NCHS Data Brief ■ No. 105 ■ September 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Generalist and Specialty Physicians: Supply and Access, 

2009–2010

Esther Hing, M.P.H., and Susan M. Schappert, M.A.

Key findings

Data from the National 

Ambulatory Medical Care 

Survey

•	 In 2009–2010, annual 

visits per generalist physician 

were 30% higher than visits 

per specialty physician. A 

similar pattern was observed in 

1999–2000. 

•	 In 2009–2010, generalist 

physicians were less likely to 

accept new Medicaid patients 

(65%) than were specialty 

physicians (71%).

•	 A greater percentage of 

generalist physicians (70%) 

than specialty physicians (61%) 

spent 31 hours or more per 

week providing direct patient 

care in 2009–2010.

•	 In 2009–2010, a greater 

percentage of generalist 

physicians (40%) worked 

evening and weekend hours 

than did specialty physicians 

(19%).

•	 Generalist physicians were 

more likely to set aside time 

for same-day appointments 

(82%) compared with 

specialty physicians (49%) in 

2009–2010.

As the overall population ages, policy makers are focusing on the current 

and growing shortage of the primary care workforce (1–3), particularly as 

provisions of the 2010 Patient Protection and Affordable Care Act (PPACA) 

expand health insurance coverage. This report presents selected trends in 

physician shortage measures and access to care measures for generalist 

physicians and specialists. Generalists are those in the specialties of family 

practice, general practice, internal medicine, and pediatrics, whereas 

specialists comprise all other specialties. Estimates are based on physicians 

who participated in the National Ambulatory Medical Care Survey (NAMCS) 

by providing data on visits. 

Keywords: National Ambulatory Medical Care Survey • office-based physicians

The number of specialty physicians was significantly larger 

than the number of generalists, but the number of visits to 

both types of physicians was about the same, resulting in 

higher annual visits per generalist than per specialist.

Figure 1. Number of physicians per population, annual visit rate per population, and annual visits 

per physician, by specialty: United States, 1999–2000 and 2009–2010 

1

Difference between generalist and specialist rates is statistically significant (p < 0.05) in each 2-year time period.

2

Trend is statistically significant (p < 0.05).

NOTE: Generalist physicians include family and general practitioners, internists, and pediatricians; specialty physicians include all

other specialties.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey.

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000

2009–2010

1999–2000

Annual visits per

specialty physician2

Annual visits per

generalist physician1

Annual rate of visits to specialist

physicians per 1,000 population2

Annual rate of visits to generalist

physicians per 1,000 population

Number of specialist physicians

per 1 million population

Number of generalist physicians

per 1 million population1

441

472

613

636

1,480

1,663

1,415

1,719

3,357

3,521

2,307

2,704
NCHS Data Brief ■ No. 105 ■ September 2012

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•	 In 2009–2010, the supply of generalist physicians per capita (472 per 1 million population) 

was 26% lower than the supply of specialty physicians (636 per 1 million population). This 

pattern was also observed in 1999–2000, when the per capita supply of generalists was 28% 

lower than the supply of specialists (Figure 1). 

•	 The per capita supply of generalist and specialty physicians did not change significantly

between 1999–2000 and 2009–2010. 

•	 The annual rate of visits per 1,000 population to generalists was not statistically different 

from the corresponding rate of visits to specialists in either time period. However, annual 

visits per 1,000 population to specialty physicians increased 21% from 1,415 in 1999–2000 

to 1,719 in 2009–2010. 

•	 In 2009–2010, the annual visit load for generalist physicians (3,521) was 30% higher than 

the annual visit load for specialty physicians (2,704). A similar pattern was observed in