FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, ECUCATION, AND WELFARE I No. 12 October 12, 1977 I Public Health Service. Health Resources Administration 

Ambulatory Medical Care


Rendered in Physicians’ Offices: United States, 1975a


The estimates presented in this report are 

intended to highlight the findings of the 1975 

Nat ion al Ambulatory Medical Care Survey 

(NAMCS). NAMCS is a sample survey designed 

to explore the provision and utilization of 

ambulatory care in the physician’s office-the 

setting where most Americans seek health care. 

The survey is conducted yearly over the conterminous United States by the Division of Health 

Resources Utilization Statistics of the National 

Center for Health Statistics. The survey sample 

is selected from doctors of medicine and osteopathy who are engaged in office-based, patient 

care practice. In its current scope, NAMCS 

excludes physicians practicing in Alaska and 

Hawaii, physicians whose specialty is anesthesiology, pathoIogy, or radiology, and physicians 

in Government service. 

Previous publications describe the develop­

�

ment and findings of NAMCS. 1-5 

NAMCS findings have been published for 

two previous 12-month periods, May 1973-

April 19741 JZ and January-December 1974.s 

aprepared by Hugo K. Koch and Norma Jean Dennison, 

Division of Health Resources Utilization Statistics. 

Data users are cautioned when mak.inq comparisons between the numerical estima;es for 

1975 and the numencaI estimates previously 

published for the two prior 12-month periods. 

Since these earlier data were reIeased, a continuing evaluation of the technical procedures 

used to project the nationzd estimates from the 

sample findings has resulted in a revision of the 

NAMCS estimating procedures. The revised 

procedures, applied to the 1975 findings, result 

in an estimated total of 567.6 miI1ion office 

encounters (visits) for that year. The application 

of these revised procedures to the findings previously reported results in the following adjustment of totaI estimated visits. 

Estimated visits 

(in millions) 

NAMCS reporting pen’od 

Pubhkhed Revised 

May 1973-April 1974 ........ 644.9 590.8 

January-December 1974 .... 634.1 577.8 

The most notable effect of the change in 

estimation procedure is to lower numerical 

estimates of office visits by 8-9 percent. DistribAdvance Data ji-o m Vital and Health Statistics replaces the supplements to the Monthly Vital Statistics Report 

as the means for early release of selected findings from the health and demographic surveys conducted by the 

NCHS. Most of these releases will be followed by detailed reports in the Vital and Health Statistics series. 

Provisional vital statistics as well as advance reports of firial data for a year will continue to be published in the 

Monthly Vital Statistics Report. 

Advance Data is being distributed on the mailing keys for the Vital and Health Statistics series, and people 

who now receive reports from a particular series will also receive all Advance Data releases for that series. 

*	 Temporarily, the mailing list for the Monthly Vital Statistics Report (’MVSR) is also being used. M VSR readers 

who wish to continue to receive Advance Data issues, as well as other persons who wish to receive all issues, 

should contact: National Center for Health Statistics, Center Building, Room 1-57, 3700 East West Highway, IHyattsville, Maryland 20782, Phone: (301) 436-8500. 
‘. 

2 admncedata 

utions and relationships—as expressed, for example, in percents and ratios —remain relatively 

unaffected by the change. 

Readers desiring more information about the 

NAMCS estimation procedures should address 

inquiries to Ambulatory Care Statistics Branch, 

National Center for Health Statistics, Center 

Building, 3700 East-West Highway, Hyattsville, 

Md. 20782. 

Figure 1 is a facsimile of the Patient Record 

used by participating physicians to record information about -their office visits. Figure 1 may 

be useful as a reference as the selected aspects of 

the survey findings are presented. 

Since the estimates presented ‘in this report 

are based on a sample rather than the entire 

universe of office-based, patient-care physicians, 

they are subject to sampling variability. See page 

11 for an explanation and for guidelines in 

judging the relative precision of estimates reported. 

DATA HIGHLIGHTS 

Physician Speciality 

Among the 13 most visited specialties, primary care providers led the other specialists in 

Figure 1. PATlENT RECORD 

ASSURANCE OF CONFIOENT!AUTY—AN i. fc.cmmm. whmh would Penn,! ,d.nl,ficmio. of an mdw,dud,


n pmclice. CMan establishment will be held .m+idomial. will be used only by persons mgagcd in and for D N?
 The purposes of the survey and will ..1 be dtsclosad cmreleased to other !xrsom or used for any olher purpose,


1. DATE OF VISIT 

Miz7%7k- ., 

2. DATE OF BIRTH 4. COLOR OFI 

RACE 

I � WHITE 

w’=7= 

3.	 SEX ~ � NEGRO/ BLACK 

PATl ENT RECORD 

NATIONAL AMBULATORY MEDICAL CARE SURVEY 

5.	 PATIENT’S PRINcIPAL PROBLEM(S) 6. SERIOUSNESS OF 7. HAVE YOU EVER SEEN COMPLAINT(S), OR SYMPTOM(SI ~ VISIT PROBLEM IN ITEM 5a THIS PATlENT BEFORE? 

