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EDITORIAL IJBRAJ?Y ;,3“- ! ~ 

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

U.S. DEPARTMENT OF HEALTH, EDJCATION. AND WELFARE i No. 13 October 13, 1977 I Public Health Service. Health Resources Administration 

Ambulatory Medical Care


Rendered in Pediatricians’ Offices During 1975a


This report presents statistics concerning an 

estimated 46.7 million visits to the offices 

of pediatricians practicing in the coterminous 

United States. The data were collected during 

calendar year 1975 in the National Ambulatory 

Medical Care Survey (NAMCS), a continuous 

survey conducted yearly by the National Center 

for Health Statistics. 

The estimates presented are based on information obtained from the “Patient Record,” a 

facsimile of which can be found in Advance Data 

No. 12. This form is used by sample physicians 

to record selected information about their office 

encounters. The sampling errors associated with 

these estimates and information concerning the 

sample design used by the 1975 NAMCS are 

presented in the section, “Technical Notes,” 

that follows. 

HIGHLIGHTS 

During 1975 there were an estimated 567.6 

million visits to “office-based, patient-care” 

physicians practicing in the coterrninous United 

States. The estimated total yearly volume of 

office-based ambulatory medical care by specialty is shown in table A. In terms of total office visits, the 46,684,000 visits to pediatricians 

ranked fourth among all physician specialties. 

Forty-two percent of these visits were to 

pediatricians in practice by themselves while the 

remaining 58 percent were to pediatricians practicing in a group or partnership arrangement. 

aThis report was prepared by Trena Ezzati, Division 

of Health Resources Utilization Statistics. 

Table A. Number and percent distribution of office visits, by 

selected physician specialties: United States, 1975 

Number of Percent Physician specialty visits in distribution 

thousands 1 

All specialties ..... .. .... .. .... . . . 567,600 100.0 

General family practice .. .. .. .... . t 234,660 41.3 

Internal medicine . . .... .. . ... . .. .... . 62,117 10.9 

Obstetrics/gynecology . .... . . .... .. 48,076 8.5 

PEDIATRICS . ... ... .. .. .. . .... .. . .... . 46,684 8.2 

General surgery ....................... 41,292 7.3 

All other specialties ... .. .. ... ... .. .. 134,771 23.8 

1Due to ~ refinement of the NAMCS estimating procedure 

used to project national estimates from sample data, caution 

should be used when comparing these estimated numbers of 

office visits with previously published estimates for 1973 and 

1974. 

Visits to pediatricians by maIes (52.3 percent) outnumbered those by femaIes (47.7 percent), whereas the proportion of visits to all 

physicians by females exceeded that by males 

(figure 1). 

Information regarding the age distribution of 

visits to pediatricians is presented in figure 2. A 

negative correlation exists between age and the 

number of visits to pediatricians, i.e., as the age 

of patients increases, the number of visits decreases. Less than 2 percent of the visits to pediatricians were by patients over 19 years of age 

and only 5 percent were by patients 15-18 years of 

age. Thus, the major portion of visits to pediatricians was by patients under 15 years of age. 

Visit rates further show that there were 

more visits made by children under 2 years of 

age than by children in any other age group 

(tabIe B), thus reflecting the most frequent rea-
2 dmcedda 

Figure 1. PERCENT OF OFFICE VISITS, BY SEX: UNITED 

STATES, 1975 

70 

60 

t 

; 50


1-u


v


L 40


%


& 30


5


; 20


cc


E 

10 

0 

Female Male 

Figure 2. PERCENT OF OFFICE VISITS TO PEDIATRICIANS, BY AGE OF PATl ENT: UNITED STATES, 1975 

35 

Cn 

k 30 ~ 

~ 25 

a 

~ 20 

k 

: 15 

1-

: 10 

0 

U5 

: 

0 

Under 2 2-5 6-10 11-14 15 and 

over 

AGE IN YEARS 

J 

Table B. Rate of office	 visits per 100 persons by age: United 

States, 1975 

I 

Age I Rate 

Tota I ... . .. ..... ... .. .... .. .. .... .. .. ..... . .. .. ... ... .... 58 

Under 2 years .. .. .... .... ... . .. ..... . .. ..... ... . .... . .. ... 244 

2-5 years .. ... .... .... .. .... .. .. .. .. .... .. .. .... .. .. .... .. .. . 106 

6-10 years ... .. .. .. .... ...t .... .. ... .... . .... .... .. ....c.@.. 57 

11-14 years .. . .. .. .. .. .. .... .... . .. ..... .. .. ..... . . ..... .. . 33 

15-18 years ... . ... ..... . ... .... ... .. .... ... . .... . .. ..... ... 16 

son for visiting a pediatrician—the well-baby examination. 

