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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE = Public Health Service I Number 23 � March 24,1978 

Office Visits to General Surgeons: National 

Ambulatory Medical Care Surveyr United States, 19751 

In 1975 there were an estimated 41.3 mil- DATA HIGHLIGHTS 

lion visits made to office-based physicians specializing in generaJ surgery, resulting in an The 41.3 million patient visits to general suraverage of 20 visits per 100 persons per year. geons in 1975 represent about 7 percent of the 

These and other preliminary data about vis- total 567.6 million visits made by Americans to 

its to general surgeons are presented in this brief all physicians engaged in office-based patient


report from the 1975 National Ambulatory care. From table 1 the reader can compare visits


iMedical Care Survey (NAMCS). NAhfCS is con- to general surgeons with those made to physi­


ducted by the Division of Health Resources Util- cians in the other largest specialties.


ization Statistics of the National Center for


Health Statistics. The sampling frame for the


sun’ey is a list of licensed physicians in “office-


Table 1. Number and rate of visits per based, patient care” practice compiled from files 100 persons per year, by selected spe­ that are classified and maintained by the Amer- cialties: United States, 1975 

ican Medical Association (AMA) and the American Osteopathic Association (AOA). NAMCS Number Number of 

currently excludes physicians practicing in Physician of visits per 

Alaska and Hawaii as weIl as physicians special- specialty visits in 100 persons 

izing in anesthesiology, pathology, or radiology thousands per year 1 

and all physicians who are Federally employed. 

A complete description of the background All specialties 567,600 273 

and survey methodology is available in an earlier 

report entitled “National Ambulatory hledical General and family 

Care Survey: Background and Methodology, practice 234,660 113 

United States, 1967 -72.”2	 Internal medicine 62,117 30 

Obstetrics and 

gynecology 48,076 23 

Pediatrics 46,684 22 

GENERAT. SURGERY---- 41,292 20 1This report prepared by Raymond O. Gagnon, Div- Psychiatry 14,806 7

ision of Health Resources Utilization Statistics. 

2National Center for Health Statistics: National 

Ambulatory Medical Care Survey: Background and lThe base populations used in computing 

Methodology, United States, 1967-72, by J. B. Tenney the rates are national estimates published 

and others. Vital and Health Statistics. Series 2-No. 61. by the U.S. Bureau of the Census for the 

DHEW Pub. No. (HRA) 76-1335. Health Resources civilian noninstitutional ized population 

<administration. Washington. U.S. Government Printing as of July 1, 1975, in Series P-25 and 

Office, Apr. 1974. o P-26 of Current Population Reports.
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Of the 41.3 million patient visits to general 

surgeons, 64 percent were made to solo practitioners and 36 percent were made to surgeons in 

other types of practice (table 2). The data in 

table 2 also show that 6 of every 10 visits to 

general surgeons were made by females. The largest proportion of visits (about one-third) was 

made by persons in the 45-64 year age group. 

As shown in tables 2 and 3, patient visits to 

surgeons in standard metropolitan statistical 

areas outnumber those to surgeons in nonmetropolitan areas by almost 3 to 1 (72 to 28 percent, 

respectively). As with other specialties, the distribution of visits by location of practice parallels the distribution of physicians (table 3). 

Table 4 lists–in order of frequency–the 15 

most common patient problems, complaints, or 

symptoms encountered by the general surgeon 

in his office practice. 3 This information represents the patient’s reason for seeking care as expressed in the patient’s own words. These 15 

problems accounted for more than half of the 

visits to general surgeons. The primary need of 

patients visiting general surgeons in 1975 was 

“surgical aftercare ,“ which accounted for 21 percent of the visits. Surgical aftercare includes cast 

and/or suture removal or inspection as well as 

other types of care which come under the general heading of postoperative care. 

Table 5 distributes office visits to general 

surgeons by seriousness of the patient’s problem, 

prior visit status, and duration of the visit. Seriousness refers to the physician’s clinical judgment as to the extent of impairment that might 

result if care were not available to the patient. 