[In patient’s own words] (Check one) 

J E Y~s >ONO — I � VERY SERIOUS 

a. MOST 

IMPORTANT 2 � SERIOUS If YES, for the problem 

I � FEMALE I � OTHER ] � sLIGHTLY SERIOUS ;ndicated in ITEM 53 ? 

I � MALE b � UNKNOWN b. OTHER 4 � NOT SERIOUS I ~ YES JUNO 

8.	 MAJOR REASON(S) FOR THIS VISIT (chck n//major ,..s..s1 9. PHYSICIAN’S PRINCIPAL OIAGNOSIS ~ VISIT . 

a. DIAGNOSIS ASSOCIATED WITH ITEM 5a ENTRY 

J � ACUTE PROBLEM w � WELL ADULT/CHILD EXAM 

01 � ACUTE PRoBLEM, FoLLoW.lJp o, � FAMILY PLANNING 

m � CHRoNIC pRo BLEM, Ro(JTINE !, � COUNSELING /AOVICE 

O. � CHRONIC PROBLEM, FLARE-UP !! � IMMUNIZATION 

O, � PRENATAL CARE !, � REFERREO BY OTHER pHYSIAGENCY b. OTHER SIGNIFICANT CURRENT OIAGNOSES 

o, � POSTNATAL CARE 1, � AOMINISTRATWE PuRPOsE 

], � POSTOPERATIVE CARE ,. � OTHER (Specify) 

7 

( Ope, adve mocedure) I 10. DIAGNOSTIC/THERAPEUTIC SERVICES OROEREO/PROVIOEO THIS VISIT /Checks// fh.x .@y) II. 

01 � NONE 11 � ORUG PRESCRIBED 

02 � LIMITED HISTORYIEXAM 12 � X-RAY 

03 � GENERAL HISTORY/EXAM 13 � INJECTION I Q 

04 n CLINICAL LAB. TEST 14 � iMMUNIZATION/DESENSITIZATION z � 

05 � ELOOO PRESSURE CHECK 15 � PHYSIOTHERAPY 3 � 

06 � EKG 16 � MEDICAL COUNSELING . 0 

07 � HEARING TEST 17 � FSYCHOTHERAPYf7HE RAPEUTIC $ � 

08 � VISION TEST LISTENING 

09 � ENDOSCOPY 18 � OTHER Specify] ‘ Q 

10 � OFFICE SURGERY ~ 0 

n � 

+RA.34-5 DEPARTMENT OF HEALTH, EDUCATION AND 

?EV. 8-74 PUBLIC !-lCALTh SE RVICZ 

HEALTH RESOUF,,;E5 ADMINISTRATION 

(In order of importance) 

DISPOSITION THIS VISIT 12. OURATION OF 

(CAeck .// fist=)	 ~ VISIT (Time 

actually spent with 

physician) 

NO FOLLOW-UP PLANNED 

RETURN AT SPECIFIED TIME 

RETURN IF NEEDEO, P.R. N. 

TELEPHONE FOLLOW-UP PLANNED 

REFERRED TO OTHER —MINUTES 

PHYSICIAN/AGENCY 

RETURNED TO REFERRING 

PHYSICIAN 

ADMIT TO HOSPITAL 

OTHER (Specify) 

WELFARE	 O.M. B. 4=58-S72106 

EXPIRATION DATE 121S1175 

NATl ONAL CENTER FOR HEALTH 5TATISTICS 
o


ackmcda3 

the provision of office-based ambulatory care; 

general and family physicians alone accounted 

for 2 of every 5 visits (table 1). 

Type and Location of Practice 

In a ratio of about 3 to 2, visits to solo 

practitioners outnumbered visits to physicians in 

muItipIe-member practice (table 1). 

Visits within standard metropolitan statistical areas (SI’VISA’S) outnumbered nonmetropolitan visits in a ratio of roughly 3 to 1. A 

comparison by annual visit rates also shows a 

higher rate within SMSA’S (2.9 visits per resident per yew-) than in the nonrnetropolitan 

areas (2.3 visits per resident pm- year). 

Patient’s Age, Sex, and Color 

Office visits per year increased in a direct 

parallel to advancing age; the rate for persons 

aged 65 and over more than doubled the rate for 

persons aged under 15 years (table 2). � Females were more commonly seen in the 

physician’s office than males; females made 

about 3 visits for every 2 visits made by males 

(table 2). 

This was due, in part, to the demographic 

fact that females outnumbered males in the general population. That other factors were at 

work, however, is confirmed by a comparison of 

annual visit rates between the sexes; here also a 

ratio of 3 to 2 prevailed in favor of the females. 

The following tabulation shows that female 

visits outnumbered male visits in every age interval except the youngest. 

