly in the 

childbearing years were. Physicians 65 years of age and 

over prescribed one or more drugs (drug visits) in 68 percent 

of their office visits, a larger proportion than that of their 

younger counterparts. However, when drugs were used for 

therapy, the average number prescribed during a visit was 

similar for all age groups of physicians because the drug 

intensity rates did not differ significantly among them (table 

W. 

An inverse relationship between the duration of the visit 

and the average number of visits per week was observed. 

8’ 

80 

60 

*

C 

.y 50 z 

E 

8

5 

a 40 

30 

20 

IO 

0 I I I I I 

Under 35-44 45-54 55-64 64 and 

35 over 

Age of physician in years 

NOTE: Does not include doctors of osteopathy. 

Figure 4. Percent of office visits to obstetrician-gynecologists, by type

of practice and age of physician: United States, January 1980-

December 1981 

The oldest group of physicians, who had the smallest average 

number of visits per week (40.6, table C) had the highest 

proportion of relatively long visits (16 minutes or more). 

However, younger physicians with a higher number of average 

weekly visits had proportionately more short visits (less than 

1I minutes) than physicians 65 years of age and over did. 

This does not appear to be an isolated statistic. The mean 

duration of visits to female Ob-Gyn’s with average weekly 

visits of 49.0 was 17.1 minutes; however, males saw 69.5 

patients for an average duration of 13.8 minutes. These data 

suggest that when estimating physician productivity a valid 

measure would be a combination of the number and the 

duration of visits. The usefulness of this idea was demonstrated 

in an earlier report from NAMCS, “Characteristics of Visits 

to Female and Male Physicians,” in which it was shown 

that although female physicians in general and family practice 

and internal medicine saw fewer patients in the average workweek than males in the same specialties did, they spent 

the same average number of hours per week in direct patient 

care. I6 

Female Ob-Gyn’s in solo practice had proprtionately more 

visits than their male counterparts did (44 percent). Visits 

to female Ob-Gyn’s in metropolitan areas were proportionately 
more numerousthan thoseto male Ob-Gyn’s in similar locations (96 percent, comparedwith 81 percent). The data on 

solo practice are similar for female Ob-Gyn’s and pediatricians. The tendencytowards metropolitanlocation is similar 

for female Ob-Gyn’s, pediatricians, and general and family 

practitioners.‘,2 In generalthe patient and clinical characteristics of visits to female Ob-Gyn’s were similar to those of 

male Ob-Gyn’s with a few exceptions.There were no visits 

to female physicians by male patients. Female Ob-Gyn’s 

were more likely than male Ob-Gyn’s were to have new 

patientsand to use PAP tests, laboratorytests, blood pressure 

checks, and diet counseling during visits. The difference 

in the proportionsof drug visits to female and maleOb-Gyn’s 

(tableD) was not statistically significant. 

9 
Patient characteristics 

The demographiccharacteristicsof female patients who 

visited obstetrician-gynecologistsare presentedin table 5. 

The numberof visits madeby male patientsduring the 2-year 

period is so small (1.1 million) comparedwith those made 

by female patients (107.9 million) that any discussion of 

visit characteristicsis, for all intentsandpurposes,a discussion 

of visits by females. The unreliability of some estimates 

basedon visits by male patientsprecludesextensiveanalysis. 

However, becausethere may be interest in knowing why 

male patients visit specialists who treat women primarily, 

some of the more salient characteristicsof visits by males 

is providedin the section“Patientconditionandmanagement.” 

Age, race, and ethnicity 

Patients 15-44 years of age constituted 88 percent of 

females’visits to Ob-Gyn’s in contrast to 45 percent of 

females’visits to all specialists, underscoringthe primary 

focus of obstetrical and gynecologicalpractice. Proportions 

of visits to Ob-Gyn’s by this age group did not vary by 

raceor ethnic@. 

In NAMCS about 6 percent of all females’visits to 

Ob-Gyn’s were made by Hispanic patients, comparedwith 

5 percent of females’visits to all specialists, a small but 

statistically significant difference. Black femalesvisited ObGyn’s in aboutthe sameproportionas they visited all specialists. 

Visit rates 

As expected, the highest visit rates were for patients 

25-44 years of age (about 95 visits per ,100 females that 

age in the population), followed by 81 visits for each 100 

females 15-24 years of age. Although general visit rates 

did not vary significantly by race or ethnicity, black females 

15-24years of age visited at a lower rate than white females 

did, and Hispanic females 25-44 years of age visited at 

a lower ratethannon-Hispanicfemalesdid. 
Patient condition 

and management 

In this section, the clinical characteristicsof visits are 

presentedin relation to the age and prior visit status of 

patients. Three age groups are used in this sectionTunder 

25 years, 25-44 years, and 45 years and over. Because 

patientsunder 15 years of age constitutedless than.1 percent 

of, all visits, and those 65 years and over about 2 percent 

of all visits, separateand meaningfnl analysis for these age 

groupswas not feasible. Condition of the patient is explored 

in tables 6-11 by means of patients’reasonsfor visit and 

physicians’diagnoses.In tables 12-15 statistics are presented 

on patient managementexemplified by the Ob-Gyn’s’use 

of diagnostic tools, nonmedicationtherapy, and medication 

therapy, as well as the duration and disposition of the visit. 

In table 16, patients’reasonsfor visit are analyzed by the 

diagnostic services ordered or provided in their presence. 

The nonmedicationtherapy, number of medicationsordered 

or prescribed, and the duration and disposition of visits for 

patients in the four leading diagnostic categoriesare shown 

in table 17. To concludethe description of patient management, the meanduration of visits for selectedprincipal,diagnosesis shownin table 18. 

Patient age 

By definition, obstetrics is the medical managementof 

women during pregnancy, childbirth, and the puerperium. 

Gynecology is the treatment of diseasesof female genital, 

. urinary, and rectal organs. The patternsof care that emerged 

from the analysis of ambulatory care renderedin the dual 

specialty of obstetrics and gynecology highlight two of the 

significantmedicalphasesin women’slives-the childbearing 

years, menopauseand postmenopause.The characteristics 

of visits to Ob-Gyn’s by patients in the age groups in this 

reporttendto form clustersrelatedto theselife cycles. 

Nonillness care was the major reasonfor visit regardless 

of age group. However, after 44 years of age the proportion 

of visits in this category dropped by about a third, from 

64 percent of visits by patients 25-44 years to 38 percent 

by patients45 yearsand over (table 6). The principal reasons 

for visits expressedby the oldest group were more likely 

to be symptomatic(38 percent)or for treatmentof a previously 

diagnosedconditon (10 percent)than those given by younger 

patients were. Younger patients proportionately more frequently requesteddiagnostic or preventive care. Regardless 

of the age group, most visits were by patients the physician 

had seenbefore and were retuning for care of a continuing 

problem. New patients were most likely to be those under 

25 years of age (16 percent, comparedwith 10 percent of 

older groups). The ratio of return visits to initi,al visits did 

not differ within sampling variability for age groups 25-44 

years and 45 years and over. However, it can be seen in 

tables 7 and 8 that the relatively high return visit ratios 

for theseage groups were probably due to different reasons. 

The most frequentspecificprincipal reasonsfor visit expressed 

by patientsare listed in descendingorder of number of visits 

in table 7. In table 8 principal reasonsfor visit are ranked 

separatelywithin age groups. The reader is cautioned that 

some estimates may not differ from other near estimates 

dueto samplingvariability. Therefore,ranksmay be somewhat 

artificial. 

Routineprenatalexaminationswere given as the principal 

reasonfor visit in 35 percent of all office encounters.The 

secondleadingreason(10 percentof visits) was gynecological 

examination. Three family planning reasons together accountedfor 4 percentof the visits. However, family planning 

services were actually provided more frequently .than the 

reasonfor visit alone indicatesbecausethey were often indicated as a diagnosisor nonmedicationtherapy when patients 

visited for other reasons.Contraceptivemanagementis discussedin the section on diagnosis, and family planning is 

included in the analysisof nonmedicationtherapy. Similarly, 

a Pap smear, which was the patient’s reason for 2 percent 

of the visits, actually was more frequently indicated on the 

form as a diagnostic service than it was a reason for the 

visit. A distinguishing characteristicbetween a service that 

is given as a reason for the visit and one that is listed 

as therapy is often that it is an indication of the patient’s 

motivation in the former and the physician’s judgment in 

the latter. 

The sametive leadingprincipal reasonsfor visit (prenatal 

examination, gynecological examination, postpartumexamination, postoperativevisit, generalmedical examination)accounted for 59 percent of visits by patients under 25 years 

of age and 60 percent of those by patients 25-44 years 

of age (table 5). Postoperativevisits and examinationsconstituted 36 percent of the principal reasons by patients 45 

years of age and over. Patients 45 years of age and over 

were more likely to visit for gynecological examinations 

(18 percent) than younger patients were (8 percent). The 

oldest group also had more postoperativevisits (9 percent), 

comparedwith 4 percentfor patientsunder45 years). 

The relationshipof patternsof obstetricaland gynecological care to the age of the patients is further reflected in 

the principal diagnosiscategoriesshownin table9. For patients 

11 
45 years of age and over there were proportionately more 

visits for neoplasms; endocrine, nutritional, metabolic diseases 

and immunity disorders; diseases of the circulatory system; 

and diseases of the genitourinary system. For patients under 

45 years of age visits in the supplementaty classification 

were proportionately higher. The detailed breakdown of the 

supplementary group of health services that is provided in 

table F reveals that the dominance of visits in this category 

by patients under 45 years of age was due mainly to the 

preponderance of visits for normal pregnancy. However, for 

patients over 44 years of age, proportionately more visits 

in this category were for followup examination following 

surgery, general medical examination, and gynecological 

examination than those of younger patients were. Contraceptive management accounted for a larger share of the supplementary classification for patients under 45 years of age 

(6 percent) than of those older (about 1 percent). 

When developing a profile of obstetiical and gynecological practice, it is instructive to examine the most frequent 

diagnoses in terms of their total distribution among specialties. 

Diseases of the genitourinary system constituted 19 percent 

of visits to Ob-Gyn’s, and three health services (normal 

pregnancy, gynecological examination, contraceptive management) together accounted for 49 percent (table IO). Of the 

total visits to physicians in all specialties for treatment of 

diseases of the genitourinary system, Ob-Gyn’s had the largest 

proportion (39 percent) (figure 5). Of all visits for normal 

pregnancy, 77 percent were to Ob-Gyn’s; 85 percent of all 

gynecological examinations were to Ob-Gyn’s; and 76 percent 

of all visits for contraceptive management were to Ob-Gyn’s. 

The most frequent specific diseases of the genitourinary 

system ,diagnosed during visits may be found in table 10. 

Inflammatory disease of cervix, vagina, and vulva (4 percent); 

disorders of menstruation (3 percent); and menopausal and 

postmenopausal disorders (2 percent) were among the leading 

conditions. For patients under 25 years and 25-44 years 

of age the first two genitourinary disorders accounted for 

Table F. Number of office visits to obstetrician-gynecologists, and percent

classification and age of patient: January 1g80-December 1981 

4 percent and 3 percent of each group’s visits, respectively. 

Menopausal and postmenopausal disorders was the most common diagnosis rendered for patients 45 years of age and 

over, and it constituted 14 percent of their visits. Patients 

over 44 years of age were more likely to visit for inflammatory 

disease of ovary, fallopian tube, pelvic cellular tissue, and! 

peritoneum (4 percent) than patients 25-44 years old were 

(1 percent). Other problems that were proportionately more 

frequent in visits by the oldest patients than in those by 

the two younger groups were uterine leimyoma (benign neoplasm, fibroid, 4 percent) and genital prolapse (3 percent). 

Because of the nature of the conditions treated in obstetrical and gynecological practice, it differs from other specialties 

in the provision of certain diagnostic services. Visits which 

included a Pap test ranged from 23 percent of those made 

by patients under 25 years of age to 47 percent of those 

by patients 45 years and older (table 12). By contrast, Pap 

tests performed by all other specialists were included in 

4 to 5 percent of visits by females 15-64 years of age 

and 2 percent of those by females 65 years of age and 

over (figure 5). There was a similar decrease in Pap tests 

used by Ob-Gyn’s for patients over 64 years of age. When 

the proportion of Pap tests performed by Ob-Gyn’s is plotted 

separately for patients 45-64 years of age and those 65 years 

of. age and over, as shown in figure 6, it is apparent that 

they occur with proportionately less frequency in visits by 

the older group. Higher than average proportions of clinical 

laboratory tests were ordered or provided by Ob-Gyn’s for 

females in all age groups (figure 7), although such tests 

were ordered proportionately less often for patients 65 years 

of age and over than for the younger age groups. Blood 

pressure was measured in proportionately more of females’ 

visits to Ob-Gyn’s (68 percent) than in females’ visits to 

all other specialists (34 percent), and percents of Ob-Gyn’s 

visits remained constant regardless of the patient’s age group. 

By contrast, proportions of visits with blood pressure checks 

made by all other specialists increased with the patient’s 

of office visits, by selected principal diagnoses in the supplementaty 

Age of patient 

Under 45 years 

45 and 

Selected principal diagnosis and ICD-9-CM code’ years over 

Number in thousands 

Allvisits................................................................... 64,134 3,986 

Percent of visits 

Normal pregnancy ..................................... . . . v22 61.2 *5.7 

Postpartum care and examination .............................. . . . V24 5.3 

Contraceptive management .......................... v25 5.5 *0.6 

Prescription or surveillance of oral contraceptives .............. . . . v2;.u;, V25.41 1.2 

Initiation of other contraceptive measures (diaphragm, foams, creams, etc.) . .... v25.02 l 0.5 

Other (e.g., family planning advice) ......................... v25.09 1.0 

Insertion or surveillance of intrauterine contraceptive device ........ . . V25.1, V25.42 1.8 l 0.6 

Followup examination following surgery ......................... V67.0 4.7 22.9 

General medical examination. ............................... , . v70 4.1 14.2 

Gynecological examination ................................ , V72.3 13.0 40.6 

‘Based on International Cfassifbation of Diseases, 9th Revision, Cfinical Modification.‘d 

12 
All other 

specialties * 

2.4% 2.0% 

80 -

20 . 

0 l -

Diseases of the Normal Gynecological Contraceptive 

genitourinary pregnancy examination management 

system 

Faure 5. Percent distribution of office visits, by selected principal diagnoses and physician specialty: United States, January 1980-December 1981 

advancing age group, ranging from 28 percent for patients 

15-24 years to 48 percent for patients 65 years and over 

(figure 8). 

The proportion designated “Other” diagnostic services 

was higher than average for Ob-Gyn’s (7 percent of all 

Ob-Gyn’s visits, compared with 4 percent of visits to all 

other physicians). Because the Patient Record form is used 

for over 50 different specialties, it is not feasible to list 

the diverse diagnostic services likely to be used by all of 

them. Therefore, it does not include some services used 

by the Ob-Gyn’s, such as pelvic examination, breast examination, and sonogram. The absence of these or other options 

on the form may partially account for the greater use of 

the “Other” category in Ob-Gyn’s visits. Furthermore, there 

were proportionately fewer “Other” diagnostic services rendered in visits by patients over 44 years of age (4 percent) 

than in those by younger patients (8 percent) suggesting 

a relationship between the omitted tests and patients in the 

childbearing years (table 12). 

Medical counseling and family planning were the nonmedication therapy most commonly used by Ob-Gyn’s, accounting for 26 percent and 16 percent of visits, respectively. 

Proportions of visits with medical counseling were relatively 

constant across age groups. As expected, family planning 

therapy was less likely for patients over 44 years of age 

(1 percent) than for younger patients (16 percent of visits 

by patients 25-44 years of age and 21 percent of visits 

by patients under 25 years of age). 

Because of the prominence of family planning visits 

to Ob-Gyn’s by patients under 45 years of age, the most 

commonly used class of drugs was hormones and synthetic 

substitutes (29 percent of drugs mentioned for patients under 

25 years of age and 22 percent for patients 25-44) (table 

13). This class of drugs was also predominant for patients 

over 45 years of age (33 percent), but it consisted largely 

of estrogens for the older patients (24 percent) and contraceptives for the younger patients (18 percent) (table G). Patients 

in the age group under 45 years were more likely than 

13 

9 
60 

50 

C

lo 

,g 40 

z 

e

(u

2 

2 30 

20 

10 

0 

Obstetrics and gynecology 

All other 

specialists 

15-24 25-44 45-64 65 and 

over 

Age in years 

Figure 6. Percent of office visits made by women .that included a Pap 

test, by age of patient and physician specialty: United States, 

January 1960~December 1981 

60 c 

50 

40 

u) .Z.F 

B 30 

E 

E 

6 

a 

20 

10 

0 c 

1 

Obstetrics and gynecology 

Y 

All other specialists 

‘\ )-I­

‘\,@, 

I I I I 

15-24 25-44 45-64 65 and 

over 

Age in years 

Fvure 7. Percent of office visits made by women that included a clinical 

laboratory test, by age of patient and physician specialty: United States, 

January 1960-December 1981 

80 

Obstetrics and gynecology 

60 -

(0.Z 

.$ 50 All other specialists 

z 0’ E

8 0’ 

zi /’ 

0. 40 - / 

// 

30 - cc*H d’ 

20 -

10 -

0 I I I I 

15-24 25-44 45-64 65 and over 

Age in years 

Figure 6. Percent of office visits made by women that included a blood 

pressure check, by age of patient and physician specialty:’ 

UnitedStates, January 1960-December 1961 

those who were older to be treated with antianemiadrugs 

(5 percent for the former, comparedwith 1 percent for the 

latter)andmultivitamin preparations(20 percentand 3 percent, 

respectively). Patients45 years of age and over were more 

likely’to be treated with hypotensive agents (6 percent for 

the older group and less than 1 percent for the younger 

group), sedativesand hypnotics (5 percent and 2 percent, 

respectively),and diuretics (6 percentand 1 percent, respectively). Thesedataexemplify the correlationof drug utilization 

with the conditions likely to be presentedby patients in 

each age group. Furthermore,they are consistent with the 

general findings in NAMCS that indicate-a higher rate of 

drugs prescribed for older than for younger patients. For 

patients45 years and over, one or more drugs were ordered 

or prescribedin 52 percent of their visits, compared,with 

37 percentof the visits by patients25-44 years of’age (table 

12). : 

The specific drugs named by Ob-Gyn’s are listed in 

table 14. The same caveat regarding rank order given for 

the listing of diagnosesapplies to the listing’of drugs. The 

reader is also reminded that numbers of drug mentions are 

14 
Table G. Number of drug mentions in office visii to obstetriciangynemlogiis by age of patient, and percent of drug mentions by selected therapeutic

categories and age of patient: United States, January 1980-December 1981 

Age of patient 

Under 45 years 

All 45 and 

Selected therapeutic categmy: ages years over

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ 

Anti-infective agents .................................................... 

Antibio~cs ......................................................... 

Sulfonamides ....................................................... 

Trichomonacides ..................................................... 

Urinary germicides .................................................... 

Blood formation and coagulation .............................................. 

Antianemia drugs. .................................................... 

Cardiovascular drugs .................................................... 

Hypotensive agents ................................................... 

Central nervous system drugs ............................................... 

Analgesics and antipyretics ............................................... 

Sedatives and hypnotics ................................................. 

Electrolytic, caloric, and water balance. .......................................... 

Diuretics ......................................................... 

Hormones and synthetic substitutes ............................................ 

Contraceptives ...................................................... 

Estrogens ......................................................... 

Progestogens....................................................... 

Skin and mucous membrane preparations ......................................... 

Anti-infectives........................................................ 

Anti-inflammatory agents ................................................. 

Vitamins ........................................................... 

Vitamins (unspecified) ................................................... 

Multivitamin preparations ................................................. 

‘Based on the classification system of the American Hospital Fomwlary Service.‘3 

for a i-year period. The drugs are listed according to the 

physician’s entry on the Patient Record Form. It can be 

seen in table 14 that the mode of entry was almost always 

the brand name of the drug. The principal generic entities 

are shown in table 14 in parentheses, and a therapeutic 

use is provided. For some drugs more than one therapeutic 

use may be possible. The association between the utilization 

of certain classes of drugs and the patient’s age group has 

already been demonstrated in this report. Therefore, age 

groups are not shown in table 14. It is apparent that a 

wide variety of oral contraceptives were utilized. Among 

these were ortho-novum, lo/ovral, ovral, norinyl, demulen, 

loestrin, ovcon, and modicon. The principal estrogen replacement therapy used was premarin (4 percent). Other drugs 

such as monistat (used for Candidiasis, 4 percent), flagyl 

(used for trichomoniasis, 2 percent), and sultrin (for vaginal 

infections, 1 percent) reflect the range of diagnoses made 

by Ob-Gyn’s. It should be noted that in some instances 

the magnitude of mentions of a specific drug is limited 

or enhanced by the availability in the market of different 

brands of the same generic entity. 

The duration of visits to Ob-Gyn’s was also related 

to the age of the patient. Proportions of relatively short 

visits (less than 11 minutes) decreased with advancing age 

groups, ranging from 54 percent of visits by patients under 

25 years of age to 33 percent ,of those by the oldest group 

Number in thousands 

. _ . _ _ . _ _ _ . _ . . _ _ . _ _ 61,204 50,352 

Percent of drug mentions 

15.9 17.0 

9.2 10.0 

0.9 0.9 

4.9 5.2 

0.8 0.9 

4.7 5.3 

4.5 5.2 

1.9 ‘0.5 

1.3 ‘0.4 

7.7 7.1 

4.4 4.5 

2.3 1.7 

3.0 1.7 

2.3 1.4 

26.0 24.6 

15.2 18.4 

6.3 2.4 

2.7 2.5 

10.7 10.9 

6.9 7.3 

1.7 1.4 

19.3 22.3 

1.8 2.2 

16.7 19.7 

10,852 

10.7 

5.2 

“1.1 

l 3.6 

l 0.6 

‘2.1 

‘1.4 

8.7 

5.9 

10.2 

*3.5 

5.1 

8.6 

6.1 

32.7 

“0.5 

24.1 

3.1 

10.0 

5.2 

‘3.2 

5.4 

‘0.2 

‘2.7 

(table 15). Relatively long visits (16 minutes or more) were 

proportionately more frequent for the oldest group (34 percent) 

than for the two younger groups (24 percent of visits by 

patients 25-44 years of age and 20 percent of visits by 

patients under 25 years of age). These observations are consistent with those based on all NAMCS visits. 

