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

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE � Public Health Service I Number 25 @ March 22,1978 

Office Visits to Doctors of Osteopathy: National 

Ambulatory Medical Care Survey, United States, 1975’ 

Using data from the National Ambulatory NAMCS scope. Overall estimates for 1975 are 

Medical Care Survey (NAMCS), this report available in an earlier report. z 

describes an estimated 46.9 milIion visits made Table 1 describes office visits to osteopathic 

by ambulatory patients to the offices of osteo- physicians in terms of age, sex, and prior visit 

pathic physicians in 1975. 

The NAMCS is a sample survey designed to 

explore the provision and utilization of ambula- 2Nation~ Center for Health Statistics: Ambulatory 

tory medics.I care in the offices of physicians mechcal care rendered in physicians’ offices, United 

practicing within the conterminous United States.	 States, 1975, by Hugo K. Koch and Norma Jean 

Dennison. Advance Data From Vital and Health StatisIt is conducted yearly by the National Center tics, No. 12. DHEW Pub. No. (HRA) 77-1250. Health 

for Health Statistics. The survey sample is Resources Administration. Hyattsville, Md. oct. 12, 

selected from doctors of medicine and osteo- 1977. 

pathy (M.D.’s and D. O.’s) who are primarily 

Table 1. Number and percent distributions of office visits to engaged in office-based, patient-care practice. It osteopathic physicians by age, sex, and prior visit status of 

excludes physicians whose specialties are anes- patient: United States, January-December 1975 

thesiology, pathology, and radiology and all 

physicians in Federal service. The 1975 sample Number 

consisted of 3,507 physicians, of whom 141 Age, sex, and prior visit of visits Percent 

were doctors of osteopathy. For the week of status of patient in distrithou- their participation in the NAMCS, physicians 1 bution 

sands 

collected information on a sample of their office


visits. Participants averaged about 30 visit re- All visits ............................. ........ 46,872 ~ 100.0


ports per physician. Response rate was about 80 * I


percent among eligible doctors of osteopathy.


Under 15 years ................................. 5,246 11.2 

15-24 years ...................................... 6,621 14.1 

25-44 years ................ ....................... 11,465 24.5 

FINDINGS	 45-64 years ...................................... 148795 31.6 

65 years and over ......................... .... 8,745 18.7 

When reference is made to an “overall” aver- — 

Sex

age or experience, it will refer to the characteristics of the 567.6 milIion visits made in 1975 to Female . .... .. . .... . .. ... .. .. .. .. ... ... .. . .... .. . .... . 27,551 58.8 

all physicians (M.D.’s and D. O.’s) within the Male ... .. .... .. .... . .. ... ... .... ... .... .. . .... . .. .... . 19,322 41.2 

Prior visit status 

New patient .. . .. ... . . ..... .. .. .. ... . ... .. . .... .. . 5,535 11.8 

Old patient, new problem .. ......==.... 11,251 24.0 

1This report prepared by Hugo Koch, Division of Old patient, old problem .... .. .. .. ... .. . .. 30,087 64.2 

Health Resources Utilization Statistics. 
2


0


status of patients. Total visits by females outnumbered visits by males in a ratio of 6 to 4, a 

finding that agrees closely with the overall ratio. 

Underscoring the generalist nature of their office 

practice, D.O.’S treated patients of all ages. An 

estimated 51 percent of visits, however, were 

made by patients over 44 years of age. In overall 

office-based” practice, about 42 percent of visits 

fell in this age category. The data on prior visit 

status show that few patients were visiting the 

osteopathic physician for the first time; about 

88 percent of visits were made by patients who 

had visited the office before. Not only did the 

D.O.’s office practice chiefly involve encounters 

with continuing patients, the largest proportion 

of visits (almost two-thirds) required the treatment of continuing problems as well. New problems were encountered in about 1 of every 3 

visits. For the average new problem presented to 

the D. O., there were roughly 1.8 return visits in 

the course of the year. 