In addition to the well-baby examination, 

other common reasons for visits to pediatricians 

as presented in the patient’s own words (or 

when necessary, the words of the parent or accompanying adult) are shown in table 1, These 

14 probIems, complaints, or symptoms accounted for about 67 percent of all visits. This 

reveals a relatively narrow clinical range for pediatricians as compared with the more varied 

range for generaI and family practitioners where 

it requires nearly two and one-half times as 

many problems to account for a comparable 67 

percent of their visits. For about one of every 

three visits to pediatricians, a “nonsymptomatic” problem (generalIy an examination) was 

the reason for a visit. Among “symptomatic” 

problems presented to pediatricians, cough, 

fever, sore throat, and earache were the most 

common. 

Data on the physician’s judgment of the seriousness of the patient’s problem, complaint, or 

symptom (in terms of the extent of impairment 

that might result if no care were obtained) revealed that only 10 percent of the visits to pediatricians were “serious or very serious” (table 

C). The proportion of conditions categorized as 

“not serious” (60 percent) is in part a reflection 

of the relatively Iarge number of visits involving 

examinations and acute, self-limiting problems 

common to children. 

Table C, Percent distribution of visits to pediatricians by degree 

of seriousness of patient’s problem: United States, 1975 

I 

Percent Degree of seriousness 

distribution 

Total .................................................... I 100.0 

Serious or very serious ... ............................ 10.1 

Slightly serious ............................... ............ 29.5 

Not serious ................................................. 60.4 

Data presented in table 2 provide statistics 

on the most frequent physician diagnoses associated with the reasons for office visits to 

pediatricians. The physician’s principal diagnosis refers to the diagnosis listed first in item 
3 

9 of the Patient Record. The diagnostic data 

are grouped by the classes used in the Eighth 

Revision International Classification of Direases, Adapted for Use in the United States 

(ICDA). As might be predicted from the previous statistics presented on problems, the ICDA 

category “special conditions and examinations 

without illness” was the largest. This also reflects that about one-third of all visits made to 

pediatricians were for well-child care. In comparison with all other physicians, only obstetricians/gynecologists exceeded pediatricians in the 

proportion of visits for special conditions and 

examinations (57 percent). The second most frequent category of illness or injury diagnosed by 

pediatricians were diseases of the respiratory 

system (28 percent). Acute pharyngitis, acute 

tonsillitis, acute upper respiratory infection, and 

bronchitis, unqualified, comprised over one-half 

(60 percent) of the diagnoses associated with 

diseases of the respiratory system. 

Further information abstracted from the 

Patient Record shows that the majority of visits 

(91 percent) to pediatricians were made by patients who had seen the physician before (table 

D). 

Table D. Percent distribution of patient visits to pediatricians by 

patient’s prior visit status: United States, 1975 

Patient’s prior-visit status Percent distribution 

.................................................... 

.......................... 

~ 

However, the percentage of new problems 

presented to pediatricians (51 percent) proportionately exceeded that for all physicians (38 

percent). 

Further reflecting the large number of visits 

to pediatricians for routine examinations, history or examinatiofis (either limited or general) 

were the most common diagnostic services provided (table 3). The proportion of visits at which 

history or examinations were performed was 

generaUy higher for pediatricians than for all 

physicians. Likewise the percentage of visits 

where medical counseling was a significant part 

of the office visit exceeded the percentage for all 

physicians. On the other hand, the pediatrician 

fell below the overall average in the proportion 

of visits involving blood pressure checks, office 

surgery, x-rays, and the prescription of drugs. 

The relatively large proportion of visits to pediatricians at which immunizations or desensitizations were provided (23 percent) reflects the age 

composition of patients. 

