PROPERTY
OFTHE .


PUBLICATIONS BRANCH 

EDITORIAL LIBRARY 

— 

FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEAL 7H STATISTICS 

U.S. DEPARTMENT OF HEALTH . public Healthservice AND HUMAN SERVICES Office of Health Research, Statistics, and Technology Number 63 � November 3, 1980 

Office Visits for Male Genitourinary Conditions: 

National Ambulatory Medical Care Survey: 

United States, 1977-78’ 

@ 

This report combines estimates from the 

1977 and 1978 National Ambulatory MedicaI 

Care Surveys to describe office visits made by 

men who, over the 2-year period, sought treatment for problems of the genitourinary system. 

Conducted annually by the National Center for 

Health Statistics, the National Ambulatory 

Medical Care Survey (NAMCS) is a sample 

urvey designed to explore the provision and 

tilization of ambulatory care in the offices of 

non-Federal, office-based physicians. (See the 

“Technical Notes” at the e;d- of this r~port for 

information on the survey design and terminology.) Because the statistics used in this report 

are based on a sample rather than on the entire 

universe of office-based physicians, they are 

estimates only and are subject to sampling 

variability. Guidelines for judging the precision 

of the estimates may be found in the “Technical 

Notes.” A premonitory note: any visit estimate 

that is under 340,000, or its percentage equivalent, is preceded by an asterisk, signifying that it 

exceeds a relative standard error of 30 percent. 

A genitourinary visit is an office visit for 

which the principal dia~osis was a condition 

classified in the major diagnostic group 

“Diseases of the Genitourinary System” (diagnostic codes 580-629), according to the Eighth 

Revision International Classification of Diseases, 

Adapted for Use in the United States 

lThis report was prepared by Hugo Koch, Division 

(ICDA-8).2 Genitourinary visits are divided 

into two subgroups : a urs”nary visit, which is 

defined as a visit for which the principal 

diagnosis was a disease of the urinary system 

(ICDA subgroup 580-599), and a genital visit, 

which is defined as a visit for which the principal 

diagnosis was one of the conditions listed in the 

ICDA code range 600-629. 

DATA HIGHLIGHTS 

Over the 2-year span 1977-78, the male visit 

rate for genitourinary problems was estimated at 

76 office visits per year for every 1,000 men in 

the population. As shown in tables 1 and 2, 

supplemented by figures 1 and 2, the genitourinary visit rate for men was modest compared 

with the corresponding visit rate for women. At 

an estimated 254 office visits per year per 1,000 

women in the population, the female visit rate 

was over three times as great as the rate for 

males, chiefly due to the dramatic difference 

between the sexes in the visit rates for genital 

disorders. For genital problems, which unlike 

urinary problems, are sex-specific, the visit rate 

for women was 176 visits per year per 1,000 as 

opposed to 46 visits per year per 1,000 for men. 

2National Center for Health Statistics: Eighth Revision International Classification of Diseases, Adapted 

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

Health Service. Washington. U.S. Government Printing 

Office, 1967. �of Health Resources Utilization Statistics. 
2 acklncedata 

— 

The male genitourinary visit rate increased 

directly and steeply with advancing age (table 2 

and figure 2). Male patients 65 years of age and 

over made 8 times as many urinary visits and 11 

times as many genital visits as those under 25 

years of age did. 

Visits made for genital ailments by men 

outnumbered visits made for urinary problems 

in a ratio of about 3 to 2. Note in table 3 that 

the prostate is the organ requiring the most 

office treatment. The conditions of hyperplasia 

and prostatitis together account for 40 percent 

of all male genitourinary visits. 

In a 1978 study of the national prevalence 

of urinary disease, women showed a higher rate 

for almost all urinary ailments than men did 

(36.4 urinary conditions per 1,000 women as 

opposed to 14.6 urinary conditions per 1,000 

men). Only with calculus of the kidney and 

ureter was the prevalence among men (4. 7 per 

1,000) higher than among women (3.4 per 

1,000 ).3 The NAMCS findings in table 4 show 

the impact of prevalence on one treatment 

setting—the doctor’s office. These findings suggest an average of about 2 office visits per year 

for every person who suffered from a urinary 

disease and faithfully reflect the female-male 

differences found in the prevalence study. 

3UnpUblished findings from the Health Interview 

Survey, 1978, a household survey conducted yearly by 

the National Center for Health Statistics. 