About half the problems presented to general 

surgeons were considered “not serious” by the 

surgeons, and 18 percent were “very serious” m­

“serious. ” Concerning prior visit status, about 

84 percent of the visits were made by patients 

who had been seen before, and three-fourths of 

these. had been seen for the same problem. 

Data on duration of visit show that the typical encounter between patient and general surgeon lasted 13 minutes. In this survey duration 

means the amount of time the physician spent in 

face-to-face contact with the patient. The data 

3 Excluded from the table are progress visits for followup care other than surgical aftercare. 

Table 2. Number and percent distributions


of office visits to general surgeons by


selected variables: United States, 1975


Selected variable


All visits


Type of practice


solo 

Other l-------------


T.ocati.on of 

practice


Metropolitan


areas


Nonmetropolit an


areas


Sex of patient


Male


Female


Age of patient


Under 25 years 

25-44 years 

45-64 years 

65 years and 

over


Number of Percent


visits in distri­


thousands bution


41,292 100.0 

26,241 63.5


15,051 36.5


29,803 72.2


11,489 27.8


16,394 39.7


24,898 60.3


8,039 19.5


11,863 28.7


14,055 34.0


7,335 17.8


lIncludes partnership and group prac­


tices.


also show that 56 percent of the visits lasted 

under 11 minutes. 

In NAMCS diagnoses are coded according to 

the Eighth Revision International Classification 

of Diseases, Adapted for Use in the United 

Mates4 (ICDA). Table 6 presents data on the 

nine most common diagnoses rendered by general surgeons, which accounted for about 

one-third of their total visits. The most frequent 

diagnoses were “medical and surgical aftercare” 

and “essential benign hypertension. ” Together 

4 National Center for Health Statistics: -Eighth Revision International Classification of Diseases, Adapted for 

Use z% the United States. PHS Pub. No. 1693. Public 

Health Service. Washington. U.S. Government Printing a Office, 1967. 
----------------------------

& a&mcdda3 

Table 3. Number and percent distributions of visits to office-based physicians by 10-


cation of practice, according to selected specialties: United States, 1.975


Location of practice
 I I 

Number in
 Selected physi$ian specialty thousands Non-


Total Metropolitan metropolitan
 area
 area


Percent distribution


All physicians------------------ 567,600 100.0 73 27 

General surgery----------------------- 41,292 100.0 

General and family practice----------- 234,660 100.0 K ;: 

Internal medicine--------------------- 62,117 100.0 85 

l?ediatrics 

Obstetrics and gynecology------------- 46,684 

48,076 

100.0 

100.0 H 

11 

18 

Table 4. Number, percent, and cumulative percent of office visits to general surgeons,


by the 15 most frequent patient problems, complaints, or symptoms: United States,


1975


Number of
 15 most frequent patient problems, visits in Percent Cumulative


complaints, or symptoms,and NAMCS codesl thousands of visits percent


Surgical aftercare2------------------------986 8,486 20.6 20.6 

Problems of lower extremity----------------4OO 2,048 25.6 

Abdominal pain-----------------------------54O 1,895 R 30.2 

Swelling or mass of skin-------------------ll5 1,651 4.0 34.2 

Problems of upper extremity----------------4O5 1,448 3.5 37.7 

Lump or mass of breast---------------------68O J_,094 2.7 40.4 

Wounds of skin-----------------------------ll6 1,092 2.6 43.0 

Weight gain--------------------------------010 929 45.3


Problems of back---------------------------415 837 ::: 47.3


Abdominal swelling-------------------------542 762 1.8 49.1


Anus, rectal problems----------------------560 751 50.9


Throat soreness----------------------------520 660 ::: 52.5


Fatigue------------------------------------OO4 647 1.6 54.1


Pain in chest------------------------------322 576 1.4 55.5


High blood pressure------------------------205 538 1.3 56.8


lSymptomatic groupings and code number inclusions are based on a symptom classifi­


cation developed for use in NAMCS.