The duration of the visit represents the 

amount of time spent by the patient in face-toface contact with the physician. The average encounter time between pediatricians and their pat i ents was approximately 12 minutes, as 

compared to an average time duration of 15 

minutes per visit for all physicians. 

Finally, data on disposition (table 3) reveal 

that pediatricians, when compared to all physicians, were more likely to have a telephone followup and less likely to schedule a return visit, 

thus indicating acute, self Iimiting problems 

characteristic of children. No followup was planned after 24 percent of the visits, thus reflecting 

the large amount of well-child care occurring at 

ambulatory pediatric office visits. 
---

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

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

4 txklncedata 

Table 1. Numberr percent, and cumulative percent of office visits to pediatricians, by the most common patient problems, complaints. or svm~toms: United States. 1975 ,! 

I 

Number of Most common patient problems, complaints or Percent of Cumulative visits symptoms (NAMCS code) in thousands visitsl percent 

Well-baby examination .. ... . ... . .. . . . .. . . .. .. .. . .. .. . .. . . .. . .. ...906 6,233 13.4 13.4 

General medical examination .. .. .. . .. .. .. . .. . . . .. .. .. .. . .. ...9oo 4,687 10.0 23.4 

cough .. . . .. .. .. . .. .. .. . .. .. .. . . . .. . .. . .. . .. .. .. . .. ... . . .. .. .. .. . . .. . .. . .. .311 3,425 7.3 30.7 

Fever ... . . .. .. .. .. . .. . . .. . .. .. .. . .. . . .. .. . .. . . .. . .. .. .. . .. . . .. .. . ... . .. .. ..oo2 3,170 6.8 37.5 

Visit for medication .. .. . ... . . .. . . .. .. . . .. . .. .. .. .. . .. .. .. .. . .. .. . .910 2,859 6.1 43.6 

Throat soreness .. .. . .. .. .. . ... . .. .. . ... . .. . . . .. .. .. . .. .. .. . ... . .. .. ..52O 2,439 5.2 48.8 

Earache .. . .. .. .. . .. .. .. .. . .. . .. . .. . .. .. .. .. . .. . . . .. .. .. .. . .. .. . . .. . .. .. .. 735 2,001 4.3 53.1 

Allergic skin reactions .. .. . .. . .. . . .. . .. . . .. .. . .. . . .. . .. .. . . .. . ....112 1,662 3.6 56.7 

Cold . .. .. .. .. . .. .. .. .. . .. .. . .. . . .. .. . .. .. . ... .. . .. .. .. . .. .. .. . .. .. .. .. .. . ..3l2 1,464 3.1 59.8 

Required physical examination .. .. . .. .. .. . .. .. .. .. . .. .. .. ...901 974 2.1 61.9 

Abdominal pain .. . . .. .. .. .. .. .. ... .. . .. .. .. .. . .. .. . .. .. .. . . .. . .. . .. ..54O 764 1.6 63.5 

Wounds of skin .. . . ... . . .. . . .. . .. .. . . .. .. . . .. . .. . .. .. .. . .. .. . . .. . .. . ..ll6 745 1.6 65.1 

Nausea and vomiting .. . . .. .. .. .. . .. .. . .. .. . . .. . .. . . . ... . .. . . . .. ...572 571 1.2 66.3 

Problems of lower extremity .. . .. . .. . . .. .. . .. .. .. . .. . . .. . .. ...4O() 531 1.1 67.4 

1 Based on a total of 46,684,000 office visits. 

SYMBOLS 

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

Category not applicable . . . 

Quantity zero --------------------------------------------- -

I Quantity more than Obut less than o.os---- O.O I 

Figure does not meet standards of 

reliability or precision * 

I I 
o achncedata 5 

Table 2. Number and percent	 of office visits to pediatricians, by principal diagnoses most frequently 

rendered by the physician: United States, 1975 

Principal diagnoses most frequently rendered by Number of visits Percent of 

the physician (ICDA code) in thousands visitsl 

� 

.1nfective and parasitic diseases . . .. . . . .. . .. .. . . . .. .. . .. .. . .. . . .. . . .. . . .. . . .. . .. . 001-136 3,286 7.0 