Male patients 

Male patients, representing a broad range of age groups, 

made an estimated 1,143,OOOvisits to Ob-Gyn’s in the 2-year 

period. Based on this number it is difficult to identify a 

typical pattern or to determine why males visited physicians 

whose specialty is treating female problems. However, the 

statistics based on their visits suggest a pattern that is closer 

to that of general medicine than the pattern that evolved 

for females’ visits. Male patients presented symptomatic 

reasons in 47 percent of their visits. Major reasons for visit 

were categorized as acute or chronic problems more often 

than as nonillness or other types of care. Surprisingly, 93 

percent of their visits were return visits for new or continuing 

problems, and in 65 percent physicians gave instructions 

to return at a specific time; thus, ruling out a hypothesis 

that males made casual, dropin visits to Ob-Gyn’s. Because 

their visits were more likely to be related to illness than 

to preventive care, 77 percent of visits by male patients 
Table H. Number of office visits to obstetrician-gynecologists, number and percent of drug visits, number of drug mentions, drug mention rate’& visii 

and drug intensity rate per drug visit, by selected characteristics: United States, January 1989-December 1981 

Selected characterisfic 

Sex of patient 

Both sexes . . . . . _ . . . . . . . . . 

Female . . . ,. . . . . . . . . . . . . . 

Male . . . . . . . . _ _ . . . . . . . . . . 

Age of patient 

Under 25 years . . . . . . . . . . . . . . . . . 

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

45yearsandover . . . . . . . . . . . . . . . . 

Race 

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

Black . . . . . . . . . . . . . . . . . . . 

Other . . . . . . . . . . . . . . . . . . . . . . . 

Ethnicity 

Hispanic. , . . . . . . . . . . . . . 

Non-Hispanic . . . . . . . . . . 

‘A visit in which 1 or mom drugs were prescribed.

2Number of drug mentions divided by number of visits. 

3Numbsr of drug mentions divided by number of drug visits. 

Drug Drus DNs 

All Drus Percent mentions mention intensiiy 

visits in visits in dnrs in rate rate per 

thousands thousands’ visits thousands per visit 2 drug visit 3 

109,035 45,369 41.6 61,204 0.56 1.35 

107,892 44,484 41.2 59,407 0.55 1.34 

1,143 885 77.4 1,798 1.57 2.03 

34,574 16,129 46.7 20,802 0.60 1.29 

81,233 22,395 36.6 29,550 0.48 1.32 

13,228 6,844 51.7 10,852 0.82 1.59 

95,107 38,622 40.6 51,135 0.54 1.32 

12,190 6,069 49.8 9,201 0.75 1.52 

1,737 678 39.1 888 0.50 1.28 

6,139 2,569 42.2 3,299 0.54 1.27 

102,895 42,780 41.8 57,905 0.56 1.35 

included one or more drugs, in contrast to 41 percent of 

visits by females (table H). The limited history and/or examination, which is commonly used with returning patients, 

was indicated in 72 percent of the visits by male patients. 

Blood pressure was measured in 43 percent. Therapy, other 

than medication, was not given in 53 percent of males’ 

visits and family planning was not a measurable aspect of 

the males’visits. 

Prior visit status 

In NAMCS, visits are assigned to one of three categories: 

Patients the physician had not seen before (new patiefits); 

patients the physician had seen before, but presenting new 

problems; and old (returning) patients,“presenting old (continuing) problems. These 3 categories may be reduced to 2 

categories by combining the first two, thus creating a category 

of new problems (as opposed to old problems that are assigned 

to only the last category). 

The major reasons for most new problem visits were 

either acute problems or n&illness care. However, the major 

reasons for old problems were overwhelmingly nonillness 

care (71 percent) (table 6). As a ,result, patients who visited 

for care of continuing problems were less likely to present 

symptoms as their principal reasons for visit than patients 

with new problems were. Disease categories such as infectious 

and parasitic diseases, and diseases of the genitourinary system 

were more commonly diagnosed during new problem visits 

than during bid problem visits. Office surgery was performed 

in about 8 percent of the visits for new problems, compared 

with 4 percent of those for old problems (table 12). Family 

planning was also a more likely service when patients presented new problems. 

When d&a on the purpose of the visit and the nonmedication therapy used in connection with it are examined, the. 

status of the problem is of interest. However, in other instances 

the status of the patient affects the utilization of health care. 

The categories “old patient, new problem” and “old patient, 

old problem” may be combined to form the category of 

“old patients” (as opposed to “new patients”). The type of 

examination used was related to the status of the patient, 

but not the status of the problem. Old patients, regardless 

of whether the problem was new or old, were given a limited 

history and/or examination in proportionately more visits than 

new patients were. New patients were more likely to have 

the more comprehensive general history and/or examination. ’ 

This was probably because data on old patients were available. 

in their medical files. New patients were also more likely 

to have Pap tests (5 1 percent) than old patients were. 

The duration of visits made by new patients was likely 

to be longer than that of visits by old patients, and old. 

patients with new problems had longer than old patients’ 

with old problems. This hrogression is shown in table J. 

Table J. Percent of oftice visits to obstetrician-gynecobgii by

duration and status of visit: United States, January 198C 

December!1981 

Duration of visit 

L&s than 16 minutes 

Status of visit II minutes or more 

Percent of vi+ 

New patient . . . . . . . . . . . . 23.7 51.6 

Old patient, new problem . . . . . . . 41 .I 30.3 

Old patient, old problem . . . . . . 54.9 18.0 

16 
About 52 percent of the visits by new patients lasted more 

than 15 minutes, compared with 31 percent and 18 percent 

of the 2 groups of old patients, respectively. Conversely, 

55 percent of the visits by old patients with old problems 

were relatively short (less than 11 minutes), compared with 

41 percent of the visits by old patients with new problems 

and 24 percent of those by new patients. This -relationship 

has been evident throughout previous NAMCS analyses. 

Reasons for visit and 

diagnostic services 

The options that physicians may select to indicate their 

use of diagnostic services on the Patient Record form are 

shown in table 16. As mentioned previously, the large proportion in the “other” category suggests that these selected services may not adequately describe the extent of services 

used in obstetrical and gynecological practice. When the 

major reason for visit was nonillness care (the principal care 

classification in the Ob-Gyn’s practice) proportionately more 

clinical laboratory tests (48 percent) and blood pressure checks 

(78 percent) were ordered or provided than when other types 

of care were provided. In addition, the proportion of “other” 

services was higher (9 percent) than that of the visits for 

other major reasons for visit, and also higher than the NAMCS 

average (7 percent). Therefore, this part of the pattern is 

less clear than other areas are. 

Principal diagnosis and 

therapy, duration, disposition 

Four groups of principal diagnoses accounted for about 

88 percent of the visits to Ob-Gyn’s. These four groups 

(shown in table 9) were infectious and parasitic diseases 

(3 percent); diseases of the genitourinary system (19 percent); 

complications of pregnancy, childbirth, and the puerperium 

(3 percent); and the supplementary classification (63 percent). 

In table 17, visits for these conditions are distributed by 

proportions of nonmedication therapy and number of medications ordered or provided in their presence. It is apparent 

that nonmedication therapy was not a common event during 

these visits because at least 44 percent of them included 

no nonmedication services. This proportion was highest when 

visits were due to infectious and parasitic diseases (56 percent) 

or in the supplementary classification (54 percent). When 

therapy was indicated it was likely to consist of family planning and medical counseling. These two forms of therapy 

accounted for 35 percent of the visits for infectious and 

parasitic diseases; 49 percent of those for diseases of the 

genitourinary system; 43 percent of those for complications 

of pregnancy, childbirth, and the puerperium; and 40 percent 

of those in the supplementary classification. When patients 

were diagnosed in the last 3 groups, medication therapy 

was not likely to be prescribed because the largest proportion 

of each group’s visits included none. However, 58 percent 

of the visits for infectious and parasitic diseases included 

one medication. Patients with diseases of the genitourinary 

system were given one medication in 38 percent of their 

visits. 

Duration of the visit varied from the average of 13.9 

minutes for all Ob-Gyn’s visits when certain characterisitcs 

were present. One of these characteristics was the diagnosis. 

The mean duration of visits for the most frequent diagnoses 

is shown in table 18. Visit length exceeded the average 

when visits were for uterine leimyoma; other disorders of 

urethra and urinary tract; inflammatory disease of cervix, 

vagina, and vulva; endometriosis; genital prolapse; noninflammatory disorders of cervix; pain and other symptoms associated with female organs; disorders of menstruation; 

menopausal and postmenopausal disorders; contraceptive management; nonspecific abnormal histological and immunological fmdings; and general medical examination. Less than 

average time was used when patients’ diagnoses were essential 

hypertension, normal pregnancy, or observation and evaluation ,for suspected conditions. Many of the lengthier visits 

involved diseases of the genitourinary system, and it can 

be seen in table 17 that, as a class, 37 percent of such 

visits exceeded 15 minutes. This was a higher proportion 

than those of the 3 groups so analyzed. Since normal pregnancy was the predominant diagnosis in the supplementary 

classification, and since such visits were shorter than average, 

it is not surprising to find that the highest proportion of 

short visits (lasting less than 11 minutes) was for this category 

(table 17). 

The other characteristic that affects visit duration and 

that was shown previously to be related to it is the patient’s 

prior visit status. When this variable is used in conjunction 

with the patient’s diagnosis, a pattern emerges that is consistent 

with the previous findings. Selected principal diagnoses are 

listed in table K with the mean duration, according to prior 

visit status. Only those diagnoses where visits provided a 

reliable basis for duration estimation were used for this analysis 

because not all diagnoses had enough visits by new patients 

for a meaningful comparison. In every case, shown in table 

K, the duration of visits by new patients exceeded that of 

old patients. The status of the problem (new or old) affected 

the duration of visits for menopausal and postmenopausal 

disorders, and normal pregnancy. When patients the physician 

had seen before presented these two conditions as new problems, the mean duration was also longer than when they 

were old problems. 

A high proportion of visits by returning patients for 

care or monitoring of continuing problems is often associated 

in NAMCS with a high proportion of visits that culminate 

in the physician’s instructions to return at a specific time. 

For the four diagnostic categories shown in table 17 this 

was the most likely disposition, especially for visits in the 

supplementary classification where appointments for return 

visits were scheduled in 83’percent of such visits. 
Table K. Mean duration of office visits to obstetriciangynecologists, by selected principal diagnoses and prior visit status: United States, January 1980. 

December 1981 

Prior visit status 

Old patient 

Selected principal diagnosis All New 

and ICC-9-CM code’ oatients oatient New oroblem Old oroblem 

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Infective and parasitic diseases ..................... 000-139 

Candidiasis ................................. 112 

Diseases of the genitourinary system .................. 580-629 

Inflammatory disease of cervix, vagina, and vulva ............ 616 

Pain and other symptoms associated with female organs ........ 625 

Disorders of menstruation and other abnormal bleeding 

from female genital tract ......................... 626 

Menopausal and postmenopausal disorders. ............... 627 

Supplementary classification ...................... VOl-V82 

Normal pregnancy ............................. V22 

Contraceptive management ........................ V25 

General medical examination ....................... V70 

Gynecological examination ........................ V72.3 

‘Based on htemational Ckssification of Diseases, 9th Revision, Clinical Modification.‘4 i 

18 

Mean duration in minutes 

13.9 19.7 15.2 12.5 

14.3 1 a.5 13.0 13.5 

14.7 18.0 13.0 14.9 

16.2 20.0 15.6 15.2 

16.2 19.4 15.1 15.5 

16.8 19.0 15.5 16.1 

16.1 18.6 15.6 15.2 

16.5 22.6 17.4 14.5 

12.6 19.3 14.9 11.5 

10.7 18.7 15.7 9.6 

16.4 23.2 16.5 14.6 

17.9 19.7 l 14.4 17.9 

15.9 19.4 15.4 15.5 
Conclusion 

The patternsof ambulatory care that emergedfrom this 

study of obstetrical and gynecologicalpractice did not vary 

appreciablyby physician, patient, or clinical characterisitcs. 

However, the general practice pattern underscoredthe visit 

characteristicsthat distinguish obstetrical and gynecological 

practice from others. Those differences among the various 

profiles of Ob-Gyn’s that were-statistically significant were 

small and not of major consequence.However, the age and 

sex of the patient were the two. most potent determinants 

of the contentof obstetricalandgynecologicalpractice, which 

was also true of general and family practice, pediatrics, 

and internal medicine, among others. The influence of the 

patient’s sex in the Ob-Gyn’s practice .is obvious. Patients 

were predominantly women in the childbearing age group, 

15-44 years, who visited Ob-Gyn’s for prenatal care, 

gynecological examinations, family planning, or disorders 

of the femalereproductivesystem.Older women were treated 

principally for menopausaland postmenopausaldisordersor 

genital tract disorders. Preventive care for this group was 

chiefly in the form of gynecologicalexaminationor followup 

following surgery. The tendency of older patients to visit 

old physicians who were likely to be in solo prcatice was 

similar to thepatternsof otherspecialists. 

Comparison with all specialties 

The principal points of departure between the pattern 

of obstetrical and gynecological practice, and that of all 

physicians in NAMCS are listed in table L. In addition 

to the higher proportions of visits to bb-Gyn’s by women 

15-44 yearsthan to all physicians, Ob.-Gyn’streatedproportionately more patients for nonillness care, and provided 

more Pap tests, clinical laboratory tests, X-rays, and blood 

pressurechecks.Family planning therapywas proportionately 

more often a part of the Ob-Gyn’s visit than of other physicians. Proportionsof visits to Ob-Gyn’s for diseasesof the 

genitourinary system and for examinationswere also higher 

than those of other physicians were. On the other hand, 

patients visiting Ob-Gyn’s were’less likely to present with 

symptomsor to have diseasesof the respiratoryor circulatory 

systemsthan patientsvisiting all other physicianswere. The 

last two diseasecategorieswere the leading groupsof conditions seen by all other physicians in contrast to those seen 

by Ob-Gyn’s where proportionsof visits for thesediagnoses 

wererelatively small. 

Comparison with 1975 data 

A comparisonof 1975 and 1980-81data revealedsome 

differences in the patterns of practice during the 2 time 

periods (table M). However, the reader is cautioned that 

a difference between 2 points in time does not necessarily 

indicate a trend. In 1975Ob-Gyn’s accountedfor 8.5 percent 

of the visits to all specialists. In 1980-81 this proportion 

was 9.4 percent, a small but statistically significant increase. 

In contrast to other specialists where proportions of visits 

to solo practice physicians decreased,visits to Ob-Gyn’s 

in solo practice in 1980-81were proportionatelyhigher than 

similar visits in 1975. In 1980-81 they saw more patients 

who visited for normal pregnancy, and used more blood 

pressurechecks and clinical laboratory tests than they did 

in 1975. However, proportions of visits for diseasesof the 

Table L. Percent ol office visits to obstetriciangynecol~ists and to all physicians, by selectad visii charactefistics: United States, January 1980-

December 1981 

Selected visit charact&stic 

Femalepatients ........................................................... 

Patients 15-44 years of age .................................................... 

Nonillness care as major reason for visit. ............................................. 

Principal reason for visit in symptom module ............................................ 

Principal reason for visit in diagnostic, screening, and prevention module ............................ 

Pap test provided as a diagnostic service ............................................. 

Clinical laboratory test, ordered or provided ............................................ 

X-ray, drdered or provided ..................................................... 

Blood pressure check ........................................................ 

Family planning therapy, ordered or provided ........................................... 

Diseases of the genitourinary system (principal diagnosis) .................................... 

Diseases of the respiratory system (principal diagnosis) ............................. i ....... 

Diseases of the circulatory system (principal diagnosis) ....... : .............................. 

Supplementary classification (principal diagnosis) .......................................... 

‘Based on total visits by female patients 15 years of age and over. 

Obstetrician- All 

gynecologists physicians 

Percent of visits 

99.0 60.3 

67.0 40.6 

61.9 17.6 

23.5 54.1 

61.9 19.5 

29.4 ‘6.5 

42.6 21.9 

7.5 1.6 

66.4 34.2 

15.6 2.1 

19.1 5.9 

0.7 12.6 

1.3 9.7 

62.5 17.5 

19 
Table M. Percent of office visitsto~obstetdciangyneco@ists, by

selected visii clwacteristics: United States, 1975 and 1990-81 

Selected visit characteristic 1975 1980-81 

Percent of visits 

Visits to all specialists . . . . . . . 0.5 9.4 

Visits to solo practices . . . . 39.0 44.5 

Blood’pressure check . . . . 57.4 66.4 

Clinical laboratory test . . . . . . 52.4 42.0 

Normal pregnancy 

(principal diagnosis) . . . . . . . 31.4 36.2 

Diseases of the genitourinary 

system (principal diagnosis) . . . 10.7 19.1 

Infectious and parasitic 

diseases (principal diagnosis) . . 3.6 3.2 

genitourinary system, and infectious and parasitic diseases 

remainedaboutthe sametime. 

The comparisonof data acrosstime periods was limited 

by the comparabilityof both the reasonfor visit classification 

system and the diagnostic coding system in use during the 

periodscontrasted.Changesmadein the PatientRecord form 

also curtailed analysis.For example, the proportion of visits 

with one or ‘more drugs prescribed in 1975 was about 36 

percent. In the more recent study this proportion was 42 

percent.However, the.two are not really comparablebecause 

“drug prescribed”was simply an option in the list of services 

printedon the 1975form, and on the 1980-81form physicians 

were requestedto actually write in the names of drugs. 

Sucha listing increasedthe likelihood of a response. 

Hospital care 

The data collectedby meansof the National Ambulatory 

Medical Care survey are generalizableonly to the universe 

of office-basedphysicians.However, office-basedphysicians, 

and surgical specialists in particular, spend time in seeing 

and treating hospitalizedpatients. It was reportedin another 

study’ that about 24 percent of all patient encountersin 

obstetrical and gynecological practice are in the hospital. 

When telephoneencountersare excluded, the proportion of 

inpatientencountersincreasesto 30 percent. 

As may be expected, delivery and postpartumcare accounted for about 30 percent of the principal diagnosesof: 

Ob-Gyn’s inpatients. The report also indicated that there 

were hospital visits for malignant neoplasmsand diseases 

of the genitourinary system, but there was no information 

on whether surgery was performed. However, the second 

leadingdiagnosis,medicaland surgicalaftercare( 18 percent), 

suggeststhat surgeryoccurred. 

According to unpublisheddatafrom the National Hospital 

DischargeSurveyI7 there were 3.9 million women with deliveries in 1981, and 4.2 million operationson the female 

genital organs. It was estimatedin a 1977 manpowersurvey 

by the American College of Obstetriciansand Gynecologists 

that Ob-Gyn’s assistedin 81 percentof hospital deliveries.I8 

There are no recent national data on the proportion of 

gynecologicalsurgeryperformedby Ob-Gyn’s or other physicians. However, in a 1970 study sponsoredby the American 

College of Surgeonsand American Surgical Association, it 

was estimatedthat in four selectedgeographicareasin the 

United States, Ob-Gyn’s were the surgeons for about 72 

percent of diagnostic dilation and curettageproceduresperformed in one area, 54 percent in another area, 51 percent 

in the third area, and 89 percent in the fourth. I9 For the 

same four areas, percentsof abdominal hysterectomiesperformed by Ob-Gyn’s were 64 percent,52 percent,54 percent, 

and65 percent,respectively. 

20 
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21 
List of detailed tables 

3. 

9. 

Number of office visits to obstetrician-gynecologists by 

type and location of physician’s practice, and percent 

distribution of office visits by selected visit characteristics, 

according to type and location of physician’s practice: 

United States, January 1980-December 198 1. . . . . . 

Number of drug mentions in office visits to obstetriciangynecologists by type and location of physician’s practice, 

and percent distribution of drug mentions by selected 

therapeutic categories, according to type and location of 

physician’s practice; United States, January 1980-December 198 1. . . . . . . . . . . . . . . . . . . . . . 

Number of office visits to obstetrician-gynecologists by 

age of physician, and percent distribution of office visits 

by selected visit characteristics, according to age of physician: United States, January 1980-December 1981 . . . 

Number of drug mentions in office visits to obstetriciangynecologists by age of physician, and percent distribution 

of drug mentions by selected therapeutic categories, according to age of physician: United States, January 1980-December 1981. . . . . . . . . . . . . . . . . . . . . . 

Number of office visits for female patients by race and 

ethnic@; percent distribution of office visits by age of 

patient, according to race and ethnicity; and average annual 

visit rate by age, race, and ethnicity: United States, January 

1980-December 198 I. . . . . . . . . . . . . . . 

Number of office visits to obstetrician-gynecologists by 

age of patient and prior visit status; percent distribution 

of office visits by selected characteristics, according to 

age of patient and prior visit status; and return visit ratio 

by age of patient and prior visit status: United States, 

January 1980-December 1981. . . . . . . . . . . ‘. . . 

Number, percent, and cumulative percent of office visits 

to obstetrician-gynecologists, by most frequent principal 

reasons for visit: United States, January 1980-December 

1981. . . . . . . . . . . . . . . . . . . . . . . . . . 

Percent and cumulative percent of office visits to obstetrician-gynecologists, by age amd most frequent principal 

reasons for visit: United States, January 1980-December 

1981. . . . . . . . . . . . . . . . . . . . . : . 

Number of office visits to obstetrician-gynecologists by 

age of patient and prior visit status, and percent distribution 

of office visits by principal diagnosis categories, according 

to age of patient and prior visit status: United States, 

January 1980-December 198 1. . . . . . . . . . . . . . 

23 

26 

26 

29 

29 

30 

31 

32 

33 

10. Number, percent, and cumulative percent of office visits 

to obstetrician-gynecologists, by most frequent principal 

diagnosis categories: United States, January 1980-December 1981. . . . . . _ . . . . . . . . . . . . . . . , . 

11. Percent and cumulative percent of office visits to obstetrician-gynecologists, by age and most frequent principal 

diagnosis categories: United States, January 1980-December 1981. . . . . . . . . . . . . , . . . . . . . . . 

12. Number of office visits to obstetrician-gynecologists by 

age of patient and prior visit status; percent of office 

visits, by age of patient; prior visit status, diagnostic 

services, and nonmedication therapy; and percent distribution of office visits by number of medications, according 

to age of patient and prior visits status: United States, 

January 1980-December 198 1. . . . . . . . . . . . . 

‘13. Number of drug mentions in office visits to obstetriciangynecologists by age of patient and prior visit status, 

and percent distribution by selected therapeutic categories, 

according to age of patient and prior visit status: United 

States, January 1980-December 198 1. . . . . . . . . . 

14. Number, percent, and cumulative percent of drugs most 

frequently mentioned in office visit to obstdtriciangynecologists, by name and therapeutic use: United States, 

January 1980-December 198 1. . . . . . . . . . . . . . 

15. Number of office visits to obstetrician-gynecologists by 

age of patient and prior visit status, and percent distribution 

of office visits by duration and disposition of visit, according to age of patient and prior visit status: United States, 

January 1980-December I98 1. . . . . . . . . . . . . . 

16. Number and percent of office visits to obstetriciangynecologists, by diagnostic services, major reasons for 

visit, and principal reason for visit module: United States, 

January 1980-December 198 1. . . . . . . . . . . . . 

17. Number of office visits to obstetrician-gynecologists by 

principal diagnosis categories, and percent of office visits 

by selected characteristics and principal diagnosis 

categories: United States, January 1980-December 1981. 