The majority (52 percent ) of all male genito 

urinary visits were made to an office-based _ 

urologist (table 5). Men were especially prone to 

visit this specialist when they suffered from a 

genital ailment. It would be shortsighted, however, to underestimate the role played by the 

primary-care physician. Table 5 shows that 

nearly one-half of the visits by men for urinary 

ailments were made to physicians in the 

primary-care specialties of general and family 

practice and internal medicine. 

When the male genitourinary ailment was a, 

new condition (in about 1 of every 3 visits), it 

resulted in roughly 2 return visits during the 

course of a year (table 6). This finding is 

compatible with the earlier statistic derived from 

prevalence data. Referral of male patients was 

more than twice as common for genital disorders 

than it was for urinary disorders. The direction , 

of this patient flow (from primary-care physician to urologist) underscores the prominence of 

this secondary-care provider in the treatment of 

male genital disease. 

The NAMCS makes it possible to identify 

the patient’s symptoms that are associated with 

the doctor’s diagnosis. For male genitourinary 

visits, 

order of 

the 

frequency 

leading 

were: 

10 presenting symptoms in�, 

1. Frequency and urgency of urination. 

2. Painful urination. 

Table 1. Number of all office visits and of genitourinary visits and visit rate per year per 1,000 members of the civilian 

noninstitutional ized population, by sex of patient and principal diagnostic condition: United States, 1977-78 

Both sexes Male Female 

Principal diagnostic condition and Number Number of Number Number of Number Number of 

I CDA codes 1 of visits visits per of visits visits per of visits visits per 

in year per 1,000 in year per 1,000 in year per 1,000 

thousands population thousands population thousands population 

All conditions, all visits .. .. ... . .. 1,154,550 2,727 460,119 2,252 694,431 3,170 

Diseases of the genitourinary system .. .... ... ...580-628 71,224 168 15,593 76 55,630 254 

Diseases of the urinary 

systam .. .. . .. .. . ... .... .. ... . .. .. .. ... ....58O-599 23,867 56 6,141 30 17,725 81 

Diseases of the genital 

system .... . ..... .. .. .... ... .... .. .. .... ...6 OO-629 47,357 112 29,452 46 37,905 173 

‘Based on Eighth Revision International 

z~nclude~ *3 I 2,000 visits for breast d@-. C’lassr”fication of Diseases, Adapted for Uee in the United States (lCDA-8). 
------

----

I 

—


3. 

4. 

5. 

6. 

7. 

8. 

9. 

Other urinary dysfunctions (e.g., retention, hesitancy, large voIume). 

Symptoms of the scrotum and testes 

(e.g., pain, swelling, inflammation, 

growths, itching). 

Prostate symptoms (e.g., swelling, infection). 

Abnormalities of urine (e.g., presence of 

blood or pus, unusual coIor or odor). 

PeniIe discharge. 

Back symptoms. 

Penis symptoms (e.g., pain, inflammation, swelling, growths). 

ackme&a3 

Figure 1. PERCENT DISTRIBUTION OF ALL GENITOURINARY 

VISITS,l BY SEX OF PATlENT AND GENITOURINARY SUBGROUP: UNITED STATES, 1977-78 

%x%%: Femaleurinarv disease \ ~ 

Figure 2 NUMBER OF URINARY AND GENITAL VISITS PER 

YEAR PER l,ODO MEMBERS OF THE CIVILIAN NONINSTITUTIONALIZED POPULATION, BY SEX OF PATl ENT: UNITED 

STATES, 1977-78 

Male urinarf visirs 

:.\. 

i 

/\ 

“-, — Male genitalvisits 

i ‘N -——Femaleurinmy visits ‘\, 

i

i \.

\ 

--—- Femalegmiral visits 

i ;

i ;,

i \ 

i ii 

i \ 

i i 

i i,

i \ 

i i 

i 

i ..-

/- ..-

//

,/ 

/“

,/ 

o- 65 and 

25 over 

AGE OF PATlENT IN YEARS 

10.Pain, site not referable to a specific 

body system (e.g., side or groin pz&). 