Percent of all vkits 

Age Females Males 

Total ........................... 60.4 39.6 

Under 15 years.................. 8.1 9.3 

15-24years........................ 10.1 5.2 

25-44years........................ 16.7 8.6 

45-64years........................ 15.5 10.2 

65 yearsand over .............. 10.1 6.3 

White patients outnumbered patients of 

other races not only in absolute numbers of � visits but also in visit rate per annum (table 2).

Major Reasons for Visit 

The information in items 5 and 8 of the Patient Record represents an effort to determine 

the reasons for visiting the physician’s office, as 

expressed by patients in their own words. The 

terms and codes applied to the patient symptoms, complaints, or other problems leading to 

the visit came from a symptom classification 

deveIoped for use in NAMCS.5 

Table 3 lists the 25 reasons most frequently 

presented. 

Of all morbid states (e.g., conditions of illness or injury) presented to office-based physicians, about 55 percent were acute problems; 

about 45 percent were chronic. An acute problem was defined as a condition having a relatively sudden or recent onset (i.e., within 

months of the visit). A chronic probIem was defined as a preexisting condition with an onset of 

3 months or more before the visit. 

The extensive role played by the office-based 

physician in family planning is underscored by 

the finding that an estimated 7.3 million visits 

were made at least partly for the purpose of obtaining such services. 

Principal Diagnosis 

Table 4 lists the 25 most common, principal 

diagnoses that were provisionally or finally assigned to office visits by the physician. The diagnostic terms and codes are found in the Eighth 

Revision International Classification of Diseases, 

Adapted for Use in the United States (ICDA). 

Table 5 shows the classification of all principal 

diagnoses by the major diagnostic (ICDA) 

groups. Tdbk 6 offers diagnostic information 

tabulated according to the age, sex, and color 

of the patient. 

The following five diagnostic groups accounted for an estimated 57 percent of all principal diagnoses rendered by physicians in office 

practice. 

Percent of 

ICDA gYou#2 all principal 

diagnoses 

Specialconditions1 andexaminationswithout illness..................... 17.8 

Diseasesof the respiratorysystem... 14.1 

Diseasesof the circulatory system... 9.9 

Diseasesof the nervoussystem 

andsenseorgans........................... 7.9 

Accidents,poisoning,andviolence.. 7.2 

1chiefly immunization, prenatal and Pos.tmitd care, 

medical and surgical aftercare. 

3 
� 

4 adfancedata 

Visits for respiratory diseases were more 

than twice as frequent among patients under 15 

years as among patients of 15 years and over. 

Vkits for circulatory diseases accounted for 

the largest proportion of all visits made by patients over 44 years of age. 

Visits for mental disorders were more common in the age interval from 25-44 years 

than in other age intervak. 

Visits for respiratory illnesses and for conditions resulting from accidents, poisoning, and 

vi 01 enc e were substantially more common 

among males than among females. 

Though overall visits by females outnumbered visits by males (table 1), in only two 

of the diagnostic groups were visits by females 

markedly more common than those by males. 

These groups were “diseases of the genitourinary 

system” and the preventive and maintenance ciit -

e gory “special conditions and examinations 

without illness. ” 

Diagnostic and Therapeutic Services 

Drug therapy was the most frequent form of 

therapy provided in office-based practice. About 

44 percent of all visits resulted in treatment by a 

prescribed drug (table 7). 

“Counseling” and “listening” were checked 

by a physician only when they constituted a major part of the treatment provided during the 

visit. The overall use of such intangible services 

is almost impossible to quantify. Certainly, the 

finding that these services were prominent in 

fewer than 1 of every 5 visits understates the 

actuaf extent of this important aspect of the 

physician’s office practice. 

Prior Visit Status 

The average office-based physician 

� Dealt chiefly with patients that he had 

seen before (“old” patients). New F-Itients accoun~ed for- only about 1 “of 

every 7 visits (tables 8 and 9). 

Figure 2. PERCENT OF OFFICE VISITS BY DEGREE OF SERIOUSNESS OF PATlENT’S PROBLEM, BY PATlENT’S AGE 

AND SEX: UNITED STATES, JANUARY-DECEMBER 1975 

Not serious Some degree of seriousness 

loo– 

80 – 

~ 

% 60 – > 

u


o


1-
 2


u


v 40 _
 K 

& 

20 – 

ok 

Under 25 25-44 45-84 65 and over Female Male 

AGE IN YEARS SEX 
5


.	 Dealt chiefly with problems for which he 

had treated the patient before (“old” 

problems). Only about 1 of every 4 visits 

by an old patient concerned a new problem. 

Seriousness of Problem 

These data express the physician’s judgment 

as to the extent .of impairment that might result 

if no care were available for the given problem. 

Office-based ambulatory care does not center on the treatment of problems which are 

“serious to very serious” in prognosis. (Only 

about 1 of every 5 visits was placed in this 

category. See tables 8 and 9). 