0 ZIncludes: cast-change or removal; suture removal or inspection.

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--------------------------------- � 

4 adwlncedata 

6 

Table 5. Number and percent distributions of office visits to general surgeons by se­
 riousness of problem, prior visit status, and duration of visit: United States, 1975


Seriousness of problem, prior visit status, Number of visits Percent


and duration of visit in thousands distribution


All visits----------------------------------- 41,292 100.0 

Seriousness of problem 

Serious and very serious--------------------------- 7,442 18.0 

Slightly serious----------------------------------- 11,883 28.8 

Not serious---------------------------------------- 21,967 53.2 

prior visit status


New patient 6,538 15.8 

Return patient: 

New problem 7,881 19.1 

Old problem-------------------------------------- 26,874 65.1 

Duration of visit


Less than 6 minutes-------------------------------- 9,034 21.9


6-10 minutes--------------------------------------- 13,928 33.7


11-15 minutes-------------------------------------- 10,747 26.0


16 minutes or more 7,583 18.4


<} 

Table 6. Number, percent, and cumulative percent of office visits to general surgeons,


bythe9 most frequent ICDA 3-digit categories containing the principal diagnosis:


United States, 1975


— 

i: 

3.


4.


5.


6.


k


9.


9 most frequent diagnoses and ICDA codesl


Medical and surgical aftercare--------------ylo


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


Chronic cystic disease of breast------------6lO


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


Inguinal hernia without mention of


obstruction--------------------------------55O


Acute upper respiratory infection-----------465


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


Varicose veins of lower extremities---------454


Synovitis, bursitis, and tenosynovitis------73l


Number of Cumulative
 Percent


thousands of visits visits in
 percent of


visits


6,992 16.9 16.9 

1,242 3.0 19.9 

957 2.3 22.2 

926 2.2 24.4 

874 2.1 26.5 

734 1.8 28.3 

680 1.6 29.9 

656 1.6 31.5 

621 1.5 33.0 

~Diagnostic groupings and code number inclusions are based on the Eighth Revision In­


ternational Classification of Diseases, Adapted for Use in the United States. o

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� 

� 

a&medaa5 

these two diagnoses accounted for 8.2 million 

patient visits to general surgeons. 

In table 7 the visits to all physicians and 

general surgeons are distributed according to the 

major diagnostic categories of the ICDA. For the 

categories shown, general surgeons’ practices 

were quite similar to the practices of physicians 

in general; however, a few differences may be 

worthy of mention. The proportions of visits 

diagnosed as mental disorders, diseases of the 

nervous system, and diseases of the respiratory 

system were slightly lower for general surgeons 

than for all physicians. On the other hand, the 

proportions of visits for neoplasms, diseases of 

the digestive system, and accidents, poisonings, 

and violence were somewhat higher for general 

surgeons than for all physicians. 

TabIe 8 distributes office visits to general 

surgeons by diagnostic and therapeutic services 

ordered or provided and disposition of the visit. 

The provision of a limited history and/or exam 

was the ,most frequently provided service being 

rendered at 47 percent of the patient visits. Data 

on disposition of visit show that the final advice 

or instruction given by the physician in the majority of patient visits (62 percent) was to 

“return at a specified time. ” 

Table 9 compares general surgeons with all 

physicians in terms of three selected diagnostic 

and/or therapeutic services provided. It is evident that fewer drugs were prescribed or dispensed by general surgeons than by alI physicians and that fewer laboratory tests were 

performed. Drugs were provided at 44 percent 

Table 7. Number and percent distributions of office visits to all physicians and gen­


eral surgeons by princiDal diagnosis: United States, 1975


I 

l%inciDal diagnosis classified by ICDA IAll physicians General surgeons category and ICDA code I 

All diagnoses


All diagnoses I 

I


Infective and parasitic diseases ------------BOO- l36


NeoDlasms -----------------------------------140-239


Endocrine, nutritional, and metabolic


diseases -----------------------------------24O-279


Mental disorders ----------------------------29C)-3l5


Diseases of nervous system and sense


organs --------------------------------_----32O-3,3g


Diseases of circulatory systera-------------- 39O-458


Diseases of respiratory systerri--------------46O-5l9


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


Diseases of genitourinary system------------58O-629


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


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


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


Accidents, poisonings, and violence---------800-999°


Special conditions and examinations without


illness -----------:------------------------YOO-Y13


All other diagnoses


Number in thowands


567,600 41,292


Fercent distribution


100.0 100.0 

4.0


2.4


4.3 

4.4 

17.8


2.5


lDiagnostic groupings and code number inclusions are based on the Eighth Revision


International Classification of Diseases, Adapted for Use in the United States.