Table 2 lists by rank the 15 most common 

patient problems, complaints, or symptoms that 

the osteopathic physician encountered in office 

practice. Symptoms and code numbers appear in 

a symptom classification developed for use in 

NAMCS.3 This information represents the reason for seeking care expressed as nearly as possible in the patient’s own words. The data offer 

distinct evidence of the functional specialization 

associated with osteopathic medicine. For 

example, in a substantial 17 percent of office 

visits, patients presented problems of the face or 

neck, the back, or the extremities. Back problems clearly exceeded all other patient complaints. The data also testify to the generalist 

nature of osteopathic office practice in that 

D.O.’S shared 11 of the 15 most common problems encountered in the overall 567.6 million 

visits. Further supportive of their generalist role 

is a marked diffuseness of clinical range, evident 

from the finding that, though a substantial 15 

most common problems are listed, they still 

account for only about one-half of all the D.O.’S 

3National Center for Health Statistics: The national 

ambulatory medical care survey: symptom classification, 

United States, by Sue Meads and Thomas McLemore. 

Vital and Health Statistics. Series 2-No. 63. DHEW Pub. 

No. (HRA) 741337. Health Resources Administration. 

Washington. U.S. Government Printing Office, May 

1974. 

Table 

Ran I 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

2.	 Number, percent, and cumulative percent of office visits to osteopathic physicians, by the 15 most common patient problems, 

complaints, or symptoms: United States, January-December 1975 

[Symptom titles and code numbers come from a symptom classification developed for usein the NAMCS] 

Number of Percent Cumulative 

15 most common patient problems, visits in of percen~ complaints, or symptoms thousands visits of visits 

Pain, swelling, injury of back region ............................................41 5 

Physical examination ........................................... ................ 900,901 

Fatigue ............................ ................ ........................................... 004 

Flu ......... ..................................................................................... 313 

Pain, swelling, injury of lower extremity .................................. . 400 

Weight gain ........................... .......................................................Ol O 

Pain, swelling, injury of upper extremity ................ ................... 405 

Sore throat ......... ........................................... ............................ 520 

Headache ............. ..................................................................... ..O56 

Pain, swelling, injury of face and neck region ............................ 410 

Abdominal pain ......................................................................... 540 

Visit for medication .................................................................... 910 

Cough ......................................................................................... 311 

Allergic skin reaction .......................................................... ........ 112 

Wounds of skin ............................... .............................................l 16 

I 

3,919 8.4 8.4 

2,080 4.4 12.8 

1,775 3.8 16.6 

1,680 3.6 20.2 

1,599 3.4 23.6 

1,442 3.1 26.7 

1,422 3.0” 29.7 

1,383 3.0 32.7 

1,221 2.6 35.3 

1,175 2.5 37.8 

1,153 2.5 40.3 

1,170 2.5 42.8 

1,140 2.4 45.2 

1,044 2.2 47.4 

911 1.9 49.3 Q 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

ackEdda3 

Table 3. Number and percent distribution of office visits to osteopathic physicians by principal diagnosis classified by major ICDA 

groups: United States, January-December 1975 

[Diagnostic groups and code number inclusions are based on the E@hth Revision International Classification of Diseases, Adapted for 

Use in the United States] 

Number 

Principal diagnosis classified by of visits Percent 

major ICDA groups in distribution 

thousands 

All principal diagnoses ... .. . .... .. .. .... .. . .... .. .. ... ... . ... .. .. ... .. .. .... . . ... ... .. ... .. . .... .. . 46,872 100.0 

Infective and parasitic diseases . .. .... .. .. ... .. . .... ... . ... .. .. ... .. ... ... . .. .... ... .... . ... ... . . 000-136 1,404 3.0 

Endocrine, nutritional, and metabolic diseases ..... .. .... ... . .... .. .. .. .. .. ... .. .. ... ...24 O.279 3,830 8.2 

Diseases of the blood and blood-forming organs . .... . .... .. .. ... .. .. ... ... . .... . .. .. .. ..28 O.289 820 1.8 

Mental disorders . . ..... . .. .... .. .. .... . .. ... .... . ... .. .. .... .. . ... ... . .... .. .. .... . .. ... .. .. .... .. .... ...29 O.3l5 1,529 3.3 