Streptococcal sore throat and scarlet fever . .. .. .. .. . .. . .. .. .. .. . .. . .. . . .. . .. 034 771 1.7 

Other viral diseases .. . . .. . .. . . . .. . . .. .. . .. . .. . .. . . .. . .. .. .. . .. .. . .. .. .. . .. .. . .. . . .. . . . . .. 079 754 1.6 

Diseases of nervous system and sense organs . .. . . .. . .. .. .. . . . .. . .. . . . ....320-389 4,625 9.9 

Otitis media . . . .. . .. .. .. .. .. . .. . .. .. . .. . . . .. . . .. . . . .. . .. .. . .. . . . .. .. .. . . .. . . .. . . .. . .. .. . .. . . ..38l 3,795 8.1 

Diseases of respiratory system . . .. . .. .. . .. . . . .. . . .. . .. . . . .. .. .. . .. .. . .. . . .. . . .. . . 460-519 13,220 28.3 

Acute pharyngitis . .. . . .. . .. .. . .. .. .. . . .. . . .. .. . .. . . .. . .. .. .. . .. .. . .. . . . .. . . .. . . . .. . .. .. . ...462 1,839 3.9 

Acute tonsillitis .. .. .. . .. .. . . .. . .. .. .. . . . . .. . . .. . .. . .. .. .. .. . . . .. . .. . . . .. . . .. . .. .. . .. . . . ....463 1,477 3.2 

Acute laryngitis and tracheitis . . .. . . .. .. .. . . . . .. .. .. .. .. . .. . .. . . .. . . . . .. .. . .. .. .. . 464 530 1.1 

Acute upper respiratory infection .. . .. . . . .. .. .. .. . . . .. . .. .. .. . . . . .. . . .. . .. .. . ....465 2,944 6.3 

Bronchitis, unqualified .. . . .. . . .. . .. . . . .. .. .. .. . . . . .. .. .. .. . . . ... . . . . .. . . . .. . . . .. . .. . . . 490 1,731 3.7 

Asthma . . . .. .. . . .. . . .. .. .. .. .. . . .. .. .. . .. . . .. . .. .. .. . .. .. . .. .. .. . .. . . . .. .. .. . . . . .. . . . .. . . .. . .. . 493 729 

Hay fever . .. .. .. .. . . .. . . .. .. .. . .. . . . . . .. . . . .. .. . .. . .. . . .. . .. .. . . . .. . . . .. . . . .. . . .. . .. .. . .. .. . .. 507 981 

Diseases of skin and subcutaneous tissue .. .. . .. .. . .. . . .. . .. . . .. . . . . .. . . .. . ..68 O-7O9 2,847 6.1 

Other eczema and dermatitis .. . .. .. . .. . . .. . .. .. .. . . . .. . .. .. . .. . . .. . .. .. . . . . .. . . .. . .. 692 1,577 3.4 

Symptoms and ill-defined conditions . .. . . . . .. .. .. .. . . . . .. .. .. . .. . . . .. .. .. ...780-796 1,967 4.2 

Observation, without need for further medical care . . .. .. . . . .. . . . .. . .. .. 793 726 1.6 

Accidents, poisoning, and violence . .. . . .. .. .. . .. . . . .. .. .. . .. .. . .. .. .. . . . . .. .. ..8 OO.999 2,174 4.7 

Special conditions and examinations without sickness . .. .. . .. . . . ... YOO-Yl3 15,137 32.4 

Medical or special examination . .. . ... . . .. .. .. .. . . .. . . .. . . .. . . . .. . .. .. .. . .. .. . .. . ..YOO 12,462 26.7 

Prophylactic inoculation and vaccination . .. .. . .. . . .. . .. .. . .. .. .. . .. . . . .. .. ...YO2 1,667 3.6 

Medical and surgical aftercare . . .. . . .. .. .. .. . . .. .. .. .. . . .. . . .. .. .. .. . .. . .. .. .. . . . . ..Yl O 841 1.8 

lBased on a total of 46,684,000 OffiCe visits. 
� 6 ackncedata 

Table	 3. Number and percent distributionsof office visits to pediatricians by selected diagnostic or 

therapeutic services ordered or provided and disposition of patient: United States, 1975 

Selected diagnostic or therapeutic services ordered Number of visits Percent 

or provided and disposition of patient in thousands distributions 

Diagnostic services 

Limited history /exam ................................................... 