The largest proportion of visits (an estimated 49 percent) was given a “not serious” 

evaluation. This is no doubt due in large 

degree to the substantial amount of preventive 

care and routine maintenance care provided 

in the physician’s office, and to the relatively 

high prevalence of acute, self-limiting conditions 

encountered there. 

Figure 2 shows the influence on judgments 

of seriousness produced by patient age and 

sex. 

Disposition and Duration of Visit 

Some form of scheduled followup was the 

rule in office-based practice. In about 60 percent 

of visits the patient was directed to return at a 

specified time (table 8). 

1National Center for Health Statistics: The National 

Ambulatory Medical Care Survey: 1973 Summary, 

United States, May 1973-April 1974. Vital and Health 

Statistics. Series 13, No. 21. DHEW Pub. No. (HRA) 

76-1772. Health Resources Administration. Washington. 

U.S. Government Printing Office, Oct. 1975. 

2National Center for Health Statistics: National 

Ambulatory Medical Care Survey: May 1973-April 1974. 

Monthly Vital Statistics Report. Vol. 24, No. 4, Supplement (2). DHEW Pub. No. (HRA) 76-1120. Health 

Resources Administration. Hyattsville, Md. July 1975. 

3National Center for Health Statistics: National 

Ambulatory Medical Care Survey: National Ambulatory 

Medical Care Survey of Vkits to General and Family 

Physicians, January 1974-December 1974. Monthly 

Only 2 percent of visits ended in hospital 

admission. 

Though it varied appreciably among specific 

specialists, the average tendency to refer patients 

(found in 3 percent of visits) is perhaps an 

understatement. It may not realistically reflect 

the actual amount of informal referral and 

consultation that may occur, especially in a 

multiple-member practice. 

Duration of visit is defined to include only 

the time spent in face-to-face encounter between 

physician and patient (table 8). 

The average encounter was of relatively brief 

duration–about 15 minutes. The following table shows the mean duration of an office cncountcr with ~ach of the 13 most visited 

specialists. 

Mean duration Specialty (in minutes) 

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

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

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

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

Pediatics ......................................... 

General surgery ............................... 

Ophthalmology ............................... 

Orthopedic surgery .......................... 

Otolaryngology ............................... 

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

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

Urolo~ ........................................... 

Cardiovascular disease ..................... 

Neurology ....................................... 

15.0 

12.6 

18.2 

13.1 

12.1 

12.7 

20.3 

14.5 

13.6 

46.9 

11.9 

15.0 

21.5 

35.5 

Vital Statistics Report. Vol. 25, No. 2 Supplement (2). 

DHEW Pub. No. (HRA) 76-1120. Health Resources 

Administration. Hyattsville, Md. May 1976. 

4 National Center for Health Statistics: National 

Ambulatory Medical Care Survey: background and 

methodology, United States. Vital and Health Statistics. 

Series 2, No. 61. DHEW Pub. No. (HRA) 76-1335. 

Heath Resources Administration. Washington. U.S. 

Government Printing Office, Apr. 1974. 

5 National Center for Health Statistics: The National 

Ambulatory Medical Care Survey: symptom classification, United States. Vital and Health Statistics. Series 2, 

No. 63. DHEW Pub. No. (HRA) 74-1337. Health 

Resources Administration. Washington. U.S. GovernmentPrinting Office, May 1974. 
------------------------

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------------------------------

-------------------------

---------------------------

----------------------

--------------------------

------------------------------

-----------------------------

---------------------------------

-----------------

-------------------------------

-------------------

----------------------------------

----------------------------

---

----------------------

----------------------------------

6 acimncedata 

Table 1. Number and percent distributions of office visits by selected physician


characteristics: United States, January-December 1975


Selected physician characteristics


All visits


Most visited specialties


General and family practice 

Internal medicine


Obstetrics and gynecology


Pediatrics


General surgery


Ophthalmology


Orthopedic surgery


Otolaryngology


Psychiatry


Dermatology


Urology


Cardiovascular diseases


Neurology


All other specialties


Type of practice


solo------------------------------------
 OtherI


Locationz


Metropolitan


Nonmetropolitan -------------------------


Number


of visits Percent


of
 in


thousands visits


567,600 100.0 

234,660 41.3


62,117 10.9


48,076


46,684 %;


41,292


24,667 i::


19,316 3.4


16,355 2.9


14,806 2.6


14.094 2.5


10;832 1.9


7,556


2,032 :::


25,113 4.4


339,554 59.8


228,046 40.2


413,685 72.9


153,915 27.1


lIncludes partnership and group practices.


2Signifies location within or outside the standard metropolitan statistical areas 

(SMSA’S).


SYMBOLS 

Data not available ---------------------------------

Category not applicable-----— 

Quantity zero 

Quantity more than O but less than 0.05-----

Figure does not meet standards of 

reliability or precision-–----–--------—----­

. . . 