Diseases of the nervous system and sense organs .. ... . .... . .. .... . ... ... .. .. ... . .. ......320-389 2,057 4.4 

Diseases of the circulatory system .. .. . ... ... . .... .. . ... .. ... ... .. ... ... . .. ... .. .. .... .. . .....39O458 4,955 10.6 

Diseases of the respiratory system . .. ... ... .. .. ... . .. ..... . . .... ... .. .. .. .. .... .. .. .. .. .. .... . 460-519 8,238 17.6 

Diseases of the digestive system . .. .. .. .. .. .. .. .. .... .. .. .... .. .. .. .. .. .... .. .. .... .. . ... .. .. ... . 520-577 1,418 3.0 

Diseases of the genitourinary system ... . ... .. .. ... ... .... .. .. .... .. . .... .. . ..... . .. .. .. .. ... ..58O.629 3,122 6.7 

Diseases of the skin and subcutaneous tissue . .. .. ... . .. .. .. .. ... ... .. .. .. ... . .... . .. ... .. 680-709 1,861 4.0 

Diseases of the musculoskeletal system and connective tissue .. .. .. .. .... .. ......71 O-738 5,432 11.6 

Symptoms and ill-defined conditions .. . ... .. .. ... .. . .... .. .. .... .. .. .. .. .. .... .. . ... .. .. ... ..78O.796 1,147 2.5 

Accidents, poisonings, and violence .. .. .... .. .. ... . .. ... ... .. ... .. .. ... .. .. ... ... . .... . .. ... ..8OO.999 4,840 10.3 

Special conditions and examinations without sickness . .. .. .... .. . .... .. . .... .. .. ....YOO-Yl3 5,103 10.9 

Residual ... ... .. .. ..... . .. ... ... .. ... .. .. ... .. .. ... . .. .... .. .. ... .. . .... .. .. .... . . .... .. .. .... . . .... .. .. .... .. .. .. .. .. .... 1,116 2.1 

office visits. Problems presented to office-based Tables 3 and 4 present data on the diagnosis 

D.O.’S were about equally divided between the associated with each office visit to an osteoacute and the chronic, i.e., persisting problems pathic physician. Table 3 uses broad diagnostic 

with an onset of 3 months or more before the classes to express the D.O.’s total diagnostic 

current visit. Overall visit experience showed a effort. TabIe 4 offers more specific diagnostic 

dominance of acute problems (in 55 percent of information by listing the 15 diagnoses most 

visits) over chronic (in 45 percent). commonly rendered by the physician. Diagnosable 4. Number, percent, and cumulative	 percent of office visits to osteopathic physicians, by the 15 most common principal diagnoses 

rendered: United States, January-December 1975 

[ Diagnoses and codes are based on the Eighth Revision International Classif%ation of Diseases, Adapted for Use in the United States] 

= 

Number of Percent Cumulative 

Rank 15 most common principal diagnoses visits in of percent 

thousands visits of visits 

Essential benign hypertension .............. ................................... ..........4Ol 2,642 5.6 5.6 

Influenza, unqualified ............... ...................................................... 470 2,381 5.1 10.7 

Medical or special examination .... .................... .. ...... ........................YOO 2,163 4.6 15.3 

Arthritis ............... ............................................ .........................713-715 1,993 4.3 19.6 

Obesity not specified as of endocrine origin ............. ....................... 277 1,857 4.0 23.6 

Acute upper respiratory injection, multiple and unspecified sites ....465 1,630 3.5 27.1 

Other nonarticular rheumatism .................................................... .. 717 1,356 2.9 30.0 

Medical and surgical aftercare .......................... .................................Yl O 1,297 2.8 32.8 

Sprains and strains of sacroiliac region .......................... ........ ...........846 1,162 2.5 35.3 

Diabetes mellitus ..............................................................................250 1,151 2.5 37.8 

Other eczema and dermatitis ......................................... ....... ...... ......692 1,048 2.2 40.0 

Neuroses ................... .............................. .........................................3OO 973 2.1 42.1 

Sprains and strains of other and unspecified parts of back ................847 946 2.0 44.1 

Prophylactic inoculation and vaccination ........................................Y02 836 1.8 45.9 

Cystitis .................................................................. ..........................595 749 1.6 47.5 
tic groups and code number inclusions are based 

on the Eighth Revision International Classification of Diseases, Adapted for Use in the 

United States. 