. . . . . . . . . . . . . . . . . . . . . . , . . . . . * 

18. Mean duration of office visits to obstetrician-gynecologists, 

by selected principal diagnoses: United States, January 

1980-December 198 1. . . . . . . , . , , . . . . . . . 

33 

34 

35 

36 

36 

37 

38 

39 

40 

22 
Table 1. Number of office visits to obstetrician-gynecologists by type and location of physician’s practice, and percent distribution of office visits by 

selected visit characteristics, according to type and location of physician’s practice: United States, January 1980-December 1981 

Type of practice Geographic region Area 

All @pe.s 

Selected visit of North Noncharacteristic practice Solo Other’ Northeast Central South West Metropolitan metmpolitan 

Number in thousands 

All visits ................................ 109,035 46,512 60,522 26,365 28,935 30,921 22,794 89,110 19,925 

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

Sex of patient 

Female ................................ 

Mate .................................. 

Age of patient 

Under 15 years ............................ 

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

2.544 years .............................. 

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

65yearsand over .......................... 

Prior visit status 

New patient .............................. 

Old patient, new problem ....................... 

Old patient, old problem ....................... 

Referral status 

Referred by another physician .................... 

Not referred by another physician .................. 

Major reason for visit 

Acute problem ............................ 

Chronic problem, routine ....................... 

Chronic problem, flareup ....................... 

Postsurgery or postinjury ....................... 

Nonillness care ............................ 

Principal reason for visit and RVC code2 

Symptom module ..................... SOOlS999 

Disease module ...................... DO01 -D999 

Diagnostic, screening, and preventive 

module ......................... X100-X599 

Treatment module .................... TlOO-T899 

Injuries and adverse effects 

module ......................... JOOl-J999 

Test results module .................... RlOO-R700 

Administrative module .................. AlOO-A140 

CtheP ................................. 

Diagnostic service4 

None .................................. 

Limited history and/or examination .................. 

General history and/or examination ............... 1 . 

Pap test ................................ 

Clinical laboratory test ........................ 

X-ray ................................. 

Blood pressure check ........................ 

Electrocardiogram .......................... 

Endoscopy .............................. 

Mental status examination ...................... 

Other ................................. 

See footnotes at end of table. 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

99.0 98.4 99.4 99.5 99.4 98.8 98.0 99.1 98.4 

1.1 1.6 ‘0.6 l 0.5 l .6 ‘1.2 2.1 0.9 l l .6 

0.9 1.1 ‘0.7 ‘1.1 ‘1 .o ‘0.8 l 0.8 0.7 ‘1.8 

30.8 32.1 29.8 29.7 31.6 32.6 28.8 29.6 35.5 

56.2 52.7 58.9 56.4 58.8 53.5 56.1 57.5 50.1 

9.6 11.2 6.3 10.4 7.0 10.3 10.9 9.5 10.0 

2.5 2.9 2.3 2.4 1.6 2.9 3.4 2.5 2.6 

11.8 11.9 11.8 12.2 10.0 12.1 13.2 12.0 10.9 

17.5 17.4 17.6 17.2 18.1 17.1 17.8 18.7 12.8 

70.7 70.7 70.6 70.6 71.9 70.6 69.0 69.4 76.5 

3.1 2.6 3.4 2.8 2.7 2.6 4.5 3.1 2.9 

96.9 97.4 96.6 97.2 97.3 97.4 95.5 96.9 97.1 

16.3 19.0 17.7 19.5 15.8 17.1 21.6 18.8 16.0 

6.3 10.0 6.9 7.5 6.5 8.2 11.5 8.2 8.6 

4.5 4.2 4.7 3.9 4.0 8.2 3.3 4.8 3.1 

7.1 7.5 6.9 6.9 6.4 7.8 7.5 8.9 8.4 

61.9 59.4 63.9 62.2 67.3 60.8 56.1 61.4 63.9 

23.5 25.1 22.1 22.3 21.4 25.9 24.1 23.8 22.0 

3.9 5.5 2.7 3.8 2.2 3.6 6.4 3.8 4.7 

6T.9 58.9 64.3 61.5 68.2 58.3 59.2 61.9 61.7 

7.2 6.9 7.4 7.5 6.0 8.1 7.0 7.1 7.2 

0.4 l 0.8 l 0.2 l 0.1 l 0.3 ‘0.4 l i .o ‘0.5 ‘0.3 

1.1 ‘0.9 1.2 ‘1.3 ‘0.8 l 1 .o ‘1.4 1.1 ‘1.0 

‘0.3 l 0.2 ‘0.4 ‘0.3 l 0.2 ‘0.3 *0.4 ‘0.3 *0.4 

1.7 1.7 1.7 3.2 l 0.9 2.2 l 0.5 1.5 2.7 

2.4 2.8 2.0 2.1 1.9 2.9 2.5 2.3 2.9 

64.0 60.4 66.9 ’ 65.2 67.9 61.2 61.5 64.2 63.3 

17.7 19.2 16.5 23.3 13.5 19.4 14.3 17.9 16.9 

29.4 27.8 30.7 33.6 25.0 31.3 27.3 30.9 22.7 

42.8 42.3 43.3 39.2 39.5 51.4 39.7 42.6 43.9 

1.6 1.3 1.8 *1 .I 1.5 2.0 l 1.7 1.6 *I.8 

68.4 66.4 69.9 69.6 75.0 70.0 56.3 69.2 64.6 

l 0.3 ‘0.4 ‘0.3 l o.o ‘0.2 ‘0.6 ‘0.4 0.3 l 0.6 

0.8 1.1 l 0.6 ‘1.6 ‘0.2 ‘0.4 ‘1.3 0.9 ‘0.3 

0.8 l 0.2 1.3 “0.0 2.0 l 0.3 l 0.9 0.3 3.0 

7.3 7.7 7.0 8.4 5.7 4.9 11.6 8.3 3.9 

23 
Number of ofiice visits to obstetrician-gynecologists by type and location of physician’s practice, and percent distribution of ofke visits by

visii characteristics, according to type and location of physician’s practice: United States, January 198tSDecember 1981-Can. 

Type of practice Geographic region Area 

All types 

Selected visit of North Noncharacteristic practice Solo Other’ Northeast Central South West Metrooolitan metroDolifan 

Nonmedication therapy 

None ................................. 51.8 51.4 52.2 50.9 52.4 49.0 55.9 51.4 53.6 

Physidherapy ............................. 1.4 1.4 1.4 l 0.4 3.0 l 0.6 l 1.7 1.6 ‘0.4 

Office surgery. ............................ 4.8 4.3 5.2 6.3 3.5 4.0 5.7 5.0 3.9 

Family planning ............................. 15.8 15.4 16.2 16.4 16.6 13.7 17.2 16.5 12.8 

Therapeutic listening ......................... 2.7 2.1 3.2 2.3 3.4 2.8 ,2.1 2.5 3.6 

Diet counseling ............................ 7.6 8.9 6.6 6.2 8.7 9.8 4.9 7.0 10.2 

Family or social counseling ...................... 2.5 2.1 2.9 3.1 2.9 2.2 l 1.9 2.2 3.7 

Medical counseling .......................... 25.6 26.0 25.2 27% 23.2 30.6 19.4 24.3 31.3 

Other ................................. 1.1 1.3 0.9 l 1 .o l 1 .5 ‘1 .l l 0.8 1.3 *0.3 

Number of medications 

None ................................. 58.4 53.6 62.3 63.0 61.9 48.4 62.2 59.4 53.9 

I.................................... 30.3 32.5 28.6 29.8 29.4 33.5 27.7 29.6 33.2 

2 ..................................... 8.8 10.7 7.3 6.1 7.5 13.5 7.3 8.8 9.6 

3 .................................... 1.9 2.5 1.5 l 0.8 ‘1.1 3.7 2.0 1.8 2.5 

4ormore ............................... 0.6 0.8 0.4 ‘0.4 ‘0.1 ‘1.0 ‘0.8 l 0.5 l 0.8 

Principal diagnosis and ICD-O-CM code5 

Infectious and parasitic diseases .............. 000-I 39 3.2 3.1 3.3 2.7 4.0 3.0 3.1 3.5 ‘2.0 

Neoplasms ......................... 140-239 1.7 2.0 1.5 2.6 l 1.I 1.3 2.2 1.8 ‘1.3 

Endocrine, nutritional and metabolic diseases, 

and immunity disorders .................. 240-279 1.3 1.6 1.0 ‘I .o l 0.6 2.2 l 1.3 1.2 l 1 .7 

Mental disorders ...................... 290919 ‘0.4 ‘0.5 ‘0.3 l 0.1 “0.1 ‘0.7 ‘0.6 ‘0.4 ‘0.4 

Diseases of the nervous system and 

senseorgans. ...................... 320-389 l 0.1 l 0.1 l 0.2 ‘0.0 l 0.2 ‘0.3 *0.1 ‘0.1 

Diseases of the circulatory system ............. 390-459 1.3 2.0 0.8 l 0.3 l 0.6 2.2 2.3 1 .o 2.7 

Diseases of the respiratory system ............. 460-519 0.7 1.1 ‘0.5 ‘0.3 ‘0.6 ‘1.3 ‘0.6 0.8 *1.2 

Diseases of the digestive system ............. 520579 0.7 0.8 ‘0.6 l 0.3 l 0.8 ‘1 .o l 0.4 0.7 l 0.6 

Diseases of the genitourinary system ........... 580-629 19.1 19.7 18.6 19.6 15.3 20.9 21 .o 19.3 18.1 

Complications of pregnancy, childbirth, and 

the puerperium ...................... 630-676 2.7 2.8 2.6 2.7 2.4 2.3 3.5 2.6 3.0 

Diseases of the skin and subcutaneous 

tissue ........................... 680-709 0.5 0.7 ‘0.4 ‘0.6 “0.3 ‘0.7 ‘0.5 ‘0.4 ‘0.9 

Diseases of the musculoskeletal system 

and connective tissue .................. 710-739 0.6 ‘0.9 “0.4 ‘0.5 ‘0.2 ‘0.9 ‘0.9 0.6 l 0.5 

Symptoms, signs, and ill-defined 

conditions ......................... 780-799 1.8 1.5 2.1 1.7 2.2 1.7 l 1.7 1.9 ‘1.4 

Injury and poisoning .................... 800-999 1.0 1.3 ‘0.7 l 0.9 ‘0.6 ‘1 .o *I .5 0.9 l 1.1 

Supplementary classification ................ VOl -V82 62.5 60.1 64.4 64.1 68.6 57.9 59.1 62.3 63.5 

All other diagnoses .......................... 0.3 ‘0.3 ‘0.4 ‘0.3 *0.2 ‘0.4 ‘0.4 0.4 *0.2 

Unknown diagnoses ......................... 2.1 1.6 2.4 2.3 2.5 2.2 1.0 2.2 l 1.3 

Duration of visit 

0 minutes6 ............................... 0.9 0.9 1.0 l 0.1 ‘0.7 2.2 l 0.5 1 .o l 0.6 

1-5 minutes .............................. 18.0 17.0 18.9 12.0 23.0 16.0 21.4 16.0 26.9 

6-10 minutes ............................. 30.7 31.9 29.8 28.6 36.2 29.3 28.1 29.5 36.2 

11-15 minutes. ............................ 26.2 25.3 26.9 30.1 23.6 26.4 24.6 27.3 21 .I 

16-30 minutes. ............................ 21.7 22.5 21.6 27.2 14.9 22.7 22.5 23.7 12.8 

31 minutes or more .......................... 2.5 2.5 2.5 2.0 1.6 3.3 2.9 2.5 2.4 

Disposition of visit’ 

No followup planned ......................... 6.7 6.5 6.8 6.7 9.7 4.0 6.6 7.0 5.4 

Return at specified time ....................... 75.7 75.1 76.1 79.1 72.3 76.4 75.1 75.6 75.8 

Return if needed ........................... 15.3 16.3 14.6 12.6 16.1 16.3 16.3 14.6 18.8 

Telephone followup planned ..................... 2.3 2.5 2.2 3.0 1.8 2.2 2.3 2.1 3.5 

Referred to other physician ...................... 1.8 1.7 1.9 l 1 .6 l 1.5 2.1 2.0 1.6 l i .7 

Returned to referring physician .................... 0.7 ‘0.8 l 0.7 ‘0.6 l 1 .o l 0.6 l 0.8 0.7 l 0.9 

Admit to hospital ........................... 3.0 3.1 2.9 2.6 3.7 3.5 ‘1.9 2.9 3.3 

Other ................................. ‘0.1 l 0.1 ‘0.1 l 0.1 l 0.1 l 0.1 l 0.2 l 0.2 l 0.1 

‘Includes partnership, 9mup, and other types of practice. 

ZBased on A Reason for visit Classification for Ambulatory Care.” 

%cludes blanks: problems, complaints not elsewhere classified: entry of “none:” and illegible entries. 

%ercents will not total 100.0 because more than 1 service may have been rendered during a visit. 

‘Based on International Classification of Diseases, 9th Revision, Clinical Modification. ‘4 

‘Represents visits in which there was no face-to-face encounter between patient and physician. 

‘Percents will not total 100.0 because more than 1 disposition was possible. 

24 
Table 2. Number of drug mentions in office visits to obstetriciangynecololgists by type and location of phykian’s practice, and percent distribution of 

dtug mentions by selected therapeutic categories, according to type and locatiin of physician’s practice: United States: January 198D-December 1981 

Type of practice 

Selected All types 

theraouetic categow’ of practice Solo OtheF 

All categories . . . . . . . . . . . . . . . . 61,204 31,373 29,832 

Geographic region Area 

North Metro- NonmetroNortheast Central South West potitan politan 

Number in thousands 

Antihistamine drugs . . . . . . . . . . . . . 

Anti-infective agents . . . . . . . . . . . . 

Autonomic drugs . . . . . . . . . . . . . . 

Blood formation and 

coagulation . . . . . . . . . . . . . . . . 

Cardiovascular drugs . . . . . . . . . . . . 

Central nervous system drugs . . . . . . . 

Electrolytic, caloric, and 

water balance . . . . . . . . . . . . . . 

Expectorants and cough 

preparations . . _ . . . _ . _ . . . _ _ . 

Gastrointestinal drugs . . . . . . . . . . . 

Hormones and synthetic 

substitutes . . . . . . . . . . . . . . . . 

Skin and mucous 

membrane preparations . . . . . . . . . 

Vitamins. . . . . . . . . . . . . . . . . . . 

Other, unclassified, or 

undetermined . . . . . . . . . . . . . . . 

‘Basedon the classificationsystemof the American 

100.0 100.0 100.0 

2.2 2.6 1.9 

15.9 15.3 16.6 

1.5 1.3 1.7 

4.7 5.3 4.0 

1.9 2.9 ‘0.9 

7.7 7.2 8.2 

3.0 3.1 2.9 

0.9 ‘1 .o ‘0.8 

1.9 1.7 2.2 

26.0 24.7 27.4 

10.7 11.2 10.2 

19.3 18.8 19.8 

4.2 5.0 3.5 

12,063 13,926 

Percent distribution 

100.0 100.0 

2.2 2.1 

17.0 13.4 

‘0.9 ‘1 .I 

4.6 4.1 

l 0.6 l 0.6 

6.3 8.2 

l l .8 l 3.1 

l 0.8 l 0.4 

1.7 1.9 

26.2 25.0 

12.4 11.0 

20.8 24.7 

4.9 4.4 

23,425 11,791 48,576 12,628 

100.0 100.0 100.0 100.0 

2.6 1.8 2.1 ‘2.8 

15.3 18.9 16.6 12.6 

l 1.7 ‘2.1 1.5 *I .6 

6.2 ‘2.6 4.6 5.0 

2.8 3.2 1.3 4.5 

8.4 7.0 7.9 6.7 

3.7 ‘2.8 2.9 ‘3.2 

l 1.5 l 0.4 l 0.6 l 2.0 

2.2 *I.6 2.0 ‘1.5 

24.9 29.3 26.5 24.2 

10.8 8.7 11.1 9.2 

17.4 15.2 18.4 22.6 

2.6 6.5 4.3 4.0 

Hospfal Fomwlary Service.‘3 

*Includespartnership.group.andothertypesof practice. 

Table 3. Number of offfce visits to obstebician-gynecologists by age of physician, and percent diitribufion of office visii by selected visii charactetfstics, 

according to age of physician: United States, January 1980-December 1881 

Age of physician’ 

Under 65 years 

Selected visit characteristics All ages 35 years 3.544 years 45-54 years 55-64 years and over 

All visits . . . . . _ . . . . . . . . . . . . . . . . . . . . . _ _ . _ _ . . 107,263 7,876 

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

Sex of patient 

Female .................................. 99.1 100.0 

Mate .................................... 0.9 

Age of patient 

Under 15 years .............................. 0.6 ‘0.6 

15-24 years ................................ 30.8 40.1 

25-44years ................................ 56.3 55.3 

45-64years ................................ 9.6 ‘3.0 

65 years and over ............................ 2.6 l 1.1 

Prior visit status 

New patient ................................ 11.8 13.4 

Old patient, new problem ......................... 17.5 17.4 

Old patient, old problem ......................... 70.6 69.3 

Referral status 

Referred by another physician .......... .’........... 3.1 2.9 

Not referred by another physician .................... 96.9 97.2 

Seefootnotesat end ot table. 

Number in thousands 

37,780 37,354 18,585 5,668 

Percent distribution 

100.0 100.0 100.0 100.0 

99.4 99.7 96.6 99.4 

l 0.6 l 0.3 3.2 ‘0.6 

‘0.6 ‘I .o ‘0.9 l 1.2 

34.7 29.5 25.2 17.6 

57.7 59.1 51.5 45.1 

5.4 8.4 17.6 28.9 

1.6 2.1 4.8 ‘7.0 

13.1 11.2 10.8 6.5 

16.3 17.6 19.8 18.2 

70.6 71.2 69.4 73.3 

3.3 3.1 2.8 3.3 

96.7 96.9 97.2 96.7 

25 
Table 3. Number of office visits to obstetrician-gynecologists by age of physician, and percer6 distribution of oftice visits by selected visit characteristics, 

according to age of physician: United States, January 199CkDecember 1981-&n. 

Age of physician’ 

Under 65 years 

Selected visit characteristics All ages 35 years 3544 years 45-54 vears 55-64 vears and over 

Major reason for visit 

Acute problem .............................. 

Chronic problem, routine ......................... 

Chronic problem, flareup ......................... 

Post surgery or postinjury ........................ 

Nonillness care .............................. 

Principal reason for visit and WC code* 

Symptom module ....................... SOOlS999 

Disease module ........................ DOOlD 

Diagnostic, screening, and preventive 

module ........................... X100-X599 

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

Injuries and adverse effects module ............. JOOlJ999 

Test results module ...................... RlOO-R700 

Administrative module .................... AlOOA140 

CtheP ................................... 

Diagnostic service4 

None ................................... 

Limited history and/or examination .................... 

General history and/or examination ................... 

Pap test .................................. 

Clinical laboratory test .......................... 

X-fay ................................... 

Blood pressure check .......................... 

Electrocardiogram ............................ 

Endoscopy .............................. 

Mental status examination ........................ 

Other ................................... 

Nonmedication therapy4 

None ................................... 

Physiotherapy .............................. 

Dffice surgery ............................... 

Family planning .............................. 

Therapeutic listening ........................... 

Diet counseling .............................. 

Family or social counseling ........................ 

Medical counseling ............................ 

Other ................................... 

Number of medications 

None ................................... 

l...................................... 

2 ...................................... 

3 ...................................... 

4ormore ................................. 

See footnotes atend of table. 

Percent distribution 

18.4 12.6 19.1 17.2 21.5 19.1 

a.3 4.8 6.1 8.2 7.9 17.2 

4.3 '2.0 3.6 4.8 4.8 8.1 

7.2 5.7 7.1 7.0 6.1 8.7 

61.7 74.9 62.0 62.9 57.7 46.9 

23.4 15.6 22.7 22.0 25.9 39.9 

4.0 '3.1 3.3 2.9 6.3 8.6 

61.7 73.0 62.6 64.5 56.3 40.2 

7.3 '4.1 7.7 7.7 6.4 8.5 

'0.4 '0.2 l 0.3 l 0.2 l 1.2 '0.4 

1.1 l 0.3 '0.9 1.7 l 0.0 '0.5 

'0.3 l 0.3 '0.2 '0.3 l 0.4 l 0.5 

1.8 '3.4 2.3 l 0.7 l 2.7 .1.4 

2.3 '1.1 2.5 2.1 3.0 2.4 

63.9 69.5 70.8 63.4 53.3 46.2 

17.7 24.6 16.6 15.8 18.9 25.0 

29.6 23.1 26.1 30.6 32.6 46.7 

43.3 39.2 39.7 43.7 49.6 49.4 

1.6 '0.4 1.2 1.5 '1.7 *5.6 

68.9 67.0 69.0 69.0 68.7 71.4 

'0.3 l 0.3 l 0.1 "0.7 '1.1 

0.8 - '0.5 1.5 '0.6 "0.2 

0.7 "0.1 *0.2 1.6 '0.1 *0.1 

7.4 9.6 9.3 6.7 3.9 6.7 

51.4 51.0 49.2 56.2 45.9 52.2 

1.4 '0.5 2.3 l 0.6 1.8 0.8 

4.9 '3.8 5.3 4.6 5.2 l 3.9 

15.9 19.1 17.4 16.2 12.8 9.2 

2.7 '2.0 1.8 2.7 4.2 l 5.9 

7.6 6.6 7.4 6.7 9.6 10.2 

2.6 l 1.7 1.8 3.3 2.6 *4.1 

25.9 24.7 26.9 22.3 30.1 31.4 

1.1 '0.7 0.9 l 1.0 '2.0 '0.7 

56.3 53.2 61.9 59.4 59.0 32.4 

30.5 38.0 28.2 31.0 27.9 39.2 

6.8 8.2 8.0 7.9 9.3 18.7 

1.9 '0.6 1.5 1.3 2.8 7.9 

0.5 '0.4 "0.4 l 1.0 '1.8 

26 
Table 3. Number of office visits to obstetrician-gynecologists by age of physician, and percent distribution of office visits by selected visit characteristics, 

according to age of physician: United States, January 1980-December 1981-Can. 