-

0.0 

* 
---------------------------------

--------------------------------- ---------------------------

amcdata7 

Table 2. Number and percent distributions of office visits and number of visits per


person per yearl by selected patient characteristics:United States, January-December


1975


Selected patient characteristics


All visits----------------------------


Age
 —


Under 15 years------------------------------
 15-24 years


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


45-64 years


65 years and over


Sex
 —


Female--------------------------------------
 Male----------------------------------------


Color


White---------------------------------------
 All other-----------------------------------


Number
 Number
 Percent of visits
 of visits


in of per


thousands visits person


per year


567,600 100.0 2.7


99,010 17.4


86,570 15.3


143,525 25.3


145,434 25.6


93,061 16.4


342,896 60.4


224,704 39.6


508,672 89.6


58,928 10.4


lBased on population estimates for July 1, 1975 furnished by the Bureau of th~


Census.


Table 3. Number, percent and cumulative percent of office visits, by LROSC common pro­


blems, complaints or symptoms classified by NAMCS code in rank order: United States,


January-December 1975


w Most common problem, complaint, or symptom (coded) 

Surgical aftercare----------------------986


Physical examination----------------9OO-9Ol


Pregnancy examination-------------------9O5


Pain, swelling, injury-lower extremity--4OO


Pain, swelling, injury-back region------4l5


Sore throat-----------------------------52O


Pain, swelling, injury-upper extremity--4O5


Abdominal pain--------------------------54O


Cough-----------------------------------3ll


Visit for medication--------------------9lO


Gynecologic examination-----------------9O4


Fatigue---------------------------------OO4


Headache--------------------------------O56


Allergic skin reaction------------------ll2


Pain in chest---------------------------322


Cold------------------------------------3l2


Well-baby examination-------------------9O6


Earache---------------------------------735


High blood pressure---------------------2O5


Pain, swelling, injury-face and neck----4lO


Wounds of skin-----~--------------------ll6


Eye examination-------------------------9O8


Vision dysfunction, except blindness----7Ol


Fever-----------------------------------OO2


Vertigo---------------------------------O69


Number
 Percent
 of visits Cumulative
 of
 in visits percent


thousands


26.090 4.6 4.6 

23;518 4.1 

22,065 1!:: 

21,229 ;:? 16.3 

17,067 3.0 19.3 

15,279 2.7 22.0 

14,933 2.6 24.6 

14,862 2.6 27.2 

13,607 2.4 29.6 

11,893 31.7 

11,092 ::; 33.7 

10,466 1.8 35.5 

10,198 1.8 37.3 

9,827 1.7 39.0 

9,751 40.7 

9,453 ;:; 42.4 

8,291 1.5 43.9 

7,754 1.4 45.3 

7,715 1.4 46.7 

7,555 48.0 

7,533 i:: 49.3 

7,060 1.2 50.5 

7,022 1.2 51.7 

7,015 52.9 

6,315 54.0 
Table 

-------------------

@ ,. 

8


- —.— &.	 Number. wercent and cumulative uercent of office visits bv most common Drincipal di;gnoses by ICDA code: Ukited States, January-Dece&ber 1975 “ 

Most common principal


diagnosis (coded)


Medical or special examination------YOO


Medical and surgical aftercare------YlO


Essential benign hypertension-------4Ol


Prenatal care-----------------------YO6


Acute respiratory infection, site


unspecified------------------------465


Neuroses----------------------------3OO


Chronic ischemic heart disease------4l2


Otitis media------------------------38l


Diabetes mellitus 250


Other eczema and dermatitis---------692


Acute pharyngitis-------------------462


Refractive errors-------------------37O


Hay fever---------------------------5O7,


Obesity-----------------------------277


Bronchitis, unqualified-------------49O


Observation, without need for


further medical care---------------793


Acute tonsillitis-------------------463


Synovitis, bursitis-----------------73l


Influenza, unqualified--------------47O


Cystitis----------------------------595


Diseases of sebaceous glands--------7O6


Osteoarthritis----------------------7l3


Arthritis, unspecified--------------7l5


Inoculations and vaccinations-------YO2


Asthma------------------------------493


Number
 Percent
 of visits
 of
 in


thousands visits


g, ’33; 

22:824 4.0 

20,851 3.7 

14,607


13,641


12,513


9.899


9;671 1.7


9,667 1.7


8,531 1.5


8,169 

7,675 ::: 7,569 1.3 

6,872 1,2 

6,794 1.2 

6,405 1.1 

6,171 1.1 

5,866 

5,721 M 

5,593 1.0 

5,445 

4,892 M 

4.846 0.9


4:633 0.8


Cumulative


percent


22.2


24.6


26.8


28.5


30.2


31.9


33.4


34.8


36.2


37.5


38.7


39.9


41.0


42.1


43.1


44.1


45.1


46.1


47.0


47.9


48.7


Table 5. Number and percent distribution of office visits by principal diagnosis clas­


sified by major ICDA group: United States, January-December 1975


Principal diagnosis classified


by major ICDA group (coded)