The data in the tables are in relatively close 

agreement with the most common reasons for 

visits expressed by patients (table 2). The generalist nature of osteopathic office practice is 

evident from the range and diversity of the diagnoses that the D.O. rendered. It requires 14 

major diagnostic classes to express the breadth 

and variety of the D.O.’s clinical activity (table 

3). On the other hand, the functional specialization expected of the D.O. is evident in the 

finding that the 15 specific conditions most 

frequently diagnosed prominently include 

arthritic conditions, rheumatism, and sprains or 

strains of the back region (table 4). 

Table 5 shows that, as with all office-based 

physicians, the diagnostic procedures most 

favored in osteopathic office practice were the 

limited examination, blood pressure check, and 

laboratory test. The three therapeutic procedures that the D.O. most often ordered or provided were treatment by prescription drug, treatment by injection, and treatment by manipulative therapy. The D.O.’s reliance on drug 

4National Center for Health Statistics: Eighth Revz’­

sion 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. 

therapy–in 54 percent of visits–exceeded the 

overall average by 10 percent. Perhaps more 

noteworthy was the 34 percent of visits in which 

the D.O. used injection therapy–a usage that 

exceeded the overall average by 20 percent. 

Table 5 also presents data on the severity of 

patient problems. These data express the doctor’s judgment of the extent of impairment that 

might result if no care were available. Clearly, 

most osteopathic practice centered on the treatment of problems which ranged in severity from 

slightly serious to not serious. The D.O. agreed 

wit h the average office-based physician in 

judging only about 1 in 5 problems as serious or 

very serious in prognosis. 

Data on disposition (table 5) show that 

scheduled followup is the rule with office-based 

D.O. ‘s, as it is with all office-based practitioners. 

D.O.’s also shared the tendency of other generalist practitioners to provide most of the care 

that their patients required; less than 2 percent 

of visits to D.O.’s resulted in referral to another 

physician. Admission to the hospital was also a 

rare event in the D.O.’s office practice; it 

occurred in only 1 percent of visits. 

The duration of visit (the portion of an 

office visit that involves face-to-face contact 

between patient and doctor) was under 16 minutes for 2 out of 3 office visits to D. O.’s. 

A@eeing closely with the average for all officebased practitioners, the average face-to-face 

encounter between D.O. and patient was estimated at about 15 minutes in duration. 
adwmeda5 

Table 5. Number and percent of office visits to osteopathic physicians by services ordered or provided, seriousness of problem, disposition, and duration of visit: United States, January-December 1975 

Number 

Percent 

service ordered or provided, seriousness of problem, of visits 

of 

disposition, and duration of visit in 

visits thousands 

Service ordered or provided 

No service ........... ................................................ .................................................... 

Diagnostic service: 1 

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

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

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

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

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

EKG ... ................... .............. .................................... .......................................... 

Hearing and/or vision test .................... ...... .................................................... .... 

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

Therapeutic service: 1 

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

Injection .. .................................... ...................................................................... 

Immunization and/or desensitization ................................................................. 

Office surgew ....... .................... ................ ................................ ...... ...... ........ ...... 

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

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

Psychotherapy and/or therapeutic listening ....... ............................ .... ............... 

Other services ...... ...................... ............................................ .. ....... ......................... 

Seriousness of problem 

Sarious or very serious .... ...................... ............ ...... ................................ ............ ... 

Slightly serious ... .... ................................................ ................................................ 

Not serious ....... ........ .................................................................................... .......... 

Disposition (selected actions)l 

No follo~p ........................... ...... ................................ ........................................... 

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

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

Telephone followup ...... .............. .................. ................................ .................. .. ..... 

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

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

Duration of visit 

Less thanl minute (no face-to-fwe contact with physician) .................... ............. 

1-5 minutes ....... ...... ................ .......................... ........................... ......................... . 