Table 7 explores the diagnostic procedures 

that were brought to bear on the presenting 

symptoms of male genitourinary disease. Predictably, the key dia~ostic tool (applied in 2 of 

every 3 visits) was the laboratory test. A general 

xamination was the exception, as it is throughout aIl male ambulatory care. The frequency of 

blood pressure checks during male genitourinary 

visits (22 percent) is primarily due to their 

Table 2. Number of urinary and genital visits and visit rate per 

year per 1,000 members of the civilian noninstitutionalized 

population, by sax and age of patient: Unitad States, 

1977-78 

I Number in thousands 

All ages...... 6,141 I 17,725 [ 29,140 I 37S05 

I Number per year per 1,000 population 

Total ... ....... 30 81 45 173 

Under 25 years ........... 12 49 12 106 

2544 years ................ 27 90 42 275 

45-64 years ................ 46 108 79 239 

65 years and over .... ... 92 122 134 72 

1Bawd on Eighth R~ision International Ck7ssmation of 

@ 

�Diseases,Adapted for Use in the United States (lCDA-8). 2Exclude~ *312,000 visits fOr breast di~ase. 
I 

4 admcecw 

Table 3. Number and percent distribution of male geni~ourinary visits and visit rate per year per 1,000 male members of the civilianc 

noninstitutionalized population, by principal diagnostic condition associated with visit: United States, 1977-78 i 

Male genitourinary visits 

Principal diagnostic condition associated with male genitourinary visit and Number 

ICDA codesl Number Percent per year 

in distribution per 1,000 

thousands male 

population 

All male genitourinary diseasas ... . ... ..... .. .. ... .. .. ... .. .. ..... . .. ..... . .. . .... . .... .... .. .. ..58O.6O7 215,281 100.0 75 

All diseases, male urinary system .... .. . . .. .. .. .. .... .. .... .. . ... .. .. .... .. . ..... ... . .... . . .... .... .. .. .. .. ... ..58O.599 6,141 40.2 30 

Diseases of the kidney and ureter ..... .. .. .... .. ...... .. .... .. .. .... .. . .... . ... . .. .. .. . ... .. ... ... ... .....58O.593 1,909 12.5 9 

Calculus of kidney and ureter .. ... . ... .... .. . .... . .... ... .. . ... .. .. ...... . . .... .. .. .. .. .. .. .. .. . .. ..... ... ...592 743 4.9 4 

Residual: nephritis andnephrosis; infections of kidney ;hydronephrosis; 

other diseases of tidney and ureter ... . . ..... ... . .... .. . .... .. .. ... .... ..... . .. ... .. .. ...... . . ... ... . .. ... ... . 1,166 7.6 6 

Diseases of the bladder and urethra and other diseases of the urinary tract .... .. . ...594.599 4,232 27.7 21 

Cystitis ... . ... ... .. .. ..... .. . .... .. ..... . .. .. .. .... .... . ... .... .. .. ..... . ..... . .. ...... .. ... ... .. ... . ... ..... .. .... .. ....595 782 5.1 4 

Urethritis (nonvenereal) ... .. .... ... . .. .. .. . ... .. .. .. .. .. .. ... ... .. ... . ... . .... .. .. .. .. ... ... .. .. .... . .. .. . .. ....597 803 5.3 4 

Stricture of urethra ... .. .... .. .... ... . ... .. .. ... .. .. ... . ... .. ... .. .. .. .. . .. . .... . . ..... . .... . ... .. ..... .. .... .....598 694 4.5 3 

Residual: calculus; other diseases of the biadder and urinary tract .. .... .. .... .. .. .. .... ..... . . 1,953 12.8 10 

All diseases, male genital system . .. ... .. .. .. . .... . ... .. .... .. ... . .. .... .. ... ... .. .. .... .. .. .. .. .. . .... .. ... .. ...6OO$O7 9,140 59.8 45 

Hyperplasiaof prostate .. .. ... .... .. . ..... . ... .... ... ... .. .. .... .. .. ..... .. .... . .. . .. ... .. .. ... ... .. . ... . .. ....6OO 2,354 15.4 12 

prostatitis .. . .... ... .... .. .... .. .. ... .. ..... . ... .. .. .. . ... .. .... .. ... ... .. .. ..... . .. .. .. .... .. ... . .. ... .. .... ... . .. ... ..6OI 3,810 24.9 19 

Orchitis and epididymitis .... ... .... .. ..... .... ..... . .. .. .. .. . ..... . .. .... . .. .. .. .. .. .... .... .... .. .. .... . . .....6O4 779 5.1 4 

Sterility ... .... ... .. ... .. . .... ... .. .. .. . .. ... . .. .. .. ... .. .... .. .. .. . .. .. ... ... . .... . .. .... .. .. .... . .. ... .. .. ..... .. ......6o6 338 2.2 2 

Residual: other prostate disease; hydrocele; redundant prepuce and 

phimosis; other diseases of male genital organs .. . .... . .. .... ... . ..... . ..... . .. ..... .. ..... . ... .. .. .. . .. 1,859 12.2 

lBasedon Eighth Revition International Classification of Diseases, Adapted for Usein the United States (ICDA-S). +xcludes *312,000 visits for breast dkease. 