All principal diagnoses----------------------------------


Infective and parasitic diseaaes------------------------000-136


Neoplaams-----------------------------------------------l4O-239


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


Diseases of the blood and blood-forming organs----------28O-289


Mental disorders----------------------------------------29O-3l5


Diaeases of the nervous system and sense organs---------32O-389


Diseaaes of the circulatory system----------------------39O-458


Diseases of the respiratory system----------------------460-519


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


Diseasea of the genitourinary system--------------------58O-629


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


Diseases of the musculoskeletal system------------------7lO-738


Symptoms and ill-defined conditions---------------------78O-796


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


Special conditions and examinations without sickness----YY13Yl3


Other diagnoses]-----------5-----------------------------------


Diagnosis “none” or unknown -----------------------------------


Number Percent


of viaits distri­


in mtion of


thousands visits


567,600 100.0 

22,747


13,332


24,177


4,744


25,061


44,941


;:,;;;


20:061


37,626


;;,;:;


26:177


40,893


100.787


3;312 0.6


5,963 1.1


‘Complications of pregnancy, childbirth, and the puerperium; congenital mmmalies;


and certain causes of perinatal morbidity and mortality.
 zInel~des blank, noncodeable, and illegible diagnoses.

--------------------

-----

----------------------

--------------------------------------

-----------------------------------

-----------------------------------------------

--------------------------------

----------------------------------------

-----------------------------------------

-------------------------------------------

-------------------------------------

-------------------------------------------

---------------------

--------------------------------------

----------------------------------

--------------

-------------------------------

a&mdata9 

Table 6. Number of office visits by selected patient characteristics and percent distribution of office visits,by


principal diagnoses as classified by major ICOA groups: United States, January-December1975


Principal diagnosis classified Age Sex Color


by major ICDA group (coded)


Under 15-24 25-44 45-64 65 ye== ~emale Male White Other
 15 years years years years and over


All principal diagnoses---- 99>010 186,571 \143,525 [145,434 I 93,061 /342,896I224,704 [ 508,672 [ 58,92S


I


I Percent distribution 

Total I 100.0 100.0 100.0 I 100.0 100.0 100.0 100.0 100.0 100.0 

I


Infective and parasitic
 diseases---------------OOO-l36


Neoplasms---------------
l4O-239
 Endocrine, nutritional, and


metabolic diseases 240-279
 Mental disorders--------
29O-3l5
 Diseases of the nervous sys­
 tem and sense organs---3238989
 Diseases of the circulatory
 system-----------------
 39O-458
 Diseases of the respiratory


systerc-----------------46O-5l9


Diseases of the digestive
 system-----------------
 52O-577
 Diseases of the genitourinary


system-----------------
 58O-629
 Diseases of the skin and
 subcutaneous tissue----680-709
 Diseases of the muscu-
 loskeletal system------7lO-73S
 Symptoms and ill-deftied
 conditions-------------
 78O-796


Accidents, poisonings, and
 violence---------. -----8OO-99S
 9
 Special conditions and exam-”
 inations without
 illness7---------------YOO-Yl
 3


Residual’


7.1 

0.5 ;. j 2.1 

4.2 3.8 

2.4 4.3 

2.2 3.9 

2.h 4.9 

1.6 

0.9 4.8 6.3 4.2 &.7 1.5 ::; 7.9 ::! 2.5 ::: ::: 4.5 3.3 

11.7 6.2 6.0 7.4 9.4 7.6 8.4 8.1 6.8 

0.5 1.3 4.6 16.6 25.9 9.2 11.0 10.0 9.4 

26.9 13.1 12.1 11.7 8.4 12.4 16.8 14.0 15.2 

1.8 2.8 3.4 4.5 4.8 3.3 3.9 3.5 3.6 

1.8 7.8 9.2 7.5 5.5 8.6 3.6 6.4 8.2 

6.3 7.7 4.5 4.1 3.6 4.8 5.4 5.1 4.5 

1.7 2.4 5.1 9.0 9.3 5.8 6.o 5.8 5.8 

4.3 4.6 5-4 4.7 3.7 4.8 4.4 4.6 4.7 

7.6 9.4 8.0 6.7 4.5 5.0 10.6 7.1 8.4 

24.7 29.o 20.9 10.2 20.0 14.4 1;.: 16.7 2.7 2.6 2.0 I 1.7 ::: 2.7 1.6 2.2 

‘Diseases of blood or blood-forming.?rgans; complicationsof pregnancy, childbirth, and the puerperium; con­ genital snomslies; certain causes of permatal morbidity and mortality; diagnosis “none” or unknown. 