General history/exam ................................................... 

Clinical lab test ............................................................. 

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

Vision test .................................................................... 

X.ray ............................................................................ 

Hearing test .................................................................. 

Therapeutic services 

Drug prescribed ............................................................ 

Immunization/desensitization ...................................... 

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

injection ....................................................................... 

Office surgery ............................................................... 

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

Disposition of patient 

No followup pIanned .................................................... 

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

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

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

Referred to other physician or agency .......................... 

19,136 41.0 

15,612 33.4 

10,442 22.4 

3,612 7.7 

1,955 4.2 

1,933 4.1 

1,277 2.7 

19,235 41,2 

10,693 22.9 

7,322 15.7 

4,340 9.3 

1,482 3.2 

1,339 2.9 

11,005 

20,795 44.5 

11,015 23.6 

4,597 9.9 

1,365 2.9 

1Percents may total more than 100.0 since more than one treatment or more than one disposition could be given at a 

single visit. . 

TECHNICAL NOTES 

SOURCE OF DATA: Data presented in this re- the first stage of selection, a sample of approxiport were obtained during 1975 through the mate y 3,500 physicians was selected from masNational Ambulatory Medical Care Survey ter files maintained by the American Medical 

(NAMCS). The target population of NAMCS en- Association and the American Osteopathic Assocompasses office visits within the conterminous ciation. Sampled physicians, randomly assigned 

United States made by ambulatory patients to to 1 of the 52 weeks in the survey year, were 

physicians who are principally engaged in office requested to complete Patient Records (brief enpractice. counter forms) for a systematic random sample 

SAMPLE DESIGN: The 1975 NAMCS utilized a of office visits taking place within their practice 

multistage probability design that involved sam- during the assigned reporting period. (A facples of primary sampling units (PSU’S), physi- simile of the Patient Record used is shown in a 

cian pmctices within PSU’S, and patient visits previous issue of Advance Data From Vital and 

within practices. Within the 87 PSU’S composing Health Statistics, No. 12, October 12, 1977.) 

* 

1 
� %

dmcdata7 

@ 

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 error of estimated number of office visits 

Estimated office visits Relative standard error in 

in thousands percentage points 

5oo ....................... .. ...................... 30.1 

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

15.3 

5;000 ;........................................... 10.0 

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

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

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

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

A-xample of use of ruble. An aggrcgute of 80,000,000 has a relutive standard error of 4.3 pw-cwrt or a standmxi error of 3,440,000 

(4.3 percent of 80,000,000). 

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,


Table 11. Approximate standard errors of percentages for estimated number of office visits 

Base of percentage Estimated percentage 

number of visits 

in thousands 1 Or 5 or 10 or 20 or 3;:r 50 

99 95 90 80 

I Standard error expressed in 

percentage points 

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 O.B 1.0 1.1 

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

Example of use of table: An estimate of 30 percent based on an 

agwegate of 75,000,000 has a standard error of 1.2 percent. The 

relative standard error of 30 percent is 4.0 percent (1.2 percent + 

30 percent). 

the sum of percentages may not equaI 100.0 per-


cent.


DEFINITIONS: An ambulatory patient is in­


dividual presenting himself for personal he th


services who is neither bedridden nor currently


admitted to any health care institution on the


premises.


An o~j$ce 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 uzkit is a direct personaI 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 (MD.) 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 specizdize 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. 
Previous Issues of Advance Data From Vital and Health Statistics 

No. 12. Ambulatory Medical Care Rendered in Physi- No. 9; Wanted and Unwanted Births Reported by 

cians’ Offices in the United States, 

(Issued: October 12, 1977) 

No. 11.	 Pregnant Workers in the United States 

September 15, 1977) 

No. 10.	 Expected Size of Complete Famify 

Currently Married Women 15-44 Years 

in the United States in 1973 (Issued: 

12, 1977) 

NCHS@ 

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1975	 Mothers 15-44 Years of Age in the United 

States in 1973 (Issued: August 10, 1977) 

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1971-74 (Issued: July 11, 1977) 

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