Table4. Number of urinary visits and visit rate per year per 1,000 members of the civilian noninstitutionalized csotmlation. bv sex of 

patient andprincipal diagnos~c condition associated with visit: United States, l977-78 

Male I Female 

Number of Number of principal 

ICDA codesl of visits visits per of visits visits per 

in year per in year per 

thousands 1,000 thousands 1,000 

Dowlation population 

All diseases, urinary system ... .. .. .. .. .. . ... .. .. .. .. ... . .... .. .. .. . ... . .... . ..58 O.599 17,725 81 

diagnostic condition associated with urina~ visit and Number Number 

Diseases of the tidney and ureter .... .. . .... ... . ..... . ... .. .. .. .... . .. ..... .. .. .. .. ... .....58 O.593 w 2,615 

Calculus of kidney and ureter ...... .. . ... .. .. .... . ... .... .. .. ... . . ..... .. .. . ... .. .. .... .. ......592 743 4 445 2 

Residual: nephritis andnephrosis; infections of kidney; 

hydronephrosis; other diseases of kidney and ureter ... ... ... . .... . .. .... . . ..... ... . ... 1,166 4 2,170 10 

Diseases of the bladder and urethra and other diseases of the 

urinary tract .... ... .. .... .. . ..... . . ..... . . ... .. .. .. .... ..... . ... ... .. ... . .. ... . .. .. ... .. .... . .. ....594.599 4,232 21 15,111 69 

Cystitis .... .. ..... .. .. ... ... .. .... . ... .... .. .. ... .. . .. .. .. .. .... .... ... .. . ..... ... ... . .. . .... . . ..... .... ...595 782 4 6,607 30 

Urethritis (nonvenereal) ... .. .... . ... .. .. .. .. . .. .. . .... .... . ... .. .. .. .. . .. ... .. .. .... . ... ... . ......597 803 4 1,055 5 

Stricture of urethra .. . .. .... .. .. .... ... .... .. .. .... . .. ..... .. .. ... . . .. .. .. .. . . .. .. . ..... . . .. ... . .. ...598 694 3 1,777 8 

Residual: calculus; other diseases of the bladder 

and urinary tract ... .. .. .. .. . . ..... ... ...... . .... . .... ... .... ... ... . ... .... .. .. .. .. .. .. . ... .. .. ... ... .. . .. S672 

~~a5e~o~Eighth Re~i~ion Intermtional ~asificafi-On Of Diseases, Adapted for Use in the United states 2DA-8). 
dvancedata 5 

Table5. Number and percent distribution of male genitourinary visits (with component subgroups), byspecialw ofphysician visited: 

United States, 1977-78 

Physician specialty 

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

Urology ........................................... ...................... ...... ...... .... ... ................................................... 

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

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

All other special~es3 ..... ........ .... .................... ................................................... ..... ................. 

Male genitourinary visits 

~ 

Number in thousands 

15,281 I I 6,141 [ -29,140 

Percent distribution 

100.0 I I 100.0 I 100.0 

1Based on Eighth Revin.on In temational Classification of Diseases,Adapted for Use in the United States (ICDA-8).


2Ex~l”des � 312,000 visits for breast disease.


?’Chiefly gener~ surgery and Pediatrics.


Table 6. Number and percent distribution of all male visits and of male geniteurinary visits (with component subgroups), by prior-visit 

status and referral status of patiant: United States, 1977-78 

Prior-visit and referral status 

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

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

Prior-visit status 

New patient (a) ........... .......................... ............ ................ .... .................................... 

Old patient ....................... ......................................................................................... 

New problem (b) ......... .............. ...... ....... ......... .... .. ...... ...... .............. ...... .... ........... 

Old problem (c) ................................ .. ............. ........... ....... ............. ............ .. ........ 

New problem visit (a+ b) ... .. ............................. ....... ........ ........................ ................. 

Return visit (c) ............ ..................................................... ......................... ............ .... 