Table 7. Number and percent distribution of office visits by diagnostic and therapeu­


tic seruices provided: United States, January-December 1975


Diagnostic and therapeutic service provided


All visits


No services provided


Diagnostic servicee


Limited history or examination ----------------------


General history or examination ----------------------


Clinical lab test


X-Ray


Blood pressure check


EKG-------------------------------------------------


Hearing test


Vision test


Endoscopy


Therapeutic services


Drug prescribed


Injection


Immunization or desensitization


Office surgery


Physiotherapy ---------------------------------------


Medical counseling


Psychotherapy or therapeutic listening


Ocher services provided


Number
 Percent
 of visits
 of
 in
 visits*
 thousands


567,600 100.0 

15,200 2.7


291,294 51.3


89,377 15.8


129,740 22.9


41,701


188,180 3<::


1;,;;; 3.4


1.3


26;650 4.7


6,696 1.2


251,538


78,085


25,704


37,991


12,565


69,72L 12$


24,234 4.3


32,738 5.8


1Will not add to totals since more than one service night be provided.

--------------

------------------------------- ---------------------------------------

--------------------------------------------

-------------------------------------------

--------------------------------------- ------------------------------------- ------------------

------------------------ --------------------------------------

---------------------------

10 advancedata 

Table 8. Number	 and percent distributions of office visits by selected characteris­


tics of visit: United States, January-December 1975


Selected characteristics of visit


All visits ---------------------------------------


Prior Visit Status


New patient --------------------------------------------


Old patient, new problem -------------------------------


Old patient, old problem -----------------


Seriousness of Problem


Serious and very serious


Slightly serious


Not serious


Disposition]


No followup


Return at specified time-------------------------------
 Return if needed


Telephone followup


Referred to other physician or agency


Returned to referring physician


Admit to hospital


Duration of Visitz


O minutes (no face-to-face encounter with


physician)--------------------------------------------


1-5 minutes-----------------
 6-10 minutes-------------------------------------------
 11-15 minutes------------------------------------------
 16-30 minutes------------------------------------------
 31 minutes or more-------------------------------------


Number


of visits


in


thousands


567,600


84,807


132,848


349,945


106,981


183,697


276,923


74,542


335,219


126,630


20,834


16.042


5;064


12,062


6,781


;;,;:;


51;964


07,709


31,975


Percent


of


visits


100.0


18.8


32.4


48.8


13.1


59.1


22.3


3.7


2.8


0.9


2.1


1.2


16.2


31.3


26.8


19.0


5.6


‘Will not add to totals since more than one disposition was possible.
 2Signifies time spent in face-to-face encounter between physician and patient.


Table 9. Number and percent distributiona of office visits by selected patient characteristics,


according to prior


1975


Selected patient


characteristics


All visits-----


Ace 

Under 15 years-------
 15-24 years----------


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


45-64 years----------
 65 years end over----


— 

Sex

Female---------------
 Male-----------------


Color


White----------------
 Other---------------­


visit status and seriousness of problem: United States, January-December


Number
 of Percent
 visits
 of
 in
 visits
 thou-


sands


567,600 100.0 F

99,010 100.0


86,571 100.0


143,525 100.0


1$:,l++: 100.0


100.0


342,896 100.0 

224,704 100.0 

5;:,;;: 100.0 

, 100.0 

Prior visit status


Old Old New patient pa~;~t 

patient new
 problem problem


14.9 23.4 61.7


15.9 35.5 48.6 21.1 26.4 52.5 17.9 22.1 60.0 

11.9 19.4 68.7 8.4 16.0 75.6 

13.8 22.6 63.6
 16.7 24.6 58.7


14.5 23.0 62.5
 18.5 27.1 54.4


Seriousness of problem


Serious


or Slightly
 very serious


serious


18.8 32.4


11.2 30.9
 11.5 ::.;
 16.8


23.7 35:5


29.4 35.6


t 

17.1 31.4
 21.5 33.8


19.0 32.1


17.7 34.4


Not


serious


48.8


57.9


61.3


52.0


40.8


35.0


51.5


44.7


48.9


47.9

akmdata 11


TECHNICAL NOTES 

SOURCE OF DATA: Data presented in this re- est thousand. The rates and percents, however, 

port were obtained during 1975 through the were calculated on the basis of original, unNat io nal Ambulatory Medical Care Survey rounded figures. Due to rounding of percents, 

(NAMCS). The target population of NAMCS en- the sum of percentages may not equal 100.0 percompasses office visits within the conterminous cent. 

United States made by ambulatory patients to 

physicians who are principally engaged in office 

practice. Table 1. Approximate relative standard errors of estimated numSAMPLE DESIGN: The 1975 NAMCS utilized a bers of office visits 

mto 

multistage probability design that involved samples of primary sampling units (PSU’S), physi- Estimate 

in 

Relative standard 

error in 

cian practices within PSU’S, and patient visits thousands percentage points 

within practices. Within the 87 PSU’S composing 

the first stage of selection, a sample of approxi- 500.......................................... 30.1 

mately 3,500 physicians was selected from master files maintained by the American Medical 

1,000 .................... ................... 

2,000....................................... 

5,000....................................... 