‘The category “all other diagnoses” includes 280-289, Diseases of the blood and


blood-forming organs; 630-678, Complications of pregnancy, chiI.dbirth, and the puer-


0 perium; 740-759, Congenital anomalies; 760-779, Certain causes of perinatal morbidity


and mortality; blank diagnosis, noncodable diagnosis, illegible diagnosis > and diag­
 nosis given as “None.”

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6 F 

Table 8. Number and percent distributions of office visits to general surgeons by di­


agnostic and/or therapeutic services ordered or provided, and disposition of visit:


United States, 1975


Number of
 Diagnostic andlor therapeutic services ordered Percent
 or provided, and disposition of visit visits in distribution
 thousands


All visits 41,292 100.0 

Diagnostic and/or therapeutic 

services ordered or provided~ 

None - 3,120 

Limited history and/or exam 19,235 4;:2 

General history and/or exam 4,532 11.0 

Clinical lab test 4,853 11.8 

Blood messure check--------------------------------- 9,531 23.1 

EKG-------------------------------------------------- 862 2.1 

Office surgery 6,844 16.6 

Drug prescribed 

X -riy” 

11,272 

2,993 

27.3 

Injection 6.034 1::: 

Medical counselin 4;839 11.7 

Psychotherapy and7or therapeutic listening 775 1.9


Other 5,044


Disposition of visitl


NO followup planned 4,320 10.5


Return at specified time 25,414 61.6


Return if needed 7,503 18.2


Telephone followup planned 689 1.7


Referred to other physfcian and/or agency 1,180 2.9


Returned to referring physician *435 >kl.
1

Admitted to hospital 2,391 5.8


Other ------_----- 899 2.2


lPercents will add to more than 100 because many patients received more than one
 service and some patient visits had more than one disposition.


Table 9. Percent of office visits to all
 of the visits to all physicians compared with 27 

percent of the visits to general surgeons. Lab 

tests were ordered at 23 percent of the visitsto 

all physicians andat 12 percent of the visits to 

surgeons. As expected, general surgeons provided office surgery considerably more often 

than did all physicians. Office surgery was provided at 17 percent of the visits to general surgeonsas compared with 7percent of the visitsto 

all physicians. These latter differences are perhaps reflective of the large proportion of visits 

to general surgeons (21 percent), where the primary need of the patient was surgical aftercare = 

(table 4). 

physicians and general surgeons, by se­


lected diagnostic and/or therapeutic


services: United states, 1975


Drug


pre -


scribed


or dis­


pensed


Clin-


ics1


lab


test


of­


fice


sur­


gery


All physicians


and general


surgeons


All physicians----


General surgeons-­


Percent

----- dmwdata7 

TECHNICAL NOTES 

SOURCE OF DATA: Data presented in this report were obtained during 1975 through the 

National Ambulatory Medical Care Survey 

(NAhlCS). The target population of NAMCS 

encompasses office visits within the conterminous United States made by ambulatory patients 

to physicians who are principally engaged in 

office practice. 

SAMPLE DESIGN: The 1975 NAMCS utilized a 

multistage probability design that involved samples of primary sampling units (PSU’S), physician practices within PSU’S, and patient visits 

within practices. Within the 87 PSU’S composing 

the first stage of selection, a sample of approximately 3,500 physicians was selected from master files maintained by the American Medical 

Association and the American Osteopathic Association. Sampled physicians, randomly assigned 

to 1 of the 52 weeks in the survey year, were 

requested to complete Patient Records (brief 

encounter forms) for a systematic random sample of office visits taking place within their practice during the assigned reporting period. (A 

facsimile of the Patient Record used is shown in 

a previous issue of Advance Data From Vital and 

Health Statistics, No. 12, October 12, 1977. ) 

Additional data concerning physician practice 

characteristics such as primary specialty and 

type of practice were obtained during an induction interview. 