Referral status 

Referred by anothar physician ... ...... ...... ............ .. ...... ...... .......................... ............... 

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

Male genitourinary visits 

All 

male Urinary Genital 

visits Total visits visits 

(580-599)1 (600-607)1 

Numtxx in thousands 

460,119 I I 15,281 I I 6,141 I *9,1 40 

Percent distribution 

100.0 100.0 100.0 100.0 

16.4 17.6 13.8 20.2 

83.6 82.3 86.3 79.8 

24.9 16.9 22.1 13.5 

58.7 65.4 64.2 66.3 

41.3 34.5 35.8 33.7 

58.7 65.4 64.2 66.3 

5.1 9.4 *5.3 12.1 

94.9 90.6 94.7 87.9 

1Based on Eighth Rmision -international Clasn.f7cati.onof Diseases,Adapted for Use in the United States (ICDA-8]. 2’&cIudes *312,000 visits for breast disease. 
6 advancedata 

relative rarity during genital visits. Symptoms of somewhat exceeds the average experience for 

urinary disease, on the other hand, are much the entire range of male visits. Also noteworthy 

more likely to prompt a measurement of blood is the finding that the frequency of hospit~ 

pressure, probably because a disorder of the admission (in 5 percent of the visits), a relatively 

urinary system can be more directly influenced rare form of disposition for male genitourinary 

by a circulatory malfunction. For example, with conditions, was still more than double the 

a suspected kidney disorder blood pressures proportion found for the entire group of male 

were. taken in 40 percent of the visits. visits. 

Table 7 also shows that physicians judged Data on the duration of the visit reveal that 

the average male urinary disorder to be the average personal encounter between the 

markedly more serious in prognosis than the physician and the male patient with a genitoaverage male genital disorder. urinary disease lasted about 14 minutes, not 

The data in table 8 show that drug therapy markedly different from the 15-minute average 

was the treatment most frequently provided or calculated for all male visits. 

ordered for male genitourinary conditions. Its An additional 1,031,223 visits for which the 

use in 58 percent of male genitourinary visits principal dia~osis was a malignant neoplasm of 

exceeded its average application in all male the prostate were not included in the diagnostic 

office-based care. Data on disposition in the scope of this report. An estimated 85 percent of 

same table demonstrate that two-thirds of male these visits were made by men 65 years of age 

genitourinary visits ended with the direction to and over resulting in a visit rate for this 

return at a specified time. This directive is condition of 47 per 1,000 members of the male 

evidence of a need for continuing care that population. 

Table 7. Number and percent distribution of all male visits and of male genitourinary visits (with component subgroups), by selecte 

diagnostic procedures and seriousness of condition: United States, 1977-78 

Male genitourinary visits I All I 

Selected diagnostic procedures and seriousness of condition male Urinary Genital 

visits Total visits visits 

(580-599)1 (600-607)1 

Numbar in thousands 

Total ... .. .. .. .. .... . ... ... . .. .. .. .. .... . .. .... . .... ... .. ... .. .. .. .... .. .. .... .. ...... . .. ..... .. . ... . ... .. . ... 460,119 I I 15,281 I I 6,141 I *9,140 

Percent distribution 

100.0 100.0 100.0 100.0 

Selected diagnostic procedures 

None .. ... ..... .. .. ..... . .. .... .. .. .. .. .. .. .. .. .. .. .... .. .. .... .. .... .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .... .. . .... . .. .... . .. 11.4 6.4 7.1 6.0 

Limited examination .. ... .. .. .... .. ... . .. .. .. ... .. .... . .. .. .. .. .. .... .. .. ... ... .. .. .... .. .... ... ... .. .. .... .. . .... ... 59.0 58.1 59.2 57.3 

General examination ... .. .. .. . ... .. ... . .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .... .. .. .. .... .. .. .... .. .... .. .. .... .. .. 21.7 18.9 18.6 19.2 

Clinical lab test ..... .. .... .. .. ... ... .. .... . . .... .... . .... .. ..... . ... ..... . . .. .. .. ... .. ..... .... .. ... . .. .. . .... .. . .... .. .. 18.2 62.1 63.6 61.0 

X.ray .... .... .. .. ..... . .. .... .. . ... ... . .. .. ... . . .... ... .. ..... . . .... .. . .... .... ..... .. . ..... ... ..... .. . .... ... .... .. .. .... . ... 9.9 8.9 10.3 7.9 