Age of physician’ 

Under 65 years 

Selected visit characteristics All ages 35 years 35-44 years 45-54 years 5544 years and over 

Principal diagnosis and ICD-O-CM code5 Percent distrfbution 

infectious and parasitic diseases ............ : ... 000-139 3.2 l 2.9 3.0 3.6 3.2 ‘3.4 

Neoplasms ........................... 140-239 1.8 l 0.6 1.4 2.1 “1.5 ‘4.7 

Endocrine, nutritional and metabolic diseases 

and immunity disorders ................... 240-279 1.3 - l 0.8 1.3 ‘1.1 ‘6.8 

Mental disorders ........................ 290-319 l 0.4 *0.2 0.3 l 0.2 ‘I .o l 0.7 

Diseases of the nervous system and sense organs ...... 320-389 ‘0.1 ‘0.2 0.1 l 0.3 ‘0.0 

Diseases of the circulatory system ............... 390-459 1.3 l 0.4 l 0.6 ‘0.5 3.0 6.7 

Diseases of the respiratory system ............... 460-519 0.7 l 0.2 ‘0.5 l 0.4 ‘1.2 ‘2.5 

Diseases of the digestive system ............... 520-579 0.7 l 0.4 ‘0.6 ‘0.8 ‘0.3 l 0.9 

Diseases of the genitourinary system ............. 580-629 19.3 12.7 17.9 19.1 21.4 32.1 

Complications of pregnancy, childbirth, 

and the puerperium ..................... 630-676 2.7 4.8 3.2 2.3 2.2 ‘1.5 

Diseases of the skin and subcutaneous tissue ........ 680-709 0.5 0.6 ‘0.6 ‘0.5 l 0.5 

Diseases of the musculoskeletal system 

and connective tissue .................... 710-739 0.6 ‘0.3 l 0.7 ‘0.3 ‘1 .o ‘0.9 

Symptoms, signs, and ill-defined conditions .......... 780-799 1.8 l 0.6 2.1 2.0 ‘1.2 l 2.6 

Injury and poisoning ...................... 800-999 0.9 l 0.7 l 0.7 l 0.7 l 2.0 l 0.9 

Supplementary classification .................. VOl-V82 62.5 75.3 64.8 84.1 58.0 32.8 

All other diagnoses ............................ 0.3 0.4 0.2 0.3 0.3 1.1 

Unknown diagnoses ........................... 2.0 l 0.4 2.7 1.7 1.9 ‘2.0 

Duration of visit 

0 minutes* ................................ 1.0 3.4 1.6 ‘0.2 ‘0.4 l 0.1 

1’5 minutes ................................. 17.5 16.2 17.1 18.8 18.4 10.6 

6-10 minutes ............................... 30.7 49.8 27.4 32.6 30.6 14.9 ‘ 

11-15 minutes: .......................... : ... 26.4 17.3 27.2 27.6 25.0 30.3 

1690 minutes. .............................. 22.0 12.2 23.3 19.6 23.3 38.0 

31 minutes or more ............................ 2.5 l i .I 3.4 1.3 ‘2.4 l 6.1 

Disposition of visit 

No followup planned ........................... 6.4 6.3 5.9 7.5 6.3 ‘2.8 

Return at specified time ......................... 75.9 81.6 76.6 75.8 71.6 78.2 

Return if needed ............................. 15.4 9.0 19.1 13.2 14.9 17.0 

Telephone followup planned ....................... 2.3 ‘1.5 2.2 1.9 3.6 l 2.9 

Referred to other physician ........................ 1.8 ‘1 .o 1.6 1.6 l 1.9 l 2.8 

Returned to referring physician ...................... 0.8 ‘0.8 l 0.7 l 0.6 l 1.1 1.1 

Admit to hospital ............................. 3.0 ‘1.3 3.2 3.1 3.3 ‘3.5 

Other ................................... *0.1 ‘0.2 0.2 l 0.2 l 0.3 

Type of practice 

solo .................................... 44.9 38.3 44.6 34.7 57.9 81.3 

Others ................................... 55.1 61.7 55.4 65.3 42.1 18.7 

Geographic region 

Northeast ................................. 24.3 43.5 26.4 18.8 24.1 21 .o 

North Central ............................... 26.5 32.6 20.2 37.5 20.2 8.0 

South ................................... 28.8 19.9 29.4 25.1 29.6 59.1 

West ................................... 20.4 l 4.1 24.1 18.6 26.1 11.8 

Area 

Metropolitan ................................ 81.4 84.9 80.0 64.3 82.0 65.5 

Nonmetropolitan ............................. 18.6 15.1 20.0 15.7 18.0 34.5 

‘Does not include doctors of osteopathy.

*Based on A Reason for Visit Classification for Ambulatory CW~.‘~ 

%cludes blanks; problems, complainis not elsewhere classified; entries of “none”; and illegible entres. 

‘Percents will not total 100.0 because more than 1 service may have been rendered during a visit. 

‘Based on lntemetional Clsssifcation of Diseases, 9th Revision, Clidcal Modificati~n.‘~ 

‘Represents visits in which there was no face-to-face encounter between patient and physician. 

‘Percents will not total 100.0 because more than 1 disposition was possible. 

‘Includes partnership, group, and other types of practice. 

27 
Table 4. Number of drug mentions in office visits to obstetrician-gynecologists by age of physician, and percent distribution of drug mentions by selected 

therapeutic categories, according to age of physician: United States, January lgBO-December 1981 

Under 65 years 

Selected therapeutic category’ AM ages 35 years 35-44 years 45-64 years 55-64 years and over 

All categories . . . , . . . . . . . . . . . . . . . . . . . . . 60,i 12 

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

Antihistamine drugs. ........................... 2.1 

Anti-infective agents ........................... 15.9 

Autonomic drugs ............................. 1.4 

Blood formation and coagulation ..................... 4,7 

Cardiovascular drugs ........................... 1.9 

Central nervous system drugs ...................... 7.5 

Electrolytic, caloric, and water balance .................. 3.0 

Expectorants and cough preparations .................. 0.9 

Gastrointestinal drugs .......................... 1.0 

Hormones and synthetic substitutes ................... 26.1 

Skin and mucous membrane preparations ................ 10.8 

Vitamins .................................. 19.6 

Other, unclassified, or undetermined ................... 4.2 

‘Basedon the,classificationsystemof the American Hospital Formulary Sewice.‘3 

%oes not include doctorsof osteopathy. 

Number in thousands 

4,434 19,038 19,545 11,002 6,093 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 

‘2.4 2.7 ‘1.9 ‘2.4 l 0.7 

*8.8 18.1 15.3 17.6 12.8 

‘0.6 ‘1.6 ‘1.3 *I .4 *2.0 

8.9 4.0 5.4 4.1 ‘2.9 

‘0.3 ‘1.1 0.5 4.2 *6.4 

*2.1 7.7 7.2 9.5 8.6 

l 0.3 l 2.3 2.9 4.4 l 5.4 

l 0.6 l 0.9 l 0.3 l 0.4 l 3.6 

l 1.2 2.8 1.3 l 1.4 ‘1.8 

22.9 24.3 28.8 25.7 25.8 

l 9.8 10.3 12.0 9.4 11.9 

39.5 20.8 18.7 14.3 13.7 

l 2.9 3.7 4.4 5.2 4.4 

Table 5. Number of office visits made by female patients by race and ethnicity; percent distribution of office visits by age of patient, according to race and 

ethnicity; and average annual visit rate by age, race, and ethnicity: United States, January lg80-December 1981 

Race Ethniciiy 

Age of patient A// races White Black All other Hispanic Non-Hispanic 

Number in thousands 

All ages .................................. 107,892 94,026 12,141 1,724 6,101 101,790 

Percent distribution 

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

Under 15 years .............................. 0.7 0.6 *I .3 l l .8 *0.3 0.7 

15-24 years ................................ 31 .o 31 .o 32.1 l 24.5 38.6 30.6 

25-44 years ................................ 56.5 56.1 58.2 67.3 52.7 56.7 

45-64 years ................................ 9.4 9.8 7.2 ‘6.0 “6.4 9.6 

65 years and over ............................ 2.4 2.6 ‘1.3 ‘0.4 *2.0 2.5 

Visit rate per 100 females in population 

All ages .................................. 46.8 47.0 43.3 30.5 41.8 47.1 

Under 15 years .............................. 1.5 1.3 l 2.1 ‘2.1 l 0.3 *1.6 

15-24 years ................................ 81.1 84.7 67.4 ‘39.7 76.6 80.4 

25-44 years ................................ 94.7 96.1 92.6 61.6 78.7 96.6 

45-84 years ................................ 21.9 22.5 18.9 11.4 l 19.1 22.0 

65 years and over ............................ 9.1 9.4 l 6.5 ‘2.2 l 15.4 9.0 

28 
Table 6. Number of oflice visits to obstetrician-gynecologists by age of patient and prior visit status; percent distribution of office visits by selected 

characteristics, according to age of patient and prior visit status; and return visit ratio by age of patient and prior visit status: United States, January

lg80-December 1981 

Age of patient Prior visit status 

Under 25-44 45 years New Old patient, Old patient, 

Selected characteristic All ages 25 years years and over patient new problem old problem 

Number in thousands 

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . 109,035 34,574 61,233 13,228 12,871 19,119 77,045 

Percent distribution 

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

Major reason for visit 

.Acute problem ...................... 10.3 18.8 17.1 22.6 36.6 47.7 7.9 

Chronic problem, routine ................. 0.3 5.5 7.5 18.9 9.2 4.8 9.0 

Chronic problem, flareup ................. 4.5 3.2 4.2 0.8 6.1 4.1 4.3 

Postsurgery or postinjuty ................. 7.1 4.9 7.5 11.5 l 1 .5 6.4 8.3 

Nonillness care ...................... 61.9 67.7 63.7 38.2 46.6 37.0 70.6 

Principal reason for visit 

module and RVC code’ 

Symptom module ............... SOOi-6999 23.5 21.3 21.6 37.6 38.8 48.1 14.8 

Disease module. ............... DOOl-D999 3.9 2.6 3.3 10.4 4.7 3.9 3.8 

Diagnostic, screening, and 

preventive module ............. Xl 00-X599 61.9 68.5 64.2 33.9 49.4 37.8 69.9 

Treatment module .............. TIOO-T8gg 7.2 4.1 7.5 13.4 l 2.3 6.6 8.1 

Injuries and adverse effects 

module ........... : ....... JOOlJ999 0.4 ‘0.5 l 0.3 ‘0.6 ‘0.6 l 1 .l ‘0.3 

Test results module. ............. RlOO-R700 1.1 ‘0.9 1.1 l 1 .5 ‘2.0 ‘0.8 1.0 

Administrative module ............ AlOO-A140 ‘0.3 ‘0.5 ‘0.2 ‘0.1 0.9 l 0.8 l 0.1 

Othe? ........................... 1.7 1.6 1.8 l 2.5 ‘1.3 ‘1 .I 2.0 

Prior visit status 

New patient ........................ 11.8 15.5 10.1 10.3 

Old patient, new problem ................. 17.5 16.6 17.8 19.0 

Old patient, old problem ................. 70.7 68.0 72.1 70.8 

Return visit ratio3 

Return visit ratio . . . . . . . . . . . , . . . . . . . . . 7.5 5.5 8.9 8.0 -

‘Based on A Reason for Visit Classificalion for Ambulatory Care.‘o 

%cludes blanks: problems, complaints not elsewhere classified; entries of “none”: and illegible entries. 

sNumber of old patients divided by number of new patients. 

29 
Table 7. Number, percent and cumulative percent of office visits to obstetricfangynecologists, by most frequent principal reasons for visit: 

United States, January 1980-December 1991 

Number of 

visits in Cumulative 

Principal reason for visit and RVC code’ thousand Percent 2 percent 

Prenatal examination, routine ........................................ X205 I 36,356 35.2 35.2 

Gynecological examination .......................................... X225 

Postoperative visit .............................................. T205 

General medical examination. ........................................ Xl00 

Postpartum examination ........................................... X215 

Other vaginal symptoms .......................................... .S765 

Vaginal discharge. .............................................. S760 

Papsmear ............................................... ..X36 5 

Abdominal pain, cramps, spasms ...................................... S550 

Uterine and vaginal bleeding ......................................... S755 

Family planning, not otherwise specified ................................... X500 

Contraceptive device ............................................. X510 

Pregnancy, unconfirmed ........................................... X200 

Pelvic symptoms : ............................................. S775 

Contraceptive medication ........................................... X505 

Absence of menstruation (amenorrhea) ................................... 5730 

For cytology findings ............................................. R300 

Irregularity of menstrual flow .......................................... 5740 

Irregularii of menstrual interval ....................................... 5735 

Symptoms of infertility ............................................ S615 

Menstrual symptoms, other and unspecified ................................. S745 

Cervicitis, vaginitis .............................................. D725 

Progress visit ................................................. T800 

Menopausal symptoms ............................................ S750 

Pain, site not referable to a specific body system .............................. SO55 

Preoperative visit for specified and unspecified types of surgery ...................... T200 

Counseling and examination for pregnancy interruption ........................... X516 

Problems of pregnancy and the postpartum period ............................. S790 

Vulvar disorders ............................................... S770 

Counseling, not otherwise specified ..................................... T605 

Headache,painin head ........................... , ............... S210 

Pain or soreness of breast .......................................... S600 

Painful urination. ............................................... 5650 

Other diseases of female reproductive system ............................... D730 

Fibroids and other uterine neoplasms .................................... D140 

Lump or mass of breast ........................................... S605 

Based on A Reason for visit Classification for Ambulatory CX.?.‘~ 

on a total of 109,035,OOO visits. 

10,365 9.5 44.7 

5,242 4.0 49.5 

4,465 4.1 53.6 

3,665 3.4 57.0 

2,494 2.3 59.3 

2,276 2.1 61.4 

2,256 2.1 63.5 

2,104 1.9 65.4 

2,081 1.9 67.3 

1,841 1.7 69.0 

1,669 1.5 70.5 

1,340 1.2 71.7 

1,311 1.2 72.9 

1,174 1.1 74.0 

1,156 1.1 75.1 

981 0.9 76.0 

924 0.8 76.8 

900 0.8 77.6 

047 0.6 78.4 

791 0.7 79.1 

776 0.7 79.8 

639 0.6 80.4 

596 0.5 80.9 

587 0.5 81.4 

545 0.5 01.9 

493 0.5 82.4 

‘441 l 0.4 02.0 

‘429 *0.4 83.2 

‘424 *0.4 83.6 

*420 *0.4 84.0 

l 399 l 0.4 64.4 

l 394 *0.4 04.8 

l 369 “0.3 85.1 

l 356 “0.3 85.4 

‘353 ‘0.3 05.7 

‘, 

30 
Table 8. Percent and cumulative percent of office visits to obstetrician-gynecologists, by age and most frequent principal reasons for visit: United States, 

January 198~Qecember 1981 

Age, principal reason for visit, and RVC code’ 

Under 25 years2 

Prenatal examination, routine ........................................ X205 

Gynecological examination .......................................... X225 

Postpartum examination ........................................... X215 

Postoperative visit .............................................. T205 

General medical examination. ........................................ Xl00 

Contraceptive medication. .......................................... X505 

Vaginal discharge. .............................................. S760 

Family planning, not otherwise specified ................................... X500 

Abdominal pain, cramps, spasms ..................................... ..855 0 

Other vaginal symptoms ........................................... S765 

Pregnancy, unconfirmed ........................................... X200 

Absence of menstruation (amenorrhea) ................................... S730 

Papsmear ................................................ ..X36 5 

Uterine and vaginal bleeding ......................................... S755 

Contraceptivedevice ............................................ .X510 

25-44 year? 

Prenatal examination, routine ........................................ X205 

Gynecological examination .......................................... X225 

Postoperative visit .............................................. T205 

General medical examination. ........................................ X100 

Postpartum examination ........................................... X215 

Papsmear ................................................ ..X36 5 

Other vaginal symptoms ........................................... S765 

Contraceptive device .............................................. X510 

Abdominal pain, cramps, spasms ...................................... S550 

Vaginal discharge. .............................................. S760 

Family planning, not otherwise specified .................................... X500 

Uterine and vaginal bleeding ......................................... S755 

Symptoms of infertility ........................................... .S815 

Pelvic symptoms ........... .‘. ................................. .S775 

Pregnancy,unconfirmed .......................................... .X200 

Absence of menstruation (amenorrhea) .................................. .S730 

Irregularity of menstrual flow ......................................... S740 

For cytology findings ............................................. R300 

Cervicitis, vaginitis .............................................. D725 

Irregularity of menstrual interval ....................................... 5735 

45 years and eve? 

Gynecological examination .......................................... X225 

Postoperative visit .............................................. T205 

General medical examination ......................................... Xi 00 

Uterineand vaginal bleeding ........................................ .S755 

Other vaginal symptoms .... : ..................................... .S765 

Menopausal symptoms ............................................. S750 

Papsmear ................................................ ..X36 5 

Vaginaldischarge. ............................................. .S760 

‘Based on A Reason for visit C%ssiffcatfon for Ambulatay Care (WC).” 

*Based on a total of 34,574,OOOvisits. 

3Based on a total of 61,233,OOO visits. 

‘Based on a total of 13,228,OOOvisits. 

Cumulative 

Percent of percent of 

visits visits 

43.9 43.9 

6.4 50.3 

3.9 54.2 

2.8 57.0 

2.4 59.4 

2.3 81.7 

2.3 64.0 

2.2 66.2 

1.9 68.1 

1.8 69.9 

1.7 71.6 

1.4 73.0 

1.3 74.3 

1.3 75.6 

1.2 76.8 

37.5 37.5 

9.4 46.9 

5.0 51.9 

4.1 56.0 

3.7 59.7 

2.3 62.0 

2.1 64.1 

2.0 66.1 

2.0 68.1 

1.9 70.0 

1.8 71.8 

1.8 73.6 

1.3 74.9 

1.2 76.1 

1.2 T1.3 

1.0 78.3 

1.0 79.3 

0.9 80.2 

0.9 81 .l 

0.8 81.9 

17.9 17.9 

9.3 27.2 

8.6 35.8 

4.2 40.0 

4.2 44.2 

3.8 48.0 

3.0 51 .o 

2.3 53.3 

31 
Table 9. Number of office visiis to obstetrician-gynecologists by age of patient and prior visii status, and percent diiffbution of oftice visits by principal

diagnosis categories, according to age of patient and prior visit status: United States, January 198O-December 1981 

Princcipaldiagnosis category 

and ICD-9-CM code’ 

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

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

Infectious and parasitic diseases ................... 

Neoplasms ............................... 

Endocrine, nutritional and metabolic diseases, and immunity disorders 

Mental disorders ............................ 

Diseases of the nervous system and sense organs .......... 

Diseases of the circulatory system ................... 

Diseases of the respiratory system. .................. 

Diseases of the digestive system ................... 

Diseases of the genitourinary system ................. 

Complications of pregnancy, childbirth, and the puerperium ..... 

Diseases of’the skin and subcutaneous tissue ............ 

Diseases of the musc~loskeletal system and connective tissue .... 

Symptoms, signs, and ill-defined conditions .............. 

Injury and poisoning .......................... 

Supplementary classification ...................... 

All other diagnoses ........................... 

Unknown diagnoses .......................... 

Age of patient Prior Visitstatus 

All Under 25-44 45 years New Old patient, Old patient, 

ages 25 years years and over patient new problem old problem 

Number in thousands 

. . . . 109,035 34,574 61,233 13,226 12,671 

Percent distribution 

. . . . 100.0 100.0 00.0 100.0 100.0 

000-139 3.2 3.3 3.2 ‘3.2 5.5 

140-239 1.7 l 0.2 1.4 7.5 l 2.4 

240-279 1.3 ‘1 .o 0.9 4.0 ‘1.9 

290519 l 0.4 ‘0.2 ‘0.4 ‘I .o l 0.5 

320-389 ‘0.1 ‘0.1 l 0.1 ‘0.3 

390459 1.3 l o.o l 0.5 8.3 *0.1 

460-519 0.7 V.0 l 0.5 ‘1.4 *I .2 

520-579 0.7 ‘0.7 ‘0.5 ‘1.4 *0.9 

560-629 19.1 15.3 16.1 33.6 30.1 

630-676 2.7 3.6 2.6 *o.o ‘3.3 

660-709 0.5 l 0.5 l 0.5 ‘0.6 l 0.6 

71 O-739 0.6 l 0.1 l 0.6 ‘1.7 *0.5 

760-799 1.6 1.4 1.9 ‘2.7 l 2.3 

600-999 1 .o *I .2 0.7 “1.5 ‘0.7 

VOl-V62 62.5 66.9 65.6 30.1 47.2 

. . . . 0.3 0.3 0.3 l 0.5 0.7 

,. . . . 2.1 2.2 1.9 ‘2.2 ‘2.3 

19,119 77,045 

100.0 100.0 

7.2 1.8 

‘1.4 1.7 

‘1.7 1.1 

0.5 0.4 

*0.4 ‘0.1 

‘1.4 1.5 

‘1.9’ l 0.4 

‘1.3 *0.5 

31 .o 14.3 

3.7 2.3 

“1.3 l 0.3 

‘1.7 l 0.4 

‘2.7 1.5 

2.5 0.6 

36.0 71.1 

0.5 0.3 

3.0 1.6 

'Based on International Classification of Diseases, 9th Revision, Clinical Modification.‘4 

Table 10. Number, percent, and cumulative percent of offtce visits to obstetriciangynecologists, by most frequent principal diagnosis categories:

United States, January 1980-December 1981 

Principal diagnosis categoty and ICD-PCM code’ 

Normal pregnancy .................................. 

Gynecological examination .............................. 

Inflammatory disease of cervix, vagina, and vulva .................. 

Followup examination following surgery ....................... 

Contraceptive management ............................. 

Postpartum care and examination .......................... 

Disorders of menstruation and other abnormal bleeding from female genital tract . 

General medical examination. ............................ 

Menopausal and postmenopausal disorders ..................... 

Candidiasis ...................................... 

Pain and other symptoms associated with female genital organs .......... 

Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum 

Observation and evaluation for suspected conditions ................ 

Infertility, female ................................... 

Essential hypertension ................................ 

Noninflammatory disorders of cervix ......................... 

Noninflammatory disorders of ovary, fallopian tube, and broad ligament ...... 

Uterine leiomyoma (benign neoplasm, fibroid) .................... 

Genital prolapse ................................... 

Cystitis ........................................ 

Papsmear ...................................... 

Trichomoniasis ......................... : .......... 

Disorders of uterus, not elsewhere classified .................... 

Endometriosis ..................................... 

Other disorders of urethra and urinary tract ..................... 

Benign mammary dysplasias (including fibrocystic disease of breast) ....... 

Nonspecific abnormal histological and immunological findings ........... 

Noninflammatory disease of vagina ......................... 

‘Based on International Classification of Diseases, 9th Revision, Clinical Modificetion.‘4 

*Based on a total of 109,035,OOO visits. 

. . 

. . 

. , 

. . 

. . 

. 

. . 

. 

. . 