A complete description of the survey’s background and development has been presented in 

an earlier publication in Series 2 of Vital and 

Health Statistics (No. 61. DHEW Pub. No. 

(HRA) 76-1335. Health Resources Administration. Washington. U.S. Government Printing Office, Apr. 1974). A detailed description of the 

1975 NAMCS design and procedures will be 

presented in future publications. 

SAMPLING ERRORS: Since the estimates for 

this report are based on a sample rather than the 

entire universe, they are subject to sampling variability. The standard error is primarily a measure 

of sampling variability. The relative standard error 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 estimate. Relative standard errors of selected aggregate statistics are shown in table I. The standard 

Table 1. Approximate relative standard errors of estimated 

numbers of office visits 

I 

Estimate Relative standard 

in error in 

thousands percentage points 

500 .......................................... 30.1 

1,000 ....................................... 21.4 

2,000 ....................................... 15.3 

5,000 ..... .. ...................... ........ 10,0 

10,000 ..................................... 7.5 

30,000 ..................................... 5.1 

100,000 ........................... ........ 4.0 

550,000 ................................... 3.5 

Example of use of table: An aggregate of 80,000,000 has a 

relative standard error of 4.3 percent or a standard error of 

3,440,000 (4.3 percent of 80,000,000). 

Table II. Approximate standard errors of Dercentaaes for 

est il ated numbers of office visits 

Base of percentage Estimated percentage 

(number of visits 

in thousands) 1or 5 or lOor 20 or 10 or 50 

99 95 90 80 70 

1,000., ................... 2.1 4.6 6.3 8.5 9.7 10.6 

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 

10,000 ................... 0.7 1.5 2.0 2.7 3,1 3.3 

50,000 ................... 0.3 0.7 0.9 1.2 1.4 1.5 

100,000 ........ ......... 0.2 0.5 0.6 0.8 1.0 1.1 

500,000 ........... ...... 0.1 0.2 0.3 0.4 0.4 0.5 

Examule of use of tabie: An estimate of 30 oercent based on 

an aggreg;te of 75,000,000 has a standard erro; of 1.2 percent. 

The relative standard error of 30 percent is 4.o percent (1.2 per- cent +-30 percent). 

errors appropriate for the estimated percentages


of office visits are shown in table II.


ROUNDING: Aggregate estimates of office visits


presented in the tables are rounded to the near­


est thousand. The rates and percents, however,


were calculated on the basis of original, un­


rounded figures. Due to rounding of percents,


the sum of percentages may not equal 100.0 per-


cent.


DEFINITIONS: An ambulatmy patient is an in­


dividual presenting himself for personal health


services who is neither bedridden nor currently


admitted to any health care institution on the


premises.


=PO 927 227 
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8 ackincedata 

An office is a place that the physician identifies as a location for his ambulatory practice. 

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

ambulatory patients, at an office location. Ex­

“eluded from NAMCS are physicians who speciali z e in anesthesiology, pathology, radiology; 

Recent Issues of Advance Data 

No. 22.	 Office Wits by Persons Aged 65 and Over: 

National Ambulatory Medical Care S1nvey, 

United States, 1975 (Issued: March 22, 1978) 

No. 21.	 Selected Findings of Dietary Food Consumption Profiles of Persons 1-74 Years of Age in 

the United States, 1971-74 (In preparation) 

No. 20.	 Office Visits to Obstetrician-Gy necologists: 

National Ambulatory Medical Care Survey, 

United States, 1975 (Issued: March 13, 1978) 

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. 

r I 

SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than O but less than 0.05-—- 0.0 

Figure does not meet standards of 

* reliability y or precision 

From Vital and Health Statistics 

No. 19.	 Exercise and Participation in Sports Among 

Persons 20 Years of Age and Over: United 

States, 1975 (Issued: March 15, 1978) 

No. 18.	 Episodes of Persons Injured: United States, 

1975 (Issued: March 7, 1978) 

A complete list of Advance Data From Vital and Health Statistics is available from the Scientific and Technical 

Information Branch. 

NCHS POSTAGE AND FEES PAIO 

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National Center for Health Statistics 

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