Endoscopy ... .... .. .. ... ... .. .... .... . .... . . .... .... . ..... . .. ... . .. .. ... .. . .. .... . .. ... ... .. .... . . .. .. .. ... ... .. .. .. .. .... 1.1 3.4 *2.2 4.1 

Blood pressure check .. .. .. .. ... ... .. .. .. .... .. .. ... ... ...... .. .. .. .... .. ... . .. ... ... .. . .... . .. .. .. .. .. . ... .. .. .. .. .. . 27.0 22.2 30.7 16.6 

Seriousness of condition 

Serious and very serious .. ... .. .. .. .. .. .. .. .. . .... .. .. .... .. ... .. .. .. .... .. .. .... . ... ... .. . .... . ... .... .. . ..... .. .. . 21.0 18.7 29.3 11.6 

Slightly serious ... .... .... .. ... .. ... ... ... . .... . .... ... .. . ..... . . .... ... .. .... . .. .... .. ... .. .. .. ..... . ... ... .. .. ... .. . ... 32.9 38.1 36.9 38.9 

Not serious ... ... . .. .... .. ... ..... .. ..... ... ..... .. .. .. .. . .. ..... . . .... .... .. ... . .. ... .. ... .... .. . .... . . ..... . ... .. ... . .... 46.1 43.2 33.8 49.5 

1 Based on Eighth Revision In temational classificati-on of Diseases, Adapted for Use in the United Sta tes (lCDA-8).


2Excludes *312,000 visits for breast disease


Swfilnot addto 100.0~erCent
 because more than 1 procedure was possible. 
7


~ Table 8. Number and percent distribution of all male visits and of male genitourinary visits (with component subgroups), by selected 

therapeutic services ordered or provided and selected dispositions of visit: United States, 1977-78 

Selected therapeutic services and dispositions of visit 

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

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

Selected therapeutic services3 

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

Drugs (prescription or nonprescription) ....... ............................... ............... ..... .......... 

Diet counseling ....... ...... .............. ...... .. .................... .............. .......... .................... ....... 

Medical counseling ..................................................... ............................................ ... 

Physiotherapy .. ...................................................... ...... ........................ ....... ..... ...... ... 

Office surgery4 ............................................................ .......................... .................... 

Selected dispositions of visit3 

No followup .................................................................................... .......................... 

Return at specified time ......................... ............... ........... ............... .................. ........ 

Return if needed .. .......... ...... ..................... ..... ........ .................................................. . 

Telephone followup planned ..... ...................... ................................ ................ .... ...... 

Referred to other physician .......................................... ........... ......... .... ................ ..... � 

Admitted to hospital .................. ........................................................... .. ....... .... ....... 

Male genitourinary visits 

All 

male Urinary Genital 

visits Total visits visits 

(580-599)1 (600-607) 1 

Number in thousends 

460,119 I I 15,281 I I 6,141 j *9,1 40 

Percent distribution 

100.0 100.0 100.0 100.0 

18.9 19.7 13.9 23.5 

51.2 57.7 61.1 55.4 

6.3 3.6 6.3 *1.8 

19.6 21.8 23.6 20.5 

4.0 7.6 *0.7 12.2 

9.4 7.7 12.6 4.3 

13.2 4.8 *2.8 6.1


57.6 65.9 67.1 65.1


23.1 19.9 21.3 18.9


3.3 3.8 5.8 *2.5


2.6 4.5 4.0 4.9


2.2 4.6 4.1 4.9


~Based on Eighth Revision International Classification of Diseases, Adapted for Use in the United States (ICDA-8]. z~xclude~ *312,000 visits for breast disease. 

3wil not add to 100.0 percent because more than 1 service or more than 1 disposition Of visit WW possible.


4AnY sur~cal procedure ~efiormed ~ the office during this VW, inchs ding suture of wounds; reduction Of fractures; application or


rem oval of casts; incision and draining of abscesses; and all tilgations, aspirations, dilatations, and excisions. 
8 ackincedata 

TECHNICAL 

SOURCE OF DATA AND SAMPLE DESIGN 

The information presented in this report is 

based on data collected in the National Ambulatory Medical Care Survey (NAMCS) during 1977 

and 1978. The target universe of NAMCS 

encompasses office visits within the conterminous United States made by ambulatory 

patients to nonfederally employed physicians 

who are principally engaged in office practice. 