Number of 

visits in 

Percent ’ 

. . . . v22 39,459 36.2 

. . . V72.3 9,927 9.1 

. . . . 616 4,247 3.9 

. . . V67.0 3,960 3.6 

. . . V25 3,569 3.3 

. . . . V24 3,411 3.1 

. . . 626 3,220 3.0 

. . . v70 3,196 2.9 

. . . 627 2,102 1.9 

. . , . 112 1,639 1.5 

. . . . 625 1,599 1.5 

. . . . 614 1,337 1.2 

. . . . v71 1,225 1.1 

. . . . 626 1,112 1.0 

. . 401 990 0.9 

. . . . 622 963 0.9 

. . . . 620 666 0.6 

. . . . 218 678 0.8 

. . . . 618 766 0.7 

. . . . 595 745 0.7 

. . . V76.2 694 0.6 

. . . . 131 669 0.6 

. . . . 621 610 0.6 

. . . 617 570 0.5 

. . . . 599 547 0.5 

. . . 610 531 0.5 

. . . . 795 509 0.5 

. . . . 623 ‘407 ‘0.4 

Cumulative 

percent 

36.2 

45.3 

49.2 

52.0 

56.1 

59.2 

62.2 

65.1 

67.0 

66.5 

70.0 

71.2 

72.3 

73.3 / 

74.2 

75.1 

75.9 

76.7 

77.4 

70.1 

70.7 

79.3 

79.9 

80.4 

80.9 

61.4 

61.9 

62.3 

32 

I 
Table 11. Percent and cumulative percent of office visits to obstetriciangyneco&#sts, by age and most frequent principal diagnosis categories:

United States, January 1980-December 1981 

Am Cumulative 

principal diagnosis category Percent of percent of 

and ED-9-CM code’ visis visits 

Under 25 ye: -s2 

Normal pregnancy .............................................. V22 

Gynecological examination ......................................... W2.3 

Postpartum care and examination ...................................... V24 

Contraceptive management ......................................... V25 

Inflammatory disease of cervix, vagina, and vulva. ............................. 616 

Disorders of menstruation and other abnormal bleeding from female genital tract ............. 626 

Followup examination following surgery .................................. V67.0 

General medical examination. ........................................ WO 

Pain and other symptoms associated with female genital organs ...................... 625 

Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum ........... 614 

Candidiasis .................................................. 112 

25-44 year?? 

Normal pregnancy .............................................. V22 

Gynecological examination .......................................... W2.3 

Followup examination following surgery .................................. V67.0 

Inflammatory disease of cervix, vagina, and vulva. ............................. 616 

Contraceptive management ......................................... V25 

Postpartum care and examination ...................................... V24 

General medical examination. ........................................ WO 

Disorders of menstruation and other abnormal bleeding from female genital tract ............. 626 

Candidiasis .................................................. 112 

Infertility, female ............................................... 628 

Pain and other symptoms associated with female genital organs . ; .................... 625 

Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum ........... 614 

Observation and evaluation for suspected conditions ............................ WI 

Noninflammatory disorders of cervix ..................................... 622 

Papsmear ................................................. W6.2 

Endometriosis. ................................................ 617 

45 years and eve? 

Menopausal and postmenopausal disorders ................................. 627 

Gynecological examination ......................................... W2.3 

Followup examination following surgery .................................. V67.0 

Essential hypertension ............................................ 401 

Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum ........... 616 

General medical examination. ........................................ WO 

Uterine leiomyoma (benign neoplasm, fibroid) ................................ 218 

Genital prolapse ............................................... 618 

'Based on International Clasificatfoon of Diseases, 9th Revision, Clinical Modification.‘4 

*Eased on a total of 34.574.1200 visits. 

%ased on atotal of 61,233,OOOvisits. 

‘Based on a total of 13,!228,000 visits. 

46.1 46.1 

7.4 53.5 

3.9 57.4 

3.9 61.3 

3.9 65.2 

2.8 68.0 

2.1 70.1 

1.9 72.0 

1.7 73.7 

1.7 75.4 

‘1.1 76.5 

38.1 38.1 

10.3 48.4 

3.8 52.2 

3.8 56.0 

3.6 59.6 

3.3 62.9 

3.2 66.1. 

3.1 69.2 

1.6 70.8 

1.5 72.3 

1.5 73.8 

1.2 75.0 

1.1 76.1 

1.0 77.1 

0.8 77.9 

0.8 78.7 

13.8 13.8 

12.2 26.0 

6.9 32.9 

5.4 38.3 

4.3 42.8 

4.3 46.9 

3.5 50.4 

3.4 53.8 

-

33 
Table 12. Number of office visits to obstetrician-gynecologists, by age of patient and prior visit status; percent of office visits, by age of patient, prior visit 

status, diagnostic services, and nonmedication therapy; and percent distribution of office visits by number of medications, according to age of patient

and prior visii status: United States, January 199~December 1991 

Age of patient Prior visit status 

All Under 25-44 45 years New Old patient, Old patient, 

Service or therapy ages 25 years years ahd over patient new problem old problem 

Number in thousands 

All visits . . . . . . . . 109,035 34,574 61,233 13,228 12,871 19,119 77,045 

Percent of visits 

Diagnostic service’ 

None . . . . . . . . 2.4 2.0 2.5 ‘2.6 *I.6 3.0 2.4 

Limited history and/or examination . 64.0 66.6 64.0 57.3 39.6 67.3 68.8 

General history and/or examination 17.7 17.2 16.9 22.6 49.2 20.0 11.9 

Pap test . . . . . . . . . . . 29.4 23.4 29.0 46.7 50.7 35.5 24.3 

Clinical laboratory test . . . . . . . 42.8 45.5 42.0 39.7 47.5 41.9 42.3 

X-ray . . . . . . . . 1.6 “0.7 1.6 3.9 *I .8 2.9 1.2 

Blood pressure check . . . 68.4 69.9 67.3 69.4 69.8 58.0 70.7 

Electrocardiogram. . . . ‘0.3 ‘0.1 l 0.2 ‘1.6 ‘0.2 l 0.4 l 0.3 

Endoscopy . . . . . . 0.8 ‘.06 0.8 ‘1.7 ‘1.7 “1.5 l 0.5 

Mental status examination . 0.8 ‘1 .o 0.7 l 0.7 l 0.3 ‘0.3 1 .o 

Other . . . . . . . 7.3 7.7 7.7 4.0 6.0 5.0 8.1 

Nonmedication therapy’ 

None . . . . . . . . 51.8 49.8 51.8 56.9 39.1 46.5 55.3 

Physiotherapy . . . . . . 1.4 ‘0.9 1.6 ‘1.5 1 .o 2.4 1.2 

Office surgery. _ . . . . 4.8 4.7 4.8 5.1 8.0 7.8 3.5 

Family planning . . . . . . 15.8 20.8 16.2 ‘1.1 20.8 18.2 14.4 

Therapeutic listening . . . 2.7 2.2 2.5 4.9 ‘3.2 2.9 2.6 

Diet counseling . . . . _ . 7.6 8.5 7.1 7.5 8.6 6.5 7.7 

Family or social counseling 2.5 2.9 2.4 “2.1 4.2 2.3 2.3 

Medical counseling . . . . 25.6 24.3 25.6 29.0 32.3 29.2 23.5 

Other . . . . . . . 1.1 *1 .o 1.1 *1.2 l 1.9 *1.2 0.9 

Percent distribution 

Total. . . 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

Number of medications 

None . .................... 58.4 63.4 63.4 48.3 49.3 48.2 62.5 

1 . . . . . .................... 30.3 35.3 27.3 31.2 35.4 36.0 28.0 

2..... .................... 8.8 9.6 7.3 13.8 12.3 12.5 7.3 

3.. . . .................... 1.9 1.4 1.7 4.6 l 2.7 2.7 1.6 

4 or more .................... 0.6 ‘0.4 ‘0.3 ‘2.1 ‘0.3 l 0.6 0.6 

'Percents will not total 100.0 because more than 1 service or therapy may have been rendered during a visit. 

34 
Table 13. Number of drug mentions in office vi&s to obstetrician-gynecologists, by age of patient and prior visit status, and percent distribution by

selected therapeutic categories, according to age of patient and prior visit status: United States, January 198Wkcember 1981 

Age of patient Prior v&f sfatus 

All Under 25-44 45 years New Old patient, Old patient; 

Selected therapeutic categow’ af2e.s 25 years years and over patient new problem old problem 

All categories . . . . . . . . . . . . . . . . . . . 61,204 20,802 29,550 

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

Antihistamine drugs ................ 

Anti-infective drugs ................ 

Autonomic drugs ................. 

Blood formation and coagulation ......... 

Cardiovascular drugs ............... 

Central nervous system drugs .......... 

Electrolytic, caloric, and water balance ...... 

Expectorants and cough preparations ...... 

Gastrointestinal drugs .............. 

Hormones and synthetic substitutes ....... 

Skin and mucous membrane preparations .... 

Vitamins ...................... 

Other, unclassified, or undetermined ....... 

100.0 100.0 100.0 

2.2 2.6 2.5 

15.9 16.6 17.2 

1.5 ‘1 .I ‘1.5 

4.7 5.0 5.4 

1.9 ‘0.2 ‘0.7 

7.7 5.7 8.1 

3.0 ‘0.8 2.4 

0.9 ‘0.7 ‘1 .o 

1.9 ‘2.1 ‘1.5 

26.0 28.5 21.8 

10.7 9.9 11.6 

19.3 22.5 22.2 

4.2 4.2 4.1 

Number in thousands 

10,852 8,933 

Percent distribution 

100.0 100.0 

l 0.9 ‘2.5 

10.7 19.1 

l 2.2 ‘1 .o 

‘2.1 5.7 

8.7 ‘0.1 

10.2 8.8 

8.8 ‘0.6 

‘1 .l l 0.8 

‘2.8 ‘0.9 

32.7 24.9 

10.0 11.7 

5.4 18.4 

4.5 5.5 

13,696 38,576 

100.0 100.0 

2.1 2.2 

24.9 12.0 

‘2.0 1.4 

2.0 5.4 

‘0.9 2.7 

9.0 6.9 

2.6 3.7 

‘1.3 ‘0.8 

l 1.9 2.2 

22.2 27.6 

15.7 8.7 

10.1 22.8 

5.4 3.5 

‘Based on the classification system of the American Hospital Fomtulary Servi~e.‘~ 

Table 14. Number, percent, and cumulative percent of drugs most frequently mentioned in office visii to obstetriciangynecokgists by name and 

therapeutic use: United States, January 1980-December 1981 

Number of 

mentions in Cumulative 

Name of drug’ Therapeutic use thousands Percent * percent

Prenatal vitamins (multivitamins prenatal) .......... 

Premarin (estrogens) ..................... 

Monistat (miconazole) .................... 

Ortho-novum (norethindrone estradiol) ............ 

Materna (vitamins) ...................... 

Lo/ovral (norgestrel) ..................... 

Stuartnatal 1 +I ....................... 

Ampicillin ........................... 

Flagyl (metronidazole) .................... 

Vitamins, unspecified ...................... 

Ovral (norgestrel, estradiol) .................. 

Provera (medroxyprogesterone) ............... 

Norinyl (norethindrone, mestranol) .............. 

Demulen (ethynodiol, estradiol) ............... 

Sultrin (sulfathiozole, sulfacetamide) ............. 

Contraceptive agent, unspecified ............... 

Betadine (povidone-iodine) .................. 

Natalins (vitamins) ...................... 

AVC (sulfanilamide) ...................... 

Iron preparation ........................ 

Tetracycline .......................... 

Gyne-lotrimin (clotrimszole) .................. 

Bendectin (decapryn) ..................... 

Mycostatin (nystatin) ..................... 

Natabec (vitamins) ...................... 

Dyszide (triamterene, hydrochlorothiazide) ......... 

Valium (diazepam) .. 1 ................... 

Motrin (ibuprofen) ....................... 

Pramet FA (vitamins) ..................... 

Mycolog (triamcinolone, neomycin) .............. 

Mycelex (clotrimazole) .................... 

Loestrin (norethindrone, estradiol) .............. 

Ovcon (norethindrone, estradiol) ............... 

Modicon (norethindrone, estradiol) .............. 

Macrodantin (nitrofurnatoin) ................. 

‘Based on the physician’s entry on the Patient Record form. 

%ased on a total of 61,204,OOO drug mentions. 

vitamins 3,043 5.0 5.0 

estrogen replacement therapy 2,355 3.8 8.8 

antifungal 2,322 3.8 12.6 

oral contraceptive 2,184 3.6 16.2 

prenatal supplement 1,897 3.1 19.3 

oral contraceptive 1,498 2.4 21.7 

vitamins 1,475 2.4 24.1 

antibiotic 1,447 2.4 26.5 

trichomonacidal agent 1,285 2.1 28.6 

vitanjins 1,112 1.8 30.4 

oral contraceptive 951 1.6 32.0 

threatened and habitual abortion 948 1.6 33.6 

oral contraceptive 920 1.5 35.1 

low estrogen oral contraceptive 916 1.5 36.6 

vaginal infections 864 1.4 38.0 

contraceptives 815 1.3 39.3 

antiseptic 801 1.3 40.6 

prenatal supplement 794 1.3 41.9 

antibacterial 777 1.3 43.2 

iron deficiency 716 1.2 44.4 

antibiotic 701 1.1 45.5 

antifungal 624 1.0 46.5 

nausea and vomiting of pregnancy 595 1.0 47.5 

antifungal 561 0.9 48.4 

prenatal supplement 541 0.9 49.3 

diuretic, edema, hypertension 509 0.8 50.1 

anxiety disorders ‘449 ‘0.7 50.8 

anti-inflammatory, analgesic l 443 l 0.7 51.5 

prenatal supplement ‘418 l 0.7 52.2 

infected or inflamed skin ‘402 ‘0.7 52.9 

antifungal ‘395 l 0.6 53.5 

oral contraceptive ‘337 ‘0.6 54.1 

oral contraceptive ‘336 l 0.5 54.6 

oral contraceptive l 335 ‘0.5 55.1 

antibacterial, urinary tract infections ‘0.5 55.6 

35 
Table 15. Number of office visits to obstetrician-gynecologists by age of patient and prior visit status, and percent distribution of offwe visits by duration 

and disposition of visits, according to age of patient and prior visit status: United States, January lgg0-December 1981 

Age of patient Prior visit status 

A// Under 25-44 45 year.5 New Old patient, Old patient, 

‘Duration and disposition of visit ages 25 years years and over patieni new problem old problem 

Number in thousands 

All visits . . . . . . . . . 109.035 34,574 61,233 13,228 12,871 19,i 19 77,045 

Percent of visits 

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

Duration of visit 

0 minutes’ ................... 0.9 l 1 .2 0.6 ‘1 .o “0.2 ‘0.7 1.1 

1-5 minutes ................... 16.0 22.4 17.7 6.1 4.4 10.0 22.3 

6-10 minutes .................. 30.7 31.6 31.6 24.7 19.3 31.1 32.6 

11-15 minutes. ................. 26.2 24.4 26.0 31.8 24.5 27.9 26.0 

16-30 minutes. ................. 21.7 1’8.5 21.5 30.6 44.3 28.0 16.3 

31 minutes or longer .............. 2.5 1.9 2.5 3.8 7.2 2.5 1.7 

Disposition of visit2 

No followup planned ............... 6.7 6.4 7.0 5.8 8.8 10.9 5.3 

Return at specified time ............. 75.7 n.9 75.8 69.1 63.3 59.8 81.7 

Return if needed ................. 15.3 15.3 14.8 18.0 17.7 20.9 13.6 

Telephone followup planned ........... 2.3 1.6 2.5 3.6 3.7 5.2 1.4 

Referred to other physician ............ 1.0 ‘1.0 1.7 4.5 l 2.8 3.5 1.2 

Returned to referring physician .......... 0.7 *0.6 *0.6 7.2 3.7 ‘0.6 l 0.3 

Admit to hospital ................. 3.0 1.6 3.1 5.4 5.2 4.6 2.2 

Other ....................... ‘0.1 “0.2 ‘0.1 ‘0.0 ‘0.4 “0.2 ‘0.1 

‘Represents visits in which there was no face-to-face encounter between patient and physician.

2Percents will not total 100.0 because more than 1 disposition was possible. 

.’ 
Table 16. Number and percent of office visits to obstetrician-gynecologists by diagnostic services, major reason for visit, and principal reason for visit module: United States, January 1980. 

December 1981 

Dtaanastic service’ 

Major reason for visit Number of 

and principal reason for visits in 

visit module thousands None 

Limited General Mental 

history history Clinical Blood status 

and/or 

examination 

and/or 

examination 

pap 

test 

laboratory 

test X-ray 

pressure 

check 

EndosCOPY examination Other 

Percent 

Major reason for visit 

Acute problem .................. 19,945 3.9 61.2 20.8 29.1 42.3 2.8 53.5 2.4 ‘0.6 4.0 

Chronic problem, routine ............. 9,001 ‘4.5 56.8 18.9 31 .o 29.8 ‘1.8 54.0 l 0.8 ‘0.5 5.6 

Chronic problem, flareup ............. 4,849 ‘5.6 64.7 18.1 29.6 38.0 *3.1 57.3 1.6 ‘0.2 ‘6.6 

Postsurgery or postinjury ............. 7,761 ^2.7 82.0 ‘4.8 10.8 18.6 l 0.5 48.7 ‘0.2 ‘0.7 ‘2.7 

Nonltlness care .................. 67,458 1.4 63.7 10.3 31.4 47.9 1.2 77.8 ‘0.4 1.0 9.4 

Principal reason for 

visit module and RVC code’ 

Symptom module . . . . . . , . . . . SOOlS999 

Disease module. . . _ . . . . . . . DOOl-D999 

Diagnostic screening, and 

preventive module . . . . . . . . . X100-X599 

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

Injuries and adverse 

effects module . . . . . . . . . . . JOOI-J999 

Test results module. . . . . . . . . RlOO-R700 

Administrative module . . . . . . . . AiOOd140 

25,589 2.8 61.9 20.6 31.8 42.0 2.7 58.1 l 0.7 l 0.7 6.3 

4,269 ‘4.5 59.5 20.3 23.5 29.3 ‘1.6 47.2 ‘1.5 ‘0.4 *4.7 

-87,473 1.3 83.9 16.1 30.8 47.0 1.3 77.0 ‘0.3 1.0 8.9 

7,799 7.7 78.1 ‘4.5 9.8 16.6 46.9 9.0 l 0.2 ‘3.1 

466 ‘4.7 ‘67.5 *22.1 ‘7.7 ‘25.2 Y4.8 ‘24.0 *2.7 

1,158 ‘10.3 42.6 ‘10.0 43.9 ^26.2 ‘0.9 ‘31.3 ‘26.0 ‘6.5 

‘310 ‘31.2 *48.6 ‘65.6 ‘81.8 ‘58.9 ‘4.9 ‘11.3 

‘Percents will not total 100.0 because more than 1 sewice may have been rendered dun’ng a visit. 

*Based on A Reason for Vtstt Classification for Ambulatory Cars.‘0 

‘. :. : 

-3 .. 
Table 17. Number of office visits to obstetriciangynecologists by principal diagnosis categories, and percent of office visits by selected characteristics 

and principal diagnosis categories: United States, January 198~December 1981 

Principal diagnosis category and ICD-BCM code’ 

ComplicAtions of 

infectious and Diseases of the pregnancy, childbiirfh Supplementary 

parasitic diseases genitourinary system and the puerperium classification 

Selected characteristic 00% 139 580-623 630-676 VOl-V82 

All visits . . . . . . . . . . 3,477 20.838 

Nonmedication therapy* 

None . . . . . . . . . 56.0 46.6 

Office surgery . . . . . ‘9.2 7.9 

Family planning . . . ‘8.2 14.1 

Therapeutic listening . . . ‘1.2 3.4 

Diet counseling . . . . . ‘2.5 2.3 

Family or social counseling *2.4 2.1 

Medical counseling . . 27.1 34.7 

Other . . . . . . . . ‘1.6 2.4 

Number of medications 

None ........ 

1 ........... 

2 ........... 

3ormore ...... 

Duration 

0 minute9 . . . 

l-5 minutes . . . . . 

6-10 minutes . . . 

11-15 minutes. . . 

‘16-30 minutes. . . . 

31 minutes or longer 

Disposition4 

No followup planned 

‘12.6 44.3 

57.5 37.9 

23.0 13.3 

*6.1 4.5 

‘2.5 “1.7 

. . l 7.6 8.9 

40.2 25.0 

26.6 27.4 

20.8 34.6 

l 2.3 2.4 

*6.3 6.4 

Return at specified time 55.3 64.5 

Return if needed . . 33.3 22.4 

Telephone followup planned “3.9 5.7 

Referred to another physician “1.4 2.6 

Returned to referring physician . l 1.7 l 1.2 

Admit to hospital . . . . . . . . . *1.9 5.8 

Other . . . . . . . *0.2 ‘0.1 

‘Based on /nfemational Classification of Diseases, 9th Revision, Clinical hfodificafi~n.‘~ 

2Percents will not total 100.0 because more than 1 service may have been rendered during a visit. 

%epresents visits in which there was no face-to-face encounter between patient and physician. 

‘Percents wilt not total 100.0 because more than 1 disposition was possible. 

Number in thousands 

2,933 66,121 

Percent 

43.6 53.9 

l 9.2 3.5 

16.7 18.4 

l 3.7 2.2 

‘7.8 9.1 

‘4.2 2.5 

26.6 21.7 

l 3.1 2.2 

53.9 67.5 

25.1 26.9 

18.2 4.9 

l 2.0 0.7 

‘0.7 *0.6 

l 1 2.0 23.3 

39.1 32.5 

27.6 25.4 

17.5 16.2 

l 3.1 2.0 

*5.9 6.6 

70.3 82.6 

‘9.8 11.7 

‘3.3 0.8 

‘1.2 1.0 

“2.6 l 0.5 

13.9 1.4 

l 0.1 
Table 18. Mean duration of oftice visits to obstetrician-gynecologists, by selected principal diagnoses: United States, January 1980-December 1981 

Principal diagnosis Mean duration 

and ICD-9-CM code’ in minutes 

All diagnoses ...................................................... 13.9 

Candidiasis ........................................................ 112 14.7 

Trichomoniasis ..................................................... 131 13.6 

Uterine leiomyoma ................................................... 218 18.4 

Essential hypertension ................................................. 401 11.2 

Cystitis ...................................................... ...59 5 14.9 

Other disorders of urethra and urinary tract ...................................... 599 18.8 

Benign mammary dysplasias .............................................. 610 14.8 

Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum ................ 614 15.7 

Inflammatory disease of cervix, vagina, and vulva ................................... 616 16.2 

Endometriosis. ..................................................... 617 17.0 

Genital prolapse .................................................... 618 19.2 

Noninflammatory disorders of ovary, fallopian tube, and broad ligament ....................... 620 15.4 

Disorders of uterus, not elsewhere classified ..................................... 621 15.7 

Noninflammatory disorders of cervix .......................................... 622 18.7 

Noninflammatory disease of vagina .......................................... 623 15.3 

Pain and other symptoms associated with female organs ............................... 625 16.8 

Disorders of menstruation and other abnormal bleeding from female genital tract .................. 626 16.1 

Menopausal and postmenopausal disorders ...................................... 627 16.5 

Infertility, female .................................................... 628 15.4 

Nonspecific abnormal histological and immunological findings ............................ 795 16.0 

Normal pregnancy ................................................... V22 10.7 

Postpartum care and examination ........................................... V24 13.5 

Contraceptive management .............................................. V25 16.4 

Followup examination following surgery ....................................... V67.0 12.3 

General medical examination. ............................................. V70 17.9 

Observation and evaluation for suspected conditions ................................. V71 11.6 

Gynecological examination .............................................. V72.3 15.9 

Papsmear .................................................... ..v76.2 12.8 

‘Based on International Classiricstion of Diseases. 9th Revision. Clinical Modification.‘4 

39 
Appendixes 

Contents 

I. Technicalnotes ........................................................................................ 

Statisticaldesign ...................................................................................... 

Scopeof the survey ............................................................. ..*. ................. 

Sampledesign ..... . ............................................................................... 

Data collection and processing.......................................................................... 

Field procedures...... . ............................................................................ 

Data collection. .................................................................................... 

Data processing.................................................................................... 

Estimation procedures................................................................................. 

Inflation by reciprocalsof probabilitiesof selection ...................................................... 

Adjustmentfor nomesponse.......................................................................... 

Ratio adjustment.................................................................................... 

Reliability of estimates............................................. ..i> ............................... 

Estimatesof aggregates ..............................................................................

Estimates‘of percents ............................................................................... 

Estimatesof rateswherethe numeratoris not a subclassof the denominator.................................. 

Estimatesof differencesbetweentwo statistics .......................................................... 

Tests of signitlcance .................................................................................. 

Populatioufiguresandrate computation.................................................................. 

Roundingofnumbers............................................~~.........~ ........................... 

Systematicbias ...................................................................................... 

II. Definitionsofcertaintermsusedinthisreport.. ................................. . ............................ Te.~srelatingtothesurvey.........................: .................................................. 

Terms relatingto the Patient RecordForm ............................................................... 

III. Survey instruments ..................................................... : ................................. 

Introductory letter from Director, NCHS. ................................................................ 

Patient RecordForm .................................................................................. 

Induction Interview Form. .............................................................................. 

IV. American Hospital Formulary Serviceclassificationsystemand therapeuticcategorycodes. ....................... 

List of appendix figures 

41 

41 

41 

41 

41 

41 

42 -. 

42 

43 

43 

43 

43 

43 

46 

46 

46 

46 

46 

41 

47 

47 

49 

49 

50 

52 

52 

53 

54 1, 

62 

I. Approximate relative standarderrors for estimatednumbersof office visits basedon all physician specialties(A), and 

individual specialties(B), 1980-8 1 National Ambulatory Medical Care Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 

II. Approximate relative standarderrors for estimatednumbersof drug mentionsbasedon all physician specialties(A), 

and individual specialties(B), 1980-81 National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 

List of appendix tables 

I. Distribution of physiciansin the 1980-S 1 National Ambulatory Medical Care Survey sampleand responserates,by 

physicianspecialty..............’..................................~....................~......~~...,..~. ‘42 

II. Estimates of the civilian noninstitutionalizedpopulation of the United Statesused in computingannual visrt rates m 

thisreport,byage,race,andsex:1980-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :- . . . . . . . 47 

40 
Appendix I 

Technical notes 

This report is based on data collected during 1980 and 

1981 in the National Ambulatory Medical Care Survey 

(NAMCS), an annual sample survey of office-basedphysicians conductedby the Division of Health Care Statistics of 

the National Center for Health Statistics (NCHS). The two 

surveyswere conductedwith identical instruments,definitions, 

and procedures.Two years of data were combinedto increase 

the reliability of the estimates.The annual survey designand 

proceduresare presentedin the following sections. 

Statistical design 

Scope of the survey 

The target population of NAMCS includes ofice visits 

made within the conterminousUnited Statesby ambulatory 

patientsto nonfederallyemployedphysicianswho are principally engagedin o&e-based patient care practice, but not in 

the specialtiesof anesthesiology,pathology,or radiology.Telephone contacts and nono%ce visits are excluded from 

NAMCS. 

Sample design 

The NAMCS utilizes a three-stagesurvey designthat involves probability samplesof primary samplingunits (PSU’s), 

physicianpracticeswithin PSU’s, andpatientvisits within physician practices. The first-stagesample of 87 PSU’s was selected by the National Opinion ResearchCenter (NORC) of 

the University of Chicago, the organization responsiblefor 

NAMCS field and data processingoperationsunder contract 

to NCHS. A PSU is a county, a group of adjacentcounties, 

or a standardmetropolitan statistical area (SMSA). A modified probability-proportional-to-sizeprocedureusing separate 

samplingframesfor SMSA’s and for nomnetropolitancounties 

was usedto selectthe samplePSU’s. Each framewas stratified 

by region,size of population, and demographiccharacteristics 

of the PSU’s, and was divided into sequentialzonesof 1 million residents;then, a randomnumberwas drawn to determine 

which PSU cameinto the samplefrom eachzone. 

The secondstageconsistedof a probability sampleof practicing physicians,selectedfrom the masterfilesmaintainedby 

the American Medical Association (AMA) and the American 

1 OsteopathicAssociation (AOA), who met the following criteria: 

l Office-based,as definedby AMA and AOA. 

l Principally engagedin patient careactivities. 

NOTE: Preparedby Thomas McLemore, Division of Health Care Statistics. 

l Nonfederally employed. 

l Not in the specialtiesof anesthesiology,pathology,clinical pathology, forensic pathology, radiology, diagnostic 

radiology,pediatric radiology, or therapeuticradiology. 

Within each PSU, all eligible physicians were sorted by 

nine specialty groups: general and family medicine, internal 

medicine,pediatrics,other medical specialties,generalsurgery, 

obstetricsand gynecology,other surgical specialties,psychiatry, and all other specialties.Then, within each PSU, a systematic random sampleof physicianswas selectedso that the 

overall probability of selecting any physician in the United 

Stateswas approximatelyconstant. 

During 1980-81 the NAMCS physician sampleincluded 

5,805 physicians.Samplephysicianswere screenedat the time 

of the survey to ensurethat they met the aforementionedcriteria; 1,124 physicians did not meet the criteria and were, 

therefore,ruled out of scope(ineligible)for the study. The most 

commonreasonsfor beingout of scopewerethat the physician 

was retired, deceased,or employed in teaching, research,or 

administration.Of the 4,681 inscope(eligible)physicians,3,676 

(78.5 percent) participated in the study. Of the participating 

physicians,509 saw no patientsduringtheir assignedreporting 

period becauseof vacations,illnesses,or other reasonsfor being temporarilyout of office-basedpractice.The physiciansample size and responsedata by physician specialty are shown 

in table I. 

The third stagewas the selection of patient visits within 

the annual practices of the samplephysicians.This stageinvolved two steps.First, the total physiciansamplewas divided 

into 52 random subsamplesof approximatelyequal size; then 

each subsamplewas randomly assignedto 1 of the 52 weeks 

in the swey year. Second, a systematic random sample of 

visits was selectedby the physicianduringthe assignedreporting week. The visit samplingrate varied for this final stepfrom 

a 100 percentsamplefor very small practicesto a 20 percent 

sample for very large practices. The method for determining 

the visit samplingrate is describedlater in this appendixand 

in the Induction Interview form in appendixIII. During 1980-

81, samplephysicianscompleted89,447 usablePatient Record forms. 

Data collection and processing 

Field procedures 

Both mail and telephonecontactswere usedto enlist sample physiciansfor NAMCS. Initially, physicianswere sentintroductory letters from the Director of NCHS (see appendix 

III). When appropriate,a letter from the physician’s specialty 

41 
Table I. Distribution of physicians in the 1980-81 National Ambulatory Medical Care Survey samples and response rates, by physician specialty 

Physician specialty Gross total Out of scope Net total Nonrespondents Respondents Response 

rate 

All specialties ................................... 5,805 

General and family practice ........................ 1,340 

Medical specialties ............................... 1,695 

Internal medicine .............................. 871 

Pediatrics .................................... 414 

Other medical specialties. ....................... 410 

Surgical specialties .............................. 1,978 

General surgery .............................. ;. 521 

Obstetrics and gynecology ...................... 484 

Other surgical specialties. ....................... 973 

Other specialties. ................................ 792 

Psychiatry .................................... 414 

Other specialties ............................... 378 

organizationendorsingthe survey and urging his participation 

was enclosedwith the NCHS letter. Approximately 2 weeks 

prior to the physician’sassignedreportingperiod, a field representativetelephonedthe physicianto explain briefly the study 

and arrangean appointmentfor a personalinterview. Physicians who did not initially respondwere usually recontacted 

via telephoneor special explanatory letter and requestedto 

reconsiderparticipationin the study. 

During the personalinterviewthe field representativedeterminedthe physician’seligibility for the study, obtainedhis cooperation,deliveredsurvey materialswith verbal and printed 

instructions, and assigneda predeterminedMonday-Sunday 

reportingperiod. A short induction interview concerningbasic 

practice characteristics,such as type of practice and expected 

numberof office visits, was conducted.Oflice staff who were 

to assistwith data collectionwere invited to attendthe instructional sessionor were offered separateinstructional sessions. 

The field representativetelephonedthe samplephysician 

prior to and duringthe assignedreportingweekto answerquestions that might have arisen and to ensurethat survey procedureswere going smoothly. At the end of the reportingweek, 

the participatingphysicianmailed the completedsurveymaterials to the field representativewho editedthe forms for completenessbeforetransmittingthem for central data processing. 

At this point problemsof missingor incompletedata were resolvedby telephonefollowup by the field representativeto the 

samplephysician;if no problemswere found, field procedures 

were consideredcompleteregardingthe samplephysician’sparticipation in NAMCS. 

Data collection .. 

The actual data collection for NAMCS was carriedout by 

the physician, assistedby his office staff when possible.Two 

data collectionforms were employedby the physician:the Patient Log and the Patient Record form (seeappendixIII). The 

Patient Log, a sequentiallisting of patients seenin the physician’s office during his assignedreportingweek, servedas the 

samplingframeto indicatethe office visits for which data were 

to be recorded.A perforationbetweenthe patient’s name and 

patient visit informationpermittedthe physicianto detachand 

retain the listing of patients, thus, assuringthe anonymity of 

the physician’spatients. 

42 

1,124 4,681 1,005 3.676 76.5 

289 1,051 272 779 74.1 

296 1,399 298 1,101 78.7 

158 713 182 531 74.5 

83 331 42 289 87.3 

55 355 74 281 79.2 

246 1,732 351 1,381 79.7 

75 446 115 331 74.2 

71 413 63 350 84.7 

100 873 173 700 80.2 

293 499 84 415 83.2 

96 318 43 275 86.5 

197 181 41 140 77.3 

Basedon the physician’sestimateof the expectednumber 

of office visits and expectednumberof days in practice during 

the assignedreporting week, each physician was assigneda 

visit samplingrate. The visit samplingrates were designedso 

that about 30 Patient Record forms would be completedby 

eachphysician duringthe assignedreportingweek. Physicians 

expecting10 or fewer visits per day recordeddata for all visits. 

Those physicians expecting more than 10 visits per day recordeddata for every second,third, or fifth visit basedon the 

predeterminedsamplinginterval. These visit samplingproceduresminimized the physician’sdata collection workload and 

maintainedapproximatelyequalreportinglevels amongsample 

physiciansregardlessof practicesize. For physiciansrecording 

data for every second,third, or fifth patient visit, a random 

start was provided on the first pageof the Patient Log so that 

the predesignatedsamplevisits recordedon each succeeding 

pageof the Patient Log provided a systematicrandomsample 

of patient visits during the reportingperiod. 

Data processing 

In addition to followups for missing and inconsistentdata 

madeby the field staff, numerousclerical edits were performed 

on data received for central data processing.These manual 

edit proceduresproved quite efficient, reducing item nonresponseratesto 2 percentor lessfor most data items. 

Information containedin item 6 (Patient’sproblemor reason for visit) of the Patient Record form was codedaccording 

to A Reason for Visit Classz@cation for Ambulatov Care 

(RVC)? Diagnostic information (item 9 of the Patient Record 

form) was coded accordingto the International ClassiJication 

of Diseases, 9th Revision, Clinical ModiJication (ICD-9-

CM).9 A maximum of three entries were codedfrom each of 

these,items.Prior to coding,PatientRecordformsweregrouped 

into batcheswith approximately650 forms per batch. Quality 

control for the medical coding operation involved a two-way 

5-percentindependentverificationprocedure.Error rates“were 

defmedas the numberof incorrectly coded entriesdivided by 

the total number of coded entries. The estimatederror rates 

for the 1980-81 medicalcodingoperationwere 1.7 percentfor 

NOTE: A list of references follows the text. 
item 6 and 2.3 percentfor item 9. Additionally, a dependent 

verification procedurewas used to review and adjudicateall 

recordsin batcheswith excessiveerror rates. This procedure 

furtherreducedthe estimatederror ratesto 1.6 percentfor item 

6 and 2.1 percentfor item 9. 

The NAMCS medicationdata (item 11 of the Patient Record form) was classifiedand codedaccordingto a schemedevelopedat NCHS basedon the American Society of Hospital 

Pharmacists’Drug Product Information File. A descriptionof 

the new drug coding schemeand of the NAMCS drug data 

processingproceduresis containedin Vital and Health Statistics, Series 2, No. 9O.7A two-way 100 percent independentverification procedurewas usedto control the medication 

codingoperation.As an additional quality control, all Patient 

Record forms with differencesbetweendrug coders or with 

illegibledrug entrieswere reviewedand adjudicatedat NCHS. 

Informationfrom the Induction Interview and Patient Record forms was keypunchedwith 100 percentverification and 

convertedto computertape. At this point, extensivecomputer 

consistencyand edit checks were performedto ensurecomplete and accuratedata. Incomplete data items were imputed 

by assigninga value from a randomly selectedPatient Record 

form with similar characteristics;patient sex and age, physician specialty, and broad diagnosticcategorieswere used as 

the basisfor theseimputations. 

Estimation procedures 

Statisticsfrom NAMCS were derivedby a multistageestimation procedurethat producesessentiallyunbiasednational 

estimatesandhasthreebasic components:(1) inflation by reciprocalsof the probabilitiesof selection,(2) adjustmentfor nonresponse,and (3) a ratio adjustmento fixed totals. Each componentis briefly describedbelow. 

Inflation by reciprocals of probabilities of selection. 

Becausethe survey utilized a three-stagesample design, 

three probabilities of selection existed: (1) the probability of 

selectingthe PSU, (2) the probability of selectingthe physician 

within the PSU, and (3) the probability of selectingan office 

visit within the physician’spractice. The third probability was 

defined as the number of office visits during the physician’s 

assignedreportingweek dividedby the numberof Patient Record forms completed.All weekly estimateswere inflated by a 

factor of 52 to derive annualestimates. 

Adjustment for nonresponse 

NAJMCS data were adjustedto accountfor samplephysicians who were inscope,but did not participate in the study. 

This adjustmentwas calculatedin order to minimize the impact of responseon final estimatesby imputingto nomesponding physiciansthe practicecharacteristicsof similar responding 

physicians.For this purpose,physicianswerejudged similar if 

they had the samespecialty designationand practiced in the 

samePSU. 

NOTE: A list of references follows the text. 

Ratio adjustment 

A poststratification adjustmentwas made within each of 

nine physician specialty groups. The ratio adjustmentwas a 

multiplication factor that had as its numeratorthe number of 

physicians in the universe in each physician specialty group 

and as its denominatorthe estimatednumberof physiciansin 

that particular specialty group. The numeratorwas basedon 

figures obtained from the Ah&4 and AOA masterfiles, and 

the denominatorwas basedon data from the sample. 

Reliability of estimates 

As in any survey, results are subjectto both samplingand 

nonsamplingerrors.Nonsamplingerrorsincludereportingand 

processingerrors, as well as biases due to nonresponseand 

incompleteresponse.The magnitudeof the nonsamplingerrors 

cannotbe computed.However,theseerrorswerekept to a miuimum by proceduresbuilt into the survey’soperation.To eliminate ambiguities and encourageuniform reporting, careful 

attention was given to the phrasing of questions,terms, and 

deftitions. Also, extensivepretestingof most data items and 

survey procedureswas performed.The stepstaken to reduce 

bias in the data are discussedin the sectionson field proceduresand data collection. Quality control proceduresand consistencyand edit checksdiscussedin the data processingsection reducederrors in data coding and processing.However, 

becausesurveyresultsare subjectto samplingandnonsampling 

errors,the total error will be largerthan the error dueto samp 

ling variability alone. 

Becausethe statisticspresentedin this report are basedon 

a sample,they differ somewhatfrom the figuresthat would be 

obtainedif a completecensushad beentaken using the same 

forms, definitions, instructions, and procedures.However, the 

probability designof NAMCS permitsthe calculationof samp 

ling errors. The standard error is primarily a measure of 

sampling variability that occurs by chance becauseonly a 

sampleratherthan the entirepopulationis surveyed.The standard error, as calculatedin this report, also reflects part of the 

variation that arisesin the measurementprocess,but doesnot 

include estimatesof any systematicbiasesthat may be in the 

data. The chancesare about 68 out of 100 that an estimate 

from the samplewould differ from a completecensusby less 

than the standarderror. The chancesare about 95 out of 100 

that the differencewould be less than twice the standarderror, 

and about 99 out of 100 that it would be less than 2?4times 

as large. 

The relative standarderror of an estimate is obtainedby 

dividing the standard error by the estimate itself and is expressedas a percentof the estimate.For this report, an asterisk (*) precedesany estimatewith morethan a 30 percentrelative standarderror. 

Estimatesof samplingvariability were calculatedusingthe 

methodof half-samplereplication. This methodyields overall 

variability through observationof variability among random 

subsamplesof the total sample.A descriptionof the development and evaluationof the replication techniquefor error estimation hasbeenpublished.i4J5Approximate relative standard 

errorsfor aggregateestimatesarepresentedin figuresI andII. 

4s 
60 

50 

40 

20 

0.7 

0.6 

0.5 

0.4 

0.2 

0.1 

A 2 3 456789A 2 3 456789A 2 3 4 5 6789A 2 3 4 56789A 2 3 4 56789A 

100 1,000 10.000 100,000 1 ,ooo,ooo 10.000.000 

Size of estimate (in thousands) 

EXAMPLE: An estimate of 20 million office visits to general surgeons (read from scale at bottom of chart) has a relative standard error of 7.7 percent (read from curve 8 on scale at left of chart) or a standard error 

of 1.540.000 office visits (7.7 percent of 20 million visits). 

Figure I. Approximate relative standard errors for estimated numbers of office visits based on all physician specialties (.4), and individual specialties (B);l980-81 National Ambulatory Medical 

Care Survey 

: 
-. 

100 100 

g i8 

70 

60 60 

50 50 

40 40 

30 

20 20 

5 5 

4 4 

3 3 

2 2 

1 1 

82 82 

::i ::ii 

0.5 0.5 

0.4 0.4 

0.3 0.3 

0.2 0.2 

0.1 

A 2 3 4 56789A 2 3 4 56789A 2 3 4 56789A 2 3 4 56789~ 2 3 4 56789~ 

100 1,000 10,000 100,000 1 ,ooo,ooo 1 o.ooo,ooo 

Size of estimate (in thousands) 

EXAMPLE: An estimate of 60 million drug mentions (read from scale at bottom of chart) has a relative standard error of 5.1 percent (read from curve A on scale at left of chart) or a standard error of 3,060,OC~O drug 

mentions (5.1 percent of 60 million drug mentions). 

Figure II. Approximate relative standard errors for estimated numbers of drug mentions based on all physician specialties (A), and individual specialties (B), 1980-81. National Ambulatory Medical 

R Care Survey 
To derive error estimatesthat would be applicableto a wide 

variety of statistics and could be preparedat moderatecost, 

severalapproximationswererequired.As a result, the relative 

standarderrorsshownin figuresI andII shouldbe interpreted 

as approximateratherthan exact for any specificestimate.Directions for determiningapproximaterelative standarderrors 

follow. 

Estimates of aggregates 

Approximate relative standarderrors (in percent) for aggregatestatisticsare presentedin figuresI and II. The approximate relative standarderrorsfor aggregateestimatesof office 

visits are shownin figureI, andthe approximaterelativestandard errorsfor aggregateestimatesof drug mentionsare shown 

in figure II. In each figure, curve A representsthe relative 

standarderrors appropriatefor estimatesbasedon all physician specialties,and curve B representsrelative standarderrors appropriatefor estimatesbasedon an individualphysician 

specialty.For the specific casewhere the aggregateestimate 

of interest is the number of mentions of a specific drug, for 

example,the numberof mentionsof Dyazide, figure I, curve 

23 should be used to obtain approximate relative standard 

errors. 

Instead of using figures I and II, relative standarderrors 

for aggregateestimatesmay be calculateddirectly using the 

following formulaewherex is the aggregateestimateof interest in thousands.For visit estimatesbasedon all physician 

specialties, 

RSE(x)= &iiiKyy. 100.0 

For visit estimatesbasedon an individual physicianspecialty, 

R%(x)= &iGT=y. 100.0 

For drugmentionestimatesbasedon all physicianspecialties, 

RSE(x)= &iLP-y. 100.0 

For drug mention estimatesbasedon an individual physician 

specialty, 

ME(x) = Jr. 100.0 

Estimates of percents 

Approximaterelative standarderrors(in percent)for estimatesof percentsmay be calculatedfrom figuresI and II as 

follows. From the appropriate curve obtain the relative 

standard error of the numerator and denominator of the 

‘percents.Squareeachof the relative standarderrors, subtract 

the resultingvaluefor the denominatorfrom the resultingvalue 

for the numerator,and extract the squareroot. This approximation is valid if the relativestandarderror of the denominator 

is less than 0.05 or if the relative ,standarderrors of the 

numeratoranddenominatorare both lessthan 0.10. 

Alternatively, relative standard errors for percentages 

may be calculateddirectly usingthe following formulaewhere 

p is the percentof interest and x is the baseof the percentin 

thousands.For visit, percentagesbasedon all physician specialties, 

RsE@)= p=y. loo.o, 

For visit percentagesbased on an individual physician specialty, 

For drug mention percentagesbased on all physician specialties, 

For drug mention percentsbasedon an individual physician 

specialty, 

Estimates of rates where the numerator 

is not a subclass of the denominator 

Approximate relative standarderrors for rates in which 

the denominatoris the total United Statespopulation or one 

or more of the age-sex-racegroupsof the total populationare 

equivalentto the relative standarderror of the numeratorthat 

can be obtainedfrom figuresI or II. 

Estimates of differences between 

two statistics 

The relative standarderrors shown in this appendixare 

not directly applicableto differencesbetweentwo sampleestimates.The standarderror of a differenceis approximatelythe 

squareroot of the sum of squaresof eachstandarderror consideredseparately,This formula representsthe standarderror 

quite accuratelyfor the differencebetweenseparateand uncorrelatedcharacteristics,althoughit is only a rough approximation in most other cases. 

Tests of significance 

In this report, the determinationof statistical inferenceis 

basedon the t-test with a critical value of 1.96 (0.05 level of 

significance).Terms relating to differences,such as “higher,” 

and “less” indicatethat the differencesare statistically significant. Terms such as “similar” or “no difference”mean that 

no statistical significanceexists betweenthe estimatesbeing 

compared.A lack of commentregardingthe differencebetween 

any two estimatesdoesnot meanthat the differencewas tested 

andfoundto be not significant. 

46 
Table II. Estimates of the civilian noninstitutionaliied population of the United States used in computing annual visit rates in this report, by race, ethnic@, 

sex, and age: 1980-91 and 1990 

Race 

Sex and age All White Black Other 

Female Numbers in thousands* 

All ages ...................... 115,244 98,412 14,005 2,829 

Under 15 years. ................ 24,856 20,327 3,787 744 

15-24 years ................... 20,634 17,217 2,886 532 

25-44 years. .................. 32,i 71 27,415 3,814 943 

45-64 years. .................. 23,114 20,357 2,305 452 

65 years and over ............... 14,470 13,098 1,213 158 

Male 

All ages ...................... 107,429 92,640 12,103 2,687 

Under 15 years. ................ 25,976 21,366 3,840 770 

15-24 years ................... 20,076 17,012 2,544 520 

25-44 years. .................. 30,487 26,558 3,057 873 

45-64 years ................... 20,849 18,637 1,838 375 

65 years and over ............... 10,042 9,067 826 150 

l9hnicity 

Hispanic’ Non-Hispanic 

7,290 108,121 

2,283 22,740 

1,538 19,348 

2,043 29,869 

1,024 22,204 

403 13,958 

7,238 100,388 

2,362 23,785 

1,636 18,680 

2,004 28,212 

931 20,029 

303 9,682 

‘Based on the April 1.1980 census. 

%lgures may not add to totals due to rounding. 

Note: Excludes Alaska and Hawaii. 

Population figures and rate 

computation 

The population figures used in computing annual visit 

rates are presented in table II. The figures are based on an 

average of the July 1, 1980, and July 1, 1981, estimates of 

the civilian noninstitutionalized population of the United 

States provided by the U.S. Bureau of the Census. Because 

NAMCS includes data for only the conterminous United 

States; the original population 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. 

Estimates of numbers of visits and drug mentions in this 

report are for a 2-year period, but ratios and rates represent 

average annual estimates. For example, the average annual 

visit rates are calculated as follows. The numerator is obtained 

by dividing the estimated number of offrce visits for 1980-81 

by 2 to obtain an average annual number of offrce visits. This 

number is then divided by the appropriate population figure to 

obtain an average annual visit rate. As previously discussed, 

estimates of reliability for. average annual visit rates may be 

calculated from figures I and II. 

Rounding of numbers 

Estimates presented in this report are rounded to the nearest thousand. For this reason detailed figures within tables do 

not always add to totals. Rates and percents are calculated on 

the basis of the original, unrounded figures and may not necessarily agree precisely with percents calculated from rounded 

data. 

Systematic bias 

No formal attempt was undertaken to determine or measure 

systematic bias in the NAMCS data. But it should be noted 

that there are several factors affecting the data which indicate 

that these data underrepresent the total number of office visits. 

Some of these factors are briefly discussed below. 

l Physicians who participated in NAMCS did a thorough 

and conscientious job in keeping the Patient Log; however, 

post survey interviews with participating physicians indicate that a small number of patient visits may have been 

accidentally omitted Tom the Patient Log; although this 

number is quite small, such omissions would result in an 

undercoverage of office visits. 

The same post survey interviews indicate that the inclusion of patient visits that did not actually occur was 

infrequent and would have a negligible effect on survey 

estimates. 

l As previously stated, the physician universe for the 

1980-81 NAMCS included all nonfederal, office-based, 

patient-care physicians on the AMA and AOA masterfiles. 

The NAMCS was designed to provide statistically unbiased estimates of office visits to this designated population. Not included in the universe were physicians who 

were classified as federally employed; or hospital-based; 

or who were principally engaged in research, teaching, administration, or other nonpatient care activity. Consequently, ambulatory patient visits to these physicians in 

an office setting would not be included in NAMCS esti- ­

mates. In an attempt to measure the number of office visits 

to physicians not in the NAMCS universe, a NAMCS 

47 
ComplementSurvey was conductedin 1980. This study methodologyand results are forthcoming.Preliminary reinvolved a sample of approximately 2,000 physicians sults indicate that about 17 percent of the Complement 

selectedfrom amongthe 230,000 physiciansin the AMA Survey physicians saw some ambulatory patients in an 

and AOA masterfileswho were not eligible (in scope)for offrcesettingandthat an estimated69 million office visits 

the 1980 NAMCS. Details of the ComplementSurvey weremadeto thesephysiciansin 1980. 

48 
Appendix II 

‘Definitions of certain terms 

used in the report 

Terms relating to the survey 

Ofice-Premises identifiedby physiciansas locations for 

their ambulatory practices. The responsibility over time for 

patient care and professionalservicesrenderedthere generally 

resideswith, the individual physician rather than with any institution. 

Ambulatory patient-An individual seeking personal 

healthserviceswho is neitherbedriddennor currently admitted 

to any health careinstitution on the premises. 

Physician-Classified as either: 

l In scope-All duly licenseddoctors of medicine or doctors of osteopathycurrently in practice who spend some 

time caringfor ambulatorypatients at an office location. 

l Out of scope-Those physicians who treat patients only 

indirectly, including physiciansin the specialtiesof anesthesiology,pathology,forensicpathology,radiology,therapeutic radiology,and diagnosticradiology,and the following physicians: 

l Physicians who are federally employed, including 

thosephysiciansin military service. 

l Physicianswho treat patients only in an institutional 

setting, for example, patients in nursing homes and 

hospitals. 

l Physicians employedfull time in industry or by an 

institutionand havingno privatepractice,for example, 

physicians who work for the Veterans’Administration or the Ford Motor Company. 

l Physicianswho spendno time seeingambulatorypatients, for example,physicianswho only teach,are engagedin research,or are retired. 

Patients-Classitied.as either: 

l In scope-All patients seen by the physician or a staff 

memberin the office of the physician. 

l Out of scope-Patients seenby the physicianin a hospital, 

nursinghome, or other extendedcare institution, or in the 

patient’s home. (Note: If the physician has a private office, meetingthe definition of “office,” located in a hospital, the ambulatory patients seen there are considered 

in scope.)The following types of patients are considered 

out of scope: 

l Patients seen by the physician in an institution, including outpatient clinics of hospitals, for whom the 

institution has primary responsibilityover time. 

l Patients who contact and receive advice from the 

physicianvia telephone. . 

l Patientswho come to the office only to leave a specimen, to pick up insuranceforms, or to pay a bill. 

l Patientswho cometo the office only to pick up medicationspreviouslyprescribedby the physician. 

Visit-A direct, personal exchangebetweenan ambulatory patient and a physician or a staff memberfor the purpose 

of seekingcare and renderinghealth services. 

Physician specilzlty-Principal specialty, including general practice, as designatedby the physician at the time of the 

survey.Thosephysiciansfor whom a specialtywas not obtained 

were assignedthe principal specialtyrecordedin the physician 

masterfiles maintainedby the American Medical Association 

or the American OsteopathicAssociation. 

R;?gion of practice location-The four geographicregions, 

excludingAlaska and Hawaii, that correspondto those used 

by the U.S. Bureauof the Census: 

Region States included 

Northeast. . . . . Connecticut, Maine, Massachusetts, New 

Hampshire, New Jersey, New York, 

Pennsylvania, Rhode Island, and 

Vermont 

North Central . . Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, 

North Dakota, Ohio, South Dakota, and 

Wisconsin 

South _ . . . . . . . Alabama, Arkansas, Delaware, District 

of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, 

North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and 

West Virgina 

West. . . . . . . . . Arizona, California, Colorado, Idaho, 

Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming 

Metropolitan status of practice location-A physician’s 

practice is classifiedby its location in, a metropolitanor nonmetropolitanarea.Metropolitanareasare standardmetropolitan 

statistical areas (SMSA’s) as defined by the U.S. Office of 

Management and Budget. The definition of an individual 

SMSA involves two considerations:first, a city or cities of 

specifiedpopulationthat constitutethe centralcity and identify 

the county in which it is located as the central county; second, 

economicand social relationshipswith “contiguous” counties 

that are metropolitan in characterso that the peripheryof the 

specific metropolitan area may be determined.SMSA’s may 
cross State lines. In New England, SMSA’s consist of cities 

and towns rather than countie!. 

Terms relating to the 

Patient Record Form 

Age-The age calculated from date of birth was the age 

at last birthday on the date of visit. 

Race-White, Black, Asian or Pacific Islander, or American Indian or Alaskan Native. Physicians were instructed to 

mark the category they judged to be the most appropriate for 

each patient based on observation or prior knowledge. The 

following definitions were provided to the physician: 

l White-A person having origins in any of the original 

peoples of Europe, North Africa, or the Middle East. 

l Black-A person having origins in any of the black racial 

groups of Africa. 

l Asian or Pacific Islander-A person having origins in 

any of the original peoples of the Far East, Southeast 

Asia, the Indian subcontinent, or the Pacific Islands, including, for example, China, India, Japan, Korea, the 

Philippine Islands, and Samoa. 

l American Indian or Alaskan Native-A person having 

origins in any of the original peoples of North America 

and who maintains cultural identification through tribal 

affiliation or community recognition. 

Ethnicity-Category judged by the physician to be the 

most appropriate. The following definitions were provided: 

l Hispanic or&in-A person of Mexican, Puerto Rican, 

Cuban, Central or South American, or other Spanish culture or origin, regardless of race. 

l Not Hispanic-Any person not of Hispanic origin. 

Patient’s complaint(s), 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. 

Major reason for this visit-The one major reason (selected from the following list) for the patient’s visit as judged 

by the physician: 

l Acute problem-A visit primarily for a condition or illness having a relatively sudden or recent onset (within 3 

months of the visit). 

l Chronic problem, routine-A visit primarily to receive 

regular care or examination for a preexisting chronic 

condition or illness (onset of condition was 3 months or 

more before the visit). 

0 Chronic problem, jlareup-A visit primarily to receive 

care for a sudden exacerbation of a preexisting chronic 

condition or illness. 

l Postsurgery orpostinjuly-A visit primarily for followup 

care of injuries or for care required following surgery, for 

example, removal of sutures or cast. 

l Nonillness care (routine prenatal, general exam, wellbaby)-General health maintenance examinations and 

routine periodic examhiations of presumably healthy persons, both children and adults, including prenatal and 

postnatal care, annual physicals, well-child examinations, 

and insurance examinations. 

Diagnostic services this visit-Physicians were instructed 

to check any of the following services that were ordered or 

provided during the current visit: 

Limited history and/or examination-History or physical examination limited to a specific body site or system 

or concerned primarily with the patient’s chief complaint, 

for example, pelvic examination or eye examination. 

General history and/or examination-History or physical examination of a comprehensive nature, including all 

or most body systems. 

Pap test-Papanicolaou test. 

Clinical lab test-One or more laboratory procedures or 

tests, including examination of blood, urine, sputum, 

smears, exudates, transudates, feces, and gastric content, 

and inclu’ding chemistry, serology, bacteriology, and pregnancy test; excludes Pap test. 

X-ray-Any single or multiple X-ray examin?tion for 

diagnostic or screening pm-p&es; excludes radiation 

therapy. 

Blood pressure check. 

EKG-Electrocardiogram. 

Vision test-Visual acuity test. 

Endoscopy-Examination of. the interior of any body 

cavity except ear, nose, and throat by means of an endoscope. 

Mental status exam-Any formal, clinical evaluation designed to assess the mental or emotional status of the patient. 

Other-All other diagnostic services ordered or provided 

that are not included in the preceding categories.. 

Principal diagnosis-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 importance. The term “principal” refers to the first-listed diagnosis. The diagnosis represents the physician’s best judgment at the time of the visit and 

may be tentative, provisional, or definitive. 

Other significant current diagnoses-The diagnosis of 

any other condition known to exist for the patient at the time 

of the visit. Other diagnoses may or may not be related to the 

patient’s reason for visit. 

Have you seen patient before?-“Seen before” means 

provided care for at any time in the past. Item lob refers to 

the patient’s current episode of illness. 

Medication therapy this visit-The physician was instructed to list, using brand or generic names, all medications, 

including drugs, vitamins, hormones, ointments, and suppositories ordered, injected, administered, or provided this visit 

including prescription and nonprescription drugs, vaccinations, 

immunization, and desensitization agents. Also included are 
drugs and medicationsorderedor provided prior to the visit 

that the physician instructed or expectedthe patient to continue taking. Medicationsfor the principal diagnosisare listed 

in item 11a; all other drugsare listed in item 1lb. 

Nonmedication therapy-Physicians were instructed to 

check any of the following servicesthat wer * orderedor pru 

vided duringthe currentvisit: 

Physiotherapy-Any form of physical therapy orderedor 

provided,includingany treatmentusing heat, light, sound, 

or physicalpressureor movement;for example,ultrasonic, 

ultraviolet, infrared, whirlpool, diathermy, cold, and 

manipulativetherapy. 

Ofice surgery-Any surgicalprocedureperformedin the 

office this visit, including suture of wounds, reduction of 

fractures, application or removal of casts, incision and 

drainingof abscesses,application of supportivematerials 

for fracturesand sprains,irrigations,aspirations,dilations, 

and excisions. 

Family planning-Services, counseling, or advice that 

might enablepatients to determinethe numberand spacing of their children, including both contraceptionand infertility services. 

Psychotherapy or therapeutic listening-All treatments 

designedto produce a mental or emotional response 

throughsuggestion,persuasion,reeducation,reassurance, 

or support,including psychologicalcounseling,hypnosis, 

psychoanalysis,andtransactionaltherapy. 

Diet counseling-Instructions, recommendations,or advice regardingdiet or dietary habits. 

Family or social counseling-Advice regardingproblems 

of family relationships,including marital or parent-child 

problems,or social problems,including economic,educational, occupational,legal, or social adjustmentdif%ulties. 

Medical counseling-Instructions and recommendations 

regardingany healthproblem,including adviceor counsel 

about a changeof habit or behavior. Physicianswere instructedto check this categoryonly if medical counseling 

was a significant part of the treatment.Family planning, 

diet counseling,and family or social counselingare excluded. 

Other-Treatments or nonmedicationtherapies ordered 

or provided that are not listed or included in the preceding categories. 

Was patient referred for this visit by anotherphysician?-

Referrals are any visits that are made at the advice or direction of a physician other than the one beingvisited. The interest is in referrals for the current visit and not in referralsfor 

any prior visit. 

Disposition this visit-Eight categoriesare provided to 

describethe physician’s disposition of the case. The physician was instructed to check as many of the categoriesas 

apply: 

No followup planned-No return visit or telephonecontact was scheduledfor the patient’sproblem. 

Return at speciJed time-Patient was told to schedulean 

appointmentor was instructed to return at a particular 

time. 

Return ,if needed, P.RX-No future appointmentwas 

made,but the patient was instructedto make an appointment with the physician if the patient consideredit necessaryTelephone followup planned-patient was instructed to 

telephonethe physicianon a particularday to report either 

on progress,or if the needarose. 

Referred to other physician-Patient was instructed to 

consult or seekcare from anotherphysician. The patient 

may or may not return to this physician at a later date. 

Returned to referring physician-Patient was instructed 

to consult againwith the referringphysician. 

Admit to hospital-Patient was instructed that further 

care or treatment would be provided in a hospital. No 

further ofice visits were expectedprior to hospital admission. 

Other-Any other disposition of the casenot included in 

the precedingcategories. 

Duration of this visit-Time the physician spentwith the 

patient, not including time the patient spentwaiting to seethe 

physician, time the patient spentreceivingcarefrom someone 

otherthan the physicianwithout the presenceof the physician, 

andtime the physicianspentin reviewingsuchthingsasrecords 

and test results.If the patient was providedcare by a member 

of the physician’s staff but did not see the physician during 

the visit, the duration of visit was recordedas 0 minutes. 

51 
Appendix III 

Survey instruments 

Endorsing Organizations 

American Academy 

of Dermatology 

American Academy of 

Family Physicians 

American Academy 

of Neurology 

American Academy of 

Orthopaedic Surgeons 

American Academy 

of Pediatrics 

American Association of 

Neurological Surgeons 

American College of 

Emergency Physicians 

American College of 

Obstetricians and 

Gynecologists 

American College 

of Physicians 

American College of 

Preventive Medicine 

American Osteopathic 

Association 

American Society of 

Colon and Rectal 

Surgeons 

American Psychiatric 

Association 

American Society of 

Internal Medicine 

American Society of 

Plastic and Reconstructive 

Surgeons, Inc. 

American Urolo&cal 

Association 

Association of American 

Medical Colleges 

National Medical 

Association 

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

PUBLIC HEALTH SERVICE 

OFFICE OF HEALTH RESEARCH,STATISTICS AND TECHNOLOGY 

HYATTSVILLE.MARYLAND 20782 

NATIONAL AMBULATORY 

MEDICAL CARE SURVEY 

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 is to collect information 

about ambulatory patients, their problems, and the 

resources used for their care. The resulting published 

statistics will 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 strictconfidence. 

Many organizations and leaders in the medical profession 

have expressed their support for this survey, including 

those shown to the left. In particular, your own specialty society has reviewed the NAMCS program and supports 

this effort (see enclosure). They join me in urging 

your cooperation in this important research. 

Within a few days, a survey representative will telephone 

you for an appointment to discuss the details of your 

participation. We greatly appreciate your cooperation. 

Sincerely yours, 

Dorothy P. Rice 

Director 

Enclosure 

52 
C No.499932 CNo.499932 

PATIENT LOG 

1, DATE OF VISIT PATIENT RECORD 

A NATIONAL AMBULATORY MEDICAL CARE SURVEY 

As each patient arrives, record name an7 

time of visit on the log below. For the 2. DATEOF .3 SEX 4. COLOR OR RACE 5, ETHNICITY 6. PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER 

patient en%xed on line M, also com- BIRTH ’ 

10 REASON(S) FOR UVISIT jIn patient’s own wordsj 

plete the patient record ,to the right WHITE 

BLACK 1 0 HISPANIC a. MOST IMPORTANT 

ORIGIN 

l-L-1 30 ASIAN/PACIFIC 2 ONOT ISLANDER MO”,hDayYear ( :“,zLE 

4q AMERICAN INDIAN/ 

HlSPANlc b. OTHER 

ALASKAN NATIVE 

7. MAJOR REASON FOR THIS 8 DIAGNOSTIC SERVICES THIS VISIT 9. PHYSICIAN’S DIAGNOSES 

VISIT [Check onej ’ [Check all ordered or providedj 

10 NONE ’ 8OEKG a. PRlNClPA,. D,AGNDS,S,PROBLEM ASSOCIATED WITH ITEM 6a. 

1 0 ACUTE PROBLEM 2 ,-, LIMITED HISTORY/EXAM. 9 0 VISION TEST. 

2 0 CHRONIC PROBLEM. ROUTINE 3 q GENERAL HISTORY/EXAM. 10 j-J ENDOSCOPY 

au 

40 

CHRONIC PROBLEM. FLAREUP 

POSTSURGERY/POST INJURY 

4 q PAP TEST 

50 

CLINICAL LABTEST 

11 0 MENTAL STATUS 

EXAM. b. OTHER SIGNIFICANT CURRENT DIAGNOSES 

5 0 NON~LLNESS CARE (ROUTINE 

PRENATAL, GENERAL EXAM., 6q X.RAY -Cl OTHER IS,xcifJq 

WELL BABY, ETC.) 70 BLOOD PRESSURE CHECK 

10 HAVE YOU SEEN 11 MEDICATION THERAPY THIS VISIT 0 NONE . ’ PATIENT BEFORE? /Usblg brand or gerterfc rtames, record all new and con timted medications ordered, h~jected, admittistered, or otherwise 

provided (1t this vist. Incltrde inmun;zittg and desensitizing ogen tsj 

iI. FOR PRINCIPALDIAGNOSES IN lTEM9a. b. FOR ALL OTHER REASONS. 

lOYES z0NO 

I 

Record items l-15 IF YES. FOR THE 

far thi* oatient. I Pm CONDITION IN 

ITEM 9a? 

10 YkS 2q ND 

‘12. NON-MEDICATION THERAPY 

[Check all services ordered or provided this visit/ 

6cl DIET COUNSELING 

PHYSIOTHERAPY 7 ,, FAMILY/SOCIAL 

COUNSELING 

3 ,-,OFFlCE SURGERY 

1. 

2. 

3. 

4. 

14, DISPOSITION THIS VISIT 

/Check all that applyj 

1 ,, NO FOLLOW.UP PLANNED 

RETURN AT SPECIFIED TlME 

1; RETURN IF NEEDED. P.R.N. 

13. WAS PATIENT 

REFERRED 

FOR THIS VISIT 

BY AMHER 

PHYSICIAN? 

15. DURATION 

OF THIS 

TELEPHONE FOLLOW-UP PLANNED 

:g REFERRED TO OTHER PHYSICIAN 

RETURNED TO REFERRlNG PHYSICIAN 

:o”. ADMIT TO HOSPITAL 

Ml”“,CI 

8 ,-, OTHER ,S,wci.v, 

OMS No. 68-R.1498 

8 0 MEDICAL COUNSELING 

4 ,-, FAMILY PLANNING 

90 OTHER ISpecif.,q 

50 PSYCHOTHERAPY/ 

THERAPEUTIC LISTENING 

CONTINUE LISTING PATIENTS I ON NEXT PAGE 

PHS-61 O&C (g/79) 
BEGIN DECK 3 

CONFIDENTIAL* 

NORC-4284 

FOR OFFICE USE 

ONLY: I 

m

5-61 

NATIONAL AMBULATORYM2DZCA.LCARE SURVEY 

INDUCTION INTERVIEW 

BEFORESTARTING INTERVIEW 

1. ENTER PHYSICIAN I.D. NlJNBERIN BOX TO 

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

this survey. 

Although ambulatory medical care accounts for nearly 90 percent 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 offtces. This kind 

of information has 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 representatives of the medical 

profession, has developed the National Ambulatory Medical Care Survey. 

Your own task 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 information you provide is held in strict confidence. 

1. First, you are a 

(ENTER SPECIALTY FROMCODEON FACE SHEET LABEL.)' 

Is that right? Yes . . . . . . . . . . . X 

No . . :. (ASK A) . . . . Y 

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

(Name of Specialty) 

'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. 

54 
-2-

2. NOW, doctor, this study will be concerned with the ambulatory patients you will 

see in your office during the week of (READ REPORTINGDATES ENTEREDBELOW). 

(that's. a (that's a 

1 Monday) through / Sunday) 

month date month date 

Are you likely to see any ambulatory patients in your office during that week? 

Yes . . . . . .(GO TO Q. 3) . . x 

No . *. . . . . (ASK A) . . . . y 

A. IF NO: Why'is that? KECORDVERBATIM, THEN READ PARAGRAPHBKECW 

Since it's very important, doctor, that we include any ambulatory patients 

'that you do 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 bacl? with your office just before (STARTING DATE) to make 

sure, and I can explain them $n detail then, if necessary. 

GIVE DOCTORTHE 4 PATIENT RECORDFORMSAND GO TO Q. 9, P. 6. 

55 
7-day period? RECORD 3, A, bi: what office location will you be se&

UNDERA BELCMAND?fiE~bu?u;t~‘y prtww dur*ng that . 

B. FOREACHOFFICE LOCATIONENTEREDIN A, CODEYES OR NO TO "IN SCOPE." 

Private offices 

Free-standing clinics 

(non-hospital based)

Groups, partnerships

Kaiser, HIP, Mayo Clinic 

Neighborhood Health Centers 

Privately operated clinics 

(except family planning) 

1-1 

liospttal emergency rooms 

Hospital outpatient departments

College or university infirmariea 

Industrial outpatient factlities 

Family planning clinics 

Goverument-operated clinics 

(VD, maternal & child health, etc.) 

IN CASEOF DOUBT,ASK: Is that (clinic/facility/institution) hospital based? 

Is that (clinic/facility/institution) govekent

operated? 

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

patientxuring that week? 

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

No . . . . . . . . . . . Y 

IF NO: OBTAIN ADDITIONALOFFICE LOCATION(S), ENTERIN "A" BELOW,AND REPEAT. 

A. B. 

Office Location In Scope? 

Yes No 

0) 1 0 

(2) 1 0 

(3) 1 0 

(4) 1 0 

TOTAL IN'SCOPF,LOCATIONS: 141 

IF ALL LOCATIONSARE OUT OF SCOPE,TUNIC TBE DOCTORAND LEAVE. 

56 
-Q- DECK 3 

4. A. During that week (REPEAT DATES),, how many ambulatory patients do you expect 

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

LOCATIONS] CODEDIN 3-B.) 

ENTER TOTAL UNDER"A" BELOWAND CIRCLE NUMBERCATEGORYON Al?I's 

B. And during those seven days (REPEAT DATES IF NECESSARY), on how many days do 

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

EXPECTSTO SEE ANY PATIENTS AT AN IN-SCOPE OFFICE LOCATION. 

CIRCLE NUMBEROF DAYS IN APPROPRIATECCLUMNUNDER"B" BELOW. 

DETERMINEPROPERPATIENT LOG FORM-FROMCHART BELOW. READ ACROSS 

ON "TOTAL PATIENTS" LINE UNDER"A" AND CIRCLE LETTER IN APPROPRIATE 

"DAYS" COLUMNUNDER "B." 

THIS LETTER TELLS YOU WHICH OF THE FOUR PATIENT LOG FORMS(A, B, C, D) 

SHOULDBE USED BY THIS DOCTOR. 

A. B. 

Expected total Total days LOG FORMDESCRIPTION patients during during week, 

in practice 

A--Patient Record is to be 

completed for ALL 

patients liste& Log. 

B--Patient Record is to be 

completed for every 

SECONDpatient listed < 

on Log. 

C--Patient Record is to be 

completed for every 

THIRD patient listed 

ong. 

*D--Patient Record is to be 

completed for every 

FIFTH patient listed 

xg. 

* 

survev I week. 1 

ENTER TOTAL FROM 1 

15-17/ 

26- 39 " C B A A A A A 

40- 52 " CBBAAAA 

53- 65 " D C B B A A A 

66- 79 " D C B B B A A 

80- 92 n D D C B B B B 

93-105 " D D C B B B B 

106-118 " D D C C B B B 

119-131 " D D C C B B B 

132-145 " D D D C C B B 

146-158 " D D D C C B B 

159-171 " D D D C C C C I 

172-184 " D F D C C C C 

185-197 11 D D D D D D D 

198-210 " D D D D D D D 

211+ I, D D D D D D D 

In the rare instance the physician will see more than 

his assigned reporting week, give him two D Patient Laolios 

to complete a patient record form for only every tenth patient. 

to draw an X t;?roug:l the Patient Record on every other page of 

starting with Page 1 of,the pad. The physician then completes 

on every page, but completes the Patient Record on every second 

500 patients during 

and instruct him 

Then you are 

the two folio pads, 

the Patient Log 

page. 

57 
-5- DECK 3 

5. FIND LOG FOLIO WITH APPROPRIATELETTERAND CIRCLE LETTER, ENTER FIRST FOUR NUMBERS 

OF THE FORMANDNUMBEROF LINES STAMPED"BEGIN ON NEXT LINE" FOR THE B-C-D LOG 

FORMS(if no lines are stamped, enter "0") BELOW. 

19-23/ 

24-261 

6. HANDDOCTORHIS FOLIO AND EXPLAIN HOWFORMSARE TO BE FILLED OUT. SHOWDOCTOR 

INSTRUCTIONSON THE POCKE?OF FOLIO, ITEMS 8 AND 11 ON &mT.X$IN POCKET 

OF FOLIO AND ITEM DEFINITIONS ON THE BACKOF FOLIO, TO WHICHHE CAN REFERAFTER 

YOU LEAVE. 

EMPHASIZETHAT EVERYPATIENT VISIT EXCEPTADMINISTRATIVEPURPOSEONLY IS TO BE 

RECORDEDON THE LOG FOR ENTIRE REPORTINGPERIOD. FOR EXAMPLE,IF A MEDICAL 

ASSISTANTGAVETti PATIENT AN INOCULATION,OR A TECHNICIANADMINISTEREDAN 

ELECTROCARDIOGRAM AND THE PATIENT DID N(Yl' SEE THE DOCTOR,THIS VISIT MUST STILL BE 

LISTED dN THE LOG. 

RECORD VERBATIMBEL(3WANY CONCERN,PROBLEMS OR QUESTIONSTHE DOCTORRAISES.

7. IF DOCTOREXPECTSTO SEE AMBULATORYPATIENTSAT ERE THAN ONE IN-SCOPEu)CATION

DURINGASSIGNEDWEEK, TELL HIM YOUW ILL DELIVER TIE FORMSTO THE OTHERLOCATION(S). ENTERTHE FORMLETTERAND NUMBER(S)AND NUMBEROF LINES STAMPED"BEGIN ON NEXT 

LINE" FOR THE B-C-D LOG FOR THOSELOCATIONSBELOW,BEFOREDELIVERINGFORM(S). 

No. Lines 'FOR OFFICE USE ONLY 

Location FOLIO Stamped "BEGIN Number patient recor 

Letter .Number ON NEXT LINE" _ 

forms completed _ _ 

27-31/ 

32-341 

35-391 

40-42/ 

43-47/ 

48-50/ 
. . 

-6- DECK 3 

8. During the survey week (REPEATEXACTDATZS), will anyone be available to help 

you %!I filltag out these records (at each INISCOPE location)? 

Yes . . . . (ASK A) . . . 1 511 

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

A. IF yEs: Who would that be? 

RECORDNAME, POSITION AND LOCATION. 

I NAME i POSITION I LOCATION I 

PERBONALLYBRIEFEACHPERSONLISTEDABOVE. 

EMPHASIZETHAT EVERYPATIENT VISIT DURINGTEE ENTIRE WEEKIS TO BE RECORDEDON TEE 

LOG EXCEPT"ALMINISTRATIVEPURPOSEONLY." 

, 

9. Do YOUhave a solo practice. or are YOUalrrociated with other phyrician+ tn a 

parinership, in a g;oup practice, or-in 6ome other way? - -

Solo. . . . . (60 T0.Q. 10) . . 1: 52/ 

Partnership , . (ASK A-C) . . . ? 

Group . . . . . (ASK A-C) . <--- Other (SPECIFY AND ASK A-C) . . 2 

IF PARTNERSHIP.GROUP.OR OTHER: 

A. I6 this a prepaid group practice? Yes . . (ASK cl]) . . . 1 531 

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

[13 IF YES TO A: What per cent 

of patient6 are __ prepaid? per cent 54-561 

B. Row many other physicians are 

associated with you? NUMBEROF PHYSICIANS: 57-591 

C. What are the specialties of the other phy6ician8 a66oCi6ted with you? 

(How many of these are there?) 

Specialty Number of Phylsicianr 

(1) 

(2) 

(3) 

(4) 

(5) 

D. CIRCLE ONE: 

All physicians in this partnership/group practice 

have the same specialty . . . . . . : . . . . . . . . . . . 1 601 

More than one specialty in this partnership/group practice . . 2 

59 
-7- BEGIN DECK 4 

10. Now I have just one more question about your practice. (NOTE: IF DOCTORPRACTICES 

IN LARGEGROUP,THE FOLLOWINGINFORMATIONCAN BE OBTAINED FR6M SOMEONELSE.) 

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, temporari% ill, 

etc. Do not include other physicians. RECORDON BOTTOMLINE OF COLUPNA BELOW. 

(1) HGany of these full-time employees are a . . . (READ CATEGORIESBELOWAS NECESSARY 

AND RECORDNUMBEROF EACH IN COLUMNA.) 

B. And what is the total number of part-time (less than 35 hours per week) employees.of your (partnership/group) practice? Again, include persons regularly employed who are now on vacation, 

ill, etc. Do not include other physicians. IuXOFUI ON BOTTOMLINE OF COLUMNB BELOW. 

(1) How many of these part-time employees are a . . . (READ CATEGORIESBELOWAS NECESSARY 

AND RECORDNUMBEROF EACH IN COLUMNB.) 

‘A. B. 

Employees .B;Pbll-time Part-time 

(35 or more hours/week) (Less than 35 hours/week) I 

(1) Registered Nurse . . . . . . . . . t . 11-131 35-37./ 

(2) Licensed Practical Wurse ....... 14-161 38-401 

(3) Nursing Aide ............. 17-s9/ 41.i3l 

(4) Physician Assistant* ......... 20-22/ 44-461 

(5) Technician .............. 23-251 47-491 

(6) Becretary or Receptionist . . . . . . 26-28/ 50-52/ 

(7) Other (SPECIFY) 29-311 53-551 

TOTAL:f-----l 32-34/ CAL: 1-j 56758/ 

* Physician Assistant rrmst be a graduate of an accredited training program for Physician kristants (Physician Extenders, Medex, etc.) or certified by the National Board of PIedical 

Exminera through the Certification Exam for Assistant to the Primary Care physician. 

BEFOREYOULEAVE, AGAIN STRESSTHAT EACHAND bVERYAMBULATORYPATIENT SEENBY TBF, 

DOCTbROR HIS STAFFDURINGTHE 7-DAYEIOD AT ALL IN-SCOPEOFFICE LOCATIONS(REPEAT

THEM) IS TO BE INCLUDEDIN THE SURVEY,THAT EACGATIENT IS TO BE RECORDEDON THE LOG, 

AND ONLYTHE APPROPRIATE NUMBEROF PATIENT RECORDSCOMPTXIXD. 

Thank you for your tfme, Dr. If you have any (more).queetione, 

please feel free to call me. My phone n&er is written in the folio. I'll 

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

11. TIME INTERVIEWENDED. . . . . . . . AM 

PM 

12. DATE OF INTERVIEW . . . . . . . . . . . . . . . 

60 
DECK 4 

INTRR.VIRWERNUMBER INTERVIEWER'S SIGNATURE 

I I I I I I 

FOR OFFICE USE ONLY: 

No. of Patients Seen: 

62i Total. Day.5 in Practice during Week: cl 

61 
Appendix IV 

American Hospital Formulary 

Service classification system 

and therapeutic category codes 

AMERICAN HOSPITAL FORMULARY SERVICE CLASSIFICATION SYSTEM 

AND THERAPEUTIC CATEGORY CODES (AHFS#) 

(Chsif~tiom in pmmthesarM providoti but may be d in -DPIF) 

AMERlCAN 36:00 DIAGNOSTIC AGENTS 6O:OO COLD COMPOUNDS 

HOSPITAL 36~04 AdrenocmticPL lnsuftkiatcy 

FORMIJLARY 36: 08 Amyloidoaia 64:OO HEAVY METAL ANTAGONISTS 

SJZRVlCE 36: 12 Blood Volume 

CLASSlFlCATlON 36:16 Brucellosis 68:OO HORMONES AND SYNTHETlC 

SYSTEM 36: 18 C&kc Function SUBSTITUTES 

36: 24 Circulation Time 68:M Adrenala 

36:2.5 (Cystic Fibrosis) 68:08 Andmans 

36126 Dkktcs Mellitus 60~12 Contrrceptiver 

36:28 Diphtheria 68:16 PUOSens 

04:OO ANTIHISTAMINE DRUGS 36: 30 Dru8 Hypersensitivity 68: 18 Gonadotropiru 

36:32 Funpi 68:20 Insulins and Anti-Dktctic 

08:OO ANTI-lNl%CTlVE AGENTS 36:34 Gallbladder Function ARents 

08~34 Amebacidor 36:36 Gastric Function 68:2O.O8”1nsulins 

O&O8 Anthelmintics 36:38 Intestinal Absorption 68~24 Parsthyroid 

08: I2 Antibiotics 36:40 Kidney Function 68:28 Pitultlrv 

08: 12.02 AmhloglS;coQides 

08: 12.04 Antifungal Antibiotics 

08:12.06 cephaloaparinr 08:12.08 Cblorampheoiwl 

36:44 Liver Function 

36~48 Lymphogtanulomr Venereum 

3652 Mumps 

3656 Myasthenia Gravis 

68:32 Pra&qenr 

6834 ‘other Corpus Luteum Hormones 

68:36 Thyroid and Antithyroid 

08:1212 Erythromycina 

08:12.16 Penicillins 

36:60 Myxedema 

36:61 Pancreatic Function 72:OO LOCAL ANESTHETICS 

08:12.24 Tetmcyclines 

OC12.24 Other Antibiotics 

36:62 Phenylketonurk 

36:64 Pheuchromocytom 76:OO OXYTOCICS 

08:16 

08:18 

Antituberculosis Agents 

AntiviIak 

36:66 Pituitary Function 

36:68 Roentpenogfaphy 78:OO RADIOACTIVE AGENTS 

08:20 

08:24 

plrsmodicides 

S ”lfOllnmi&S 

36:72 Scatlet Fbver 

36:76 Sweatiq+ 8O:oO SERUMS, TOXOIDS AND VACCINES 

MI:26 SUlfOMA 36:78 (Thyroid Function) 8064 Serums 

08:28 

08:32 

Treponcmicides 

Trichomonacides 

36:80 Tricbinosb 

36: 84 Tvberculosir 

80:08 Toxoids 

80:12 vaccines 

08:36 

08:40 

Urinary Germicides 

other Anti-Infective 

36~88 Urine Contenta 

84:00 SKIN AND MUCOUS MEMBRANE 

4O:OO ELmROLYTlC. CALORIC, AND PREPARATIONS 

1o:oa ANTINEOPLASTIC AGENTS WATER BALANCE 84:W Anti-lnfectivn 

40:04 Acidifying Agents 84Z4.04 Antibiotics 

12:oo AUTONOMIC DRUGS 

12:04 Para~ympdhombnetic Agents 

12:08 Pamsympatholyiic Agents 

12:12 Sympatbomlmetic Agents 

12:16 Sympatbolytic A8enu 

12:20 Skeletal Muscle Relaxants 

16:OO BLOOD DERIVATIVES 

40: 08 Alkaunizing Agcntr 

40: 10 Ammonia Detoxicants 

40~12 Replacement Solutions 

40: 16 Sodium-Removing Rcsinr 

40: 18 Pot.wium-Removing Resins 

40:20 Caloric Agmta 

40:24 Salt and Sugm Substitutes 

40:28 Dhuciica 

84:04.08 Fungicides 

84:04.12 Subicides and Pediculicides 

84:04.16 Misc. Local Anti-lnfectivea 

84336 Anti4nllammatory Agents 

84:08 Antipruritics and Local 

Anesihetics 

84 : 12 Aaln@nta 

84: 16 Cell Stimulnntr and Rolifermts 

2o:!M BLOOD FORMATlON AND COAGULATlON 

40: 36 lrrlgatiog Solutions 

40:40 uemJtic Agents 

&1:20 lktugents 

84:24 Emollknts. Demukentr and 

Rotectants 

20:04 Antianemk Drug3 

2o:fM.M iron Preparations 

20:04.08 Liver and Stomach 

44:00 ENZYMES 

48:00 EXPECTORANTS AND COUGH 

84:24&l Basic Lotions and Liniments 

84:24.08 Basic Oils and Other Solvents 

84:24.12 Basic Ointments and 

Reparations 20: 12 Coyllantr and Anticoagulants 

20:12.04 Anticoag”knts 

2til2.08 Antlhcpuin Aents 

20:12.12 Cna&ukn(s 

20: 12.16 Hematatics 

PREPARATIONS 

52:OO EYE. FAR, NOSE AND THROAT 

PREPARATIONS 

52:04 Anti-Infectives 

52:04&t Antibiotics 

RoteCtaotS 

84:24.16 Basic Powders and Demulcmts 

84:28 Keraiolytic Agents 

84: 32 Keratoplrrtic Agents 

84:36 Ml,celheour Agents 

8450 Pigmenting & Depigmenting Agents 

20:40 Thrombolytic Agents 52:04.06 Antivids 

52:04.08 Sulfonamides 

8450.04 Depigmmting Agents 

84:50.06 Pigmenting Agents 

2400 CARDIOVASCULAR DRUGS 52:04.12 Miac Ant!-lnfectives r&$:80 Sunsceen Agents 

24:M Cardiac Drue 

24:06 Antilipemk Agents 

52:08 Anti-lntlammatorY Agents 

52: 10 Carbonic Anhydraac Inhibitors 86:OO SPASMOLYTIC AGENTS 

24:08 Hypotensive &ents 

L?d:12 bOdiitbl~ &WS 

52: 12 Contact Lens Solutions 

52:16 Local Anesthetics 88x30 VITAMINS 

24~16 Sckroring A&eats 

28:OO CENTRAL NERVOUS SYSTEM DRUGS 

28:04 Cenetal Anesthetics 

52: 20 Miotics 

52:24 Mydrktics 

52:28 Mouth Wwhes and Gargles 

52: 32 Vnmconrtictors 

88% VttaminA 

88:08 Vitamin B Complex 

88: 12 Vitamin C 

88:16 Vitamin D 

28~08 Ana@esics and Antipyretics 

28:10 Narcotic Anta8adsts 

52:36 Unclaaitied A@nts 88: 20 Vitamin E 

88:24 Vitamin K Activity 

20: I2 Anticonvulsants 56:W GASTROINTESTINAL DRUGS 88:28 Multivitamin Rcpsmtions 

28: 16 Psychotherapeutic Agcnb 

28:16.04 Antidepressants 

56x34 Antacids and Adsorbcots 

56:08 An&Diarrhea Agents 92:OO UNCLASSIFIED THERAPEUTIC AGENTS 

28~16.08 Tnnquitizers 

28: 16.12 Other Psychotherapeutic 

56:lO Antifktuknts 

56: 12 Chtharticr and Laxatives 94:OO (DEVICES) 

Agents 

28:20 Respiratory and Cerebral 

56: 16 D&&ants 

56:20 EmeticsandAnti-Emetics 96:00 (PHARMACEUTIC AIDS) 

Stimulants 5624 Lipotropic Agwts 

2824 Sedatives and Hypnotics 56:40 Ml% Cl Dr”@ 

Copyright 01980. Drug Products Information File; American Society of Hospital Pharmacists, Bethesda, Maryland. 

All rights reserved. Reprinted with permission. 

62 *Km. 00-T FRIUTIIff OPPICE i 1984 O-421-616/302 
-_ ,. . 

. ._ 

SERIES 1. 

SERIES 2. 

SERIES 3. 

SERIES 4. 

SERIES 10. 

SERIES 11. 

SERIES 12. 

SERIES 13. 

Programs and Collection Procedure+Reports describing the 

general programs of the National Center for Health Statistics 

and its offices and divisions and the data collection methods 

used. They also include definitions and other material necessary 

for understanding thedata. 

Data Evaluation and Methods Research-Studies 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 statistical theory. 

Analytical and Epidemiological Studies-Reports presenting 

analytical or interpretive studies based on vital and health statistics, carrying the analysis further than the expository types of 

reports in the other series. 

Documents and Committee Reports-Final reports of major 

committees concerned with vital and health statistics and documents such as recommended model vital registration laws and 

revised birth and death certificates. 

Data From the National Health Interview Survey-Statistics 

on illness, accidental injuries, disability, use of hospital, medical, 

dental, and other services, and other health-related topics, all 

based on data collected in the continuing national household 

interview survey. 

Data From the National Health Examination Survey and the 

National Health and Nutrition Examination Survey-Data from 

direct examination, testing, and measurement of national samples 

of the civilian noninstitutionalized population provide the basis 

for (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. 

Data From the lnstltutfona!iied Population Surveys-Discontinued in 1975. Reports from these surveys are included in Series 

13. 

Data on Heafth Resources Utifiiion-Statistics on the utiliza: 

tion of health manpower and facilities providing long-term care, 

ambulatory care, hospital care, and family planning services. 

SERIES 14. 

SERIES 15. 

SERIES 20. 

SERIES 21. 

SERIES 22. 

SERIES 23. 

Data on HeaRh Resources: Manpovler and Faciliies-Statistics on the numbers, geographic distribution, and characteristics 

of health resources including physicians, dentists, nurses, other 

health occupations, hospitals, nursing homes, and outpatient facilities. 

Data From Special Surveys-Statistics on health and health-related topics collected in special surveys that are not a part of 

the continuing data systems of the National Center for Health 

Statistics. 

Data on p.lottafff+Various statistics on mortality other than 

as included in regular annual or monthly reports. Special analyses 

by cause of death, age, and other demographic variables: geographic and time series analyses; and statistics on characteristics 

of deaths not available from the vital records based on sample 

surveys of those records. 

Data on Ma&My, Marriage, and Divorce-Various statistics 

on natality, marriage,and divorce other than as included in regular 

annual or monthly reports. Special anaylses by demographic 

varfables; geographic and time series analyses; studies of fertility; 

and statistics on charapteristics of births not available from the 

vital records based on sample surveys of those records. 

Data From the National Monthly and Natali Suweys-Discontinued in 1975. Reports from these sample surveys based on 

vital records are included in Series 20 and 21, respectively. 

Data From the National Survey of Family Grovdh-Statistics 

on fertility, family formation and ,dissolution, family planning, and 

related maternal and infant health topics derived from a periodic 

survey of a nationwide probability sample of ever-married women 

15-44 years of age. 

For a list of titles of reports published in these series, write to: 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Public Health Service 

Hyattsville, Md. 20782 

301436NCHS 

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