6-10 minutes ........... ........ .............. .......................... ...... .. .................. .................. ... 

11-15 minutes ......................... ................................ ...... .................. .. ..................... 

16-30 minutes ................ .. ............ ................................................ .......................... 

31 minutes or more . ...... ........................................ .............. ...... ...... ........ ............... 

810 1.7 

21,603 46.1 

4,673 10.0 

6,358 13.6 

2,051 4.4 

14,761 31.5 

559 1.2 

952 2.1 

447 1.0 

25,217 53.8 

15,705 33.5 

799 1.7 

2,581 5.5 

4,954 10.6 

4,944 10.6 

3,580 7.6 

4,689 10.0 

8,791 18.8 

18,692 39.9 

19,388 41.4 

5,083 10.8 

24,593 52.5 

16,653 35.5 

1,326 2.8 

831 1.8 

491 1.1 

383 0.8 

6,680 14.3 

12,909 27.5 

12,028 25.7 

13,677 29.2 

1,196 2.5 

lSince more than one service and disposition were possible per visit, estimates will not add to total number of visits (46,872,000). 
6 A 

TECHNICAL NOTES 

SOURCE OF DATA: Data presented in this re- Table 1. Approximate relative standard errors of estimated numport were obtained during 1975 through the bers of office visits 

National Ambulatory Medical Care Survey 

(NAMCS). The target population of NAMCS en- Estimate Relative standard 

in error in compasses office visits within the conterminous thousands percentage points

United States made by ambulatory patients to


physicians who are principally engaged in office


practice. 500 .......................................... 30,1


1,000 ...................................... 21.4 SAMPLE DESIGN: The 1975 NAMCS utilized a 2,000 ....................................... 15.3 

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 

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 i 1. Approximate standard errors of percentages for estimated numbers of office visits 

Records (brief encounter 

random sample of office 

in their practice during 

period. (A facsimile of 

is shown in a previous 

From Vital and Health 

ber 12, 197 7.) Additional 

forms) for a systematic 

visits taking place withthe assigned reporting 

the Patient Record used 

issue of Advance Data 

Statistics, No. 12, Octodata concerning physiBase of percentage 

(number of visits 

in thousands) 

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


3,000 .....................


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


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


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


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


500,000 .................


Estimated percentage 

1or 5 or 10or 200r 30 or 50 99 95 90 80 70 

2,1 4.6 6.3 8.5 9.7 10.6 

1.2 2.7 3.7 4.9 5.6 6.1 

0.9 2.1 2.8 3.8 4.3 4.7 

0.7 1.5 2.0 2.7 3.1 3.3 

0,3 0.7 0.9 1.2 1.4 1.5 

0.2 0.5 0.6 0.8 1.0 1.1 T0.1 0.2 T0.3 0,4 0.4 0.5

cian 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 aggre -

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

an aggregate of 75,000,000 has a standard error of 1.2 percent. 

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

gate statistics are shown in table I. The standard


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.

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

------

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

admcecw7 

DEFINITIONS: An ambulatory patient is an individual presenting himself for personal health 

services who is neither bedridden nor currently 

admitted to any health care institution on the 

premises. 

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. 

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. 

SYMBOLS -

Data not available 

Category not applicable------------------------------- . . . 

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

Quantity more than Obut less than 0.05 0.0 

Figure does not meet standards of * reliability or precision 

Recent Issues of Aduunce Data From Vital and Health Statistics 

No. 24. Utilization of Selected Medical Practitioners: No. 21. Selected Findings of Dietary Food ConsumpUnited States, 1974 (In preparation) tion Profiles of Persons 1-74 Years of Age in 

the United States, 1971-74 (In preparation) 

No. 23.	 Office Visits to General Surgeons: National No. 20. Office Vkits to Obstetrician-Gy necologists: 

Ambulatory Medical Care Survey, United National Ambulatory Medical Care Survey, 

States, 1975 (In preparation) United States, 1975 (Issued March 13, 1978) 

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

National Ambulatory Medical Care Survey, 

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

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

Information Branch. 

GPO 92.T.z8T