The National Opinion Research Center, under 

contract to the National Center for Health 

Statistics, was responsible for the survey’s field 

operations. 

The NAMCS utilizes a multistage probability 

design that involves samples of primary sampling 

units (PSU’S), physicians’ practices within PSU’S, 

and patient visits within practices. For 1977-78 

a sample of 6,007 non-Federal, office-based 

physicians was selected from master files maintained by the American Medical Association and 

American Osteopathic Association. The physician response rate for 1977-78 was 75.1 percent. 

Sampled physicians were asked to complete 

Patient Records for a systematic random sample 

of office visits taking place within their practice 

during a randomly assigned weekly reporting 

period. During 1977-78, 98,335 Patient Records 

were completed by sampled physicians, of which 

1,567 involved a male genit ourinary disease as 

the principal diagnosis. 

SAMPLE ERRORS AND 

ROUNDING OF NUMBERS 

The standard error is primarily a measure of 

the sampling variability that occurs by chance 

because only a sample, rather than the entire 

universe, is surveyed. 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 percentage of the 

estimate. Relative standard errors of selected 

aggregate statistics are shown in tables I and II. 

NOTES ~ 

The standard errors for estimated percentages of 

visits are shown in tables III and IV. 

Estimates of office visits have been rounded 

to the nearest thousand. For this reason detailed 

figures within tables do not always add to totals. ~ 

Percents were calculated on the basis of original, 

unrounded figures and will not necessarily agree 

precisely with percents calculated from rounded 

data. 

Table 1. Approximate relative standard errors of estimated 

number of office visits based on all physician 

NAMCS, 1977-78 

Estimated number of office 

visits in thousands 

5oo ..................................... ..................................... 

l.ooo .......... .......................... .... .. ............................. 

2.000 .......... ........ ...................................... ............... 

5.0m .................. .............................. .......... ...... ....... 

lo.ooo ...................... .. ................ ............................. 

20.000 .... .......... .......................................................` 

50.000 ........ ......................... ....... ............................. 

loo.ooo ....... ............................................................ 

5oo.ooo .............. .. ....... ..... ................ .................. ..... 

Example of use of table: An aggregate of 35,000,000 

specialties: 

Relative 

standard 

error in 

percent 

24.9 

17.7 

12.7 

8.3 

6.2 

4.8 

3.8 

3.3 � 3.0 

visits has a 

relative standard error of 4.3 percent or a standard error of 

1,505,000 visits (4.3 percent of 35,000,000). 

Table II. Approximate relative standard errors of estimated 

number of office visits based on an individual physician 

specialty: NAMCS, 1977-78 

Estimetad number of office 

visits in thousands 

5oo .......... .. ....................... ...................................... . 

l.ooo ........... ...................... ..... ................ ................. 

2.000 .......................................... ............................. 

5.000 .......... ............................................ .......... ....... 

lo.ooo ......... ............................................................ 

mrooo ................ ......... .......e....................... ............. 

50.000 ..................................................................... 

loo.ooo ................. .... ........... ............ .. ........ ............. 

2oo.ooo ................................................................... 

Example of use of table: An aggregate of 7,500,000 

Relative 

standard 

error in 

percent 

27.0 

19.6 

14.5 

10.3 

8.5 

7.4 

6.7 

6.4 

6.3 

visits has a 

relative standard error of 9.4 percent or a standard error of 

705,000 visits (9.4 percent of 7,500,000). 
achncedata 9 

~ Table 1I 1. Approximate standard errors of percent of estimated numbers of office visits based on all physician specialties: NAMCS, 

1977-78 

Base of percent 

Estimated percent 

(number Of Office visits in thousands) 1 or 99 5 or 95 100r90 20 or 80 30 or 70 50 

500 .... . .. .... ... . . .. .. .. . .. .... . .. ... . ... . ... . ..... . .. .. .. . .... . .. .... ... . ... . .. ... .. .. ... .. .... .. .. ... . .. . 2.5 5.4 7.4 9.9 11.4 12.4 

l.ooo .... .. ..... .. ... ... .. . .... .. .. ... . .. .... . . ... .. . .... . ... ..... . . .... . . ..... .. .... . ... .... . . .. .. . .... . .. 1.7 3.8 5.3 7.0 8.0 8.8 

2,000 .. .. .. ... .. .. .. ... .. . .... ... .... .... .... . ... .. . .. .. ... .. . ... .. . ..... .. .... .. .... .. .. .. .. . . .... .. .. .. .. 1.2 2.7 3.7 5.0 5.7 6.2 