21.4 

15.3 

10.0 

Association and the American Osteopathic Asso- 10,000..................................... 7.5 

ciation. Sampled physicians, randomly assigned 30,000..................................... 

100,000................................... 

5.1 

4.0 1 of the 52 weeks in the survey year, were 550,000................................... 3.5 

requested to complete Patient Records (figure 1) 

fo; a systematic &ndom sample of offic; visits ExampIe of use of table: An aggregate of 80,000,000 has a 

relative standard error of 4.3 percent or a standard error of 

taking place within their practice during the as- 3,440,000 (4.3 percent of 80,000,000). 

signed reporting period. Additional data concerning physician practice characteristics such as 

primary specialty and type of practice were ob- Table 11. Approximate standard errors of percentages for estitained during an induction interview. — mated numbers of office visits .— 

A complete description of the survey’s backEstimated percentage ground and development has been presented in Base of percentage 

an earlier publication in Series 2 of Vital and (number of visits 1 or 5or lOor 20 or 30 or so Health Statistics (No. 61. DHEW Pub. No. in thousands) 99 95 90 80 70 I (HRA) 76-1335. Health Resources Administration. Washington. U.S. Government Printing 1,000 ..................... TF 2.1 4.6 6.3 8.5 9.7 10.6

Office, Apr. 1974). A detailed description of the	 3,000..................... 1.2 2.7 3.7 4.9 5.6 6.1 

5,000..................... 0.9 2.1 2.8 3.8 4.3 4.7 1975 NAMCS design and procedures will be 10,000................... 0.7 1.5 2.0 2.7 3.1 3.3 

presented in future publications. 50,000................... 0.3 0.7 0.9 1.2 1.4 1.5 

SAMPLING ERRORS: Since the estimates for 100,000................. 0.2 0.5 0.6 0.8 1.0 1.1 

0.1 0.2 0.3 this report are based on a sample rather than the 500,000................. -LL0.4 0.4 0.5 

entire universe, they are subject to sampling vari- Example of use of table: An estimate of 30 Dercent based on 

ability. The standard error is primarily a measure an aggregate of 75,000,000 has a standard erro; of 1.2 percent. 

The relative standard error of 30 percent is 4.0 percent (1.2 per.

of sampling variability. The relative standard er- cent+30 percent). 

ror of an estimate is obtained by dividing the 

standard error of the estimate by the estimate 

itself and is expressed as a percent of the esti- DEFINITIONS: An ambulatory patient is an 

mate. Relative standard errors of selected aggre- individual presenting himself for personal health 

gate statistics are shown in table I. The standard services who is neither bedridden nor currently 

0 errors appropriate for the estimated percentages admitted to any health care institution on the 

of office visits are shown in table II. premises. 

ROUNDING: Aggregate estimates of office visits An o~j$ce is a place that the physician identipresented in the tables are rounded to the near- fies as a location for his ambulatory practice. 
� 

... , 

12


Responsibility over time for patient care and 

professional services rendered there generally resides with the individual physician rather than 

an institution. 

A visit is a direct personal exchange between 

an ambulatory patient and a physician or a staff 

member working under the physician’s supervision for the purpose of seeking care and 

rendering health services. 

A physician is a duly licensed doctor of medI Previous Issues of Advance Data 

No. 11	 Pregnant Workers in the United States (Issued: 

September 15, 1977) 

No. 10	 Expected Size of Complete Family Among 

Currently Married Women 15-44 Years of Age 

in the United States in 1973 (Issued August 

12, 1977) 

No. 9	 Wanted and Unwanted Births Reported by 

Mothers 15-44 Years of Age in the United 

States in 1973 (Issued: August 10, 1977) 

NCHSI$Y 

uS. DEPARTMENT OF HEALTH, EDUCATION, AND wELFARE 

Public Health se,vI.. 

Health R.3murces AdrniniHratio. 

National Center for Health Smtistics 

Center Building 

3700 ErJst.WE.SIHi9hway 

Wamsvil!e, MarWand 207S2 

OFFICIAL e.usl NEss


PENALTY FOR PRIVATE USE, $300


HRA 77-1250 

icine (M. D.) or doctor of osteopathy (D.O.) currently in practice who spends time in caring for 

ambulatory patients at an office location. Excluded from NAMCS are physicians who specialize in anesthesiology, pathology, radiology; 

physicians who are Federally employed; physicians who treat only institutionalized patients; 

physicians employed full time by an institution; 

and physicians who spend no time seeing ambulatory patients. GPO 919.620 

From Vital and Health Statistics 

No. 8	 Total Serum Cholesterol Level of Children 

4-17 Years of Age in the United States in 

1971-74 (Issued: Jtdy 11, 1977) 

No. 7	 Total Serum Cholesterol Level of Adults 18-74 

Years of Age in the United States in 1971-74 

(Issued: May 25, 1977) 

POSTAGE AND FEES PAID 

U.S. DEPARTMENT OF HEW 

HEW 390 

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