5,000 ..... . ... ... . .. ..... . ... ... . .. .. . ... .... .. .... .. . .... .. . ..... . .. ... . ...... . .. .. . ... ... .. .. ... .. . ... . . . 0.8 1.7 2.3 3.1 3.6 3.9 

10,000 ... . ... .. ... .. .... . .. ... .. .. ... .. .. .... .. .... . .. ... . ... ... ... .... .. .. ... .. . ... ... . ... ... .... . .. .. .. . 0.6 1.2 1.7 2.2 2.5 2.8 

20,000 .... .. .. .... . . .. ... . ... ... .. . ... .. . ... .. . . .. ... .. ... . . .. ... ... ... .. .. .. ... .. ... .. . .... . . .... . . ..... . 0.4 0.9 1.2 1.6 1.8 2.0 

50,000 ... ... . .... .. .. .... .... .. ... . .. .. . . ..... . .. .. .. .. .... . .. ..... .. ... .. . .... .. . ..... .. .... . .. .. . .... .. . 0.2 0.5 0.7 1.0 1.1 1.2 

100,000 ... .. .. .... .. . .... .. .. ... .. . .... . ... ... . ... .. .. .. .. .. .. .. .. .. .. .. . .. ... .. .. .. .. .. .... ... ... .. .... . 0.2 0.4 0.5 0.7 0.8 0.9 

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

Example of use of table: An estisnate of 20 percent based on an aggregate of 15,000,000 visits has a standard error of 1.9 percent or a 

relative standard error of 9.5 percent (1.9 percent + 20 percent). 

Table IV. Approximate standard errors of percent of estimated numbers of office visits based on an individual physician specialty: 

NAMCS, 1977-78 

Base of percent 

(number Of office visits in thousands) 

500 ................................................................................ ........ ................. 

l.om ..................................................... .......#................. ............ ...... ...... 

2;mo .................................... .......... .............. .............. ...... ...................... 

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

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

20,000 ........ ................................................................ ............. ............... 

50,000 .......................................... ....... ...................................... ............. 

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

200,000 .................................... ...... .................................................. ...... 

�

Estimated percent 

1 or99 5 or 95 100r90 20 or 80 30 or 70 50 

2.6 5.7 7.9 10.5 12.1 13.1 

1.9 4.1 5.6 7.4 8.5 9.3 

1.3 2.9 3.9 5.3 6.0 6.6 

0.8 1.8 2.5 3.3 3.8 4.2 

0.6 1.3 1.8 2.4 2.7 2.9 

0.4 0.9 1.2 1.7 1.9 2.1 

0.3 0.6 0.8 1.1 1.2 1.3 

0.2 0.4 0.6 0.7 0.9 0.9 

0.1 0.3 0.4 0.5 0.6 0.7 

Example of use of table: An estimate of 50 percent based on an aggregate of 15,000,000 visits hasastandard error of2.5percent ora 

relative standard error of 5percent (2.5 percent+ 50 percent). 

DEFINITIONS 

Ambulatory patient.–h ambulatory patient is an individual presenting himself for 

personal health services who is neither bedridden 

nor currentIy admitted to any health care institution on the premises. 

Office. -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. 

Visit.–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 seeking care and rendering health 

services. 

Physician. –A physician is a duIy licensed 

doctor of medicine (M.D.) or doctor of osteopathy (D. O.) currently in an office-based practice who spends time in caring for ambulatory 

patients. Excluded from NAMCS are physicians 

who are hospitaI based; physicians who specialize in anesthesiology, pathology, or radioIogy; 

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. 
---------------------------------------

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

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

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

---

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 

* 
ackincedata 11 & 

Recent Issues of Advance Data From Vital and Health Statistics 

No. 62.	 Expected Principal Source of Payment for No. 59. Trends in Breast Feeding (Issued: March 

Hospital Discharges: United States, 1977 28, 1980) 

(Issued: October 31, 1980) 

No. 58. Remarriages of Women 15-44 Years of Age 

No. 61. Selected Demographic Characteristics of Teen- Whose First Marriage Ended in Divorce 

age Wives and Mothers (Issued: September United States, 1976 (Issued: February 14, 

26, 1980) 1980) 

No. 60.1978 Summary: National Ambulatory Medical 

Care Survey (Issued: April 23, 1980) 

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

Information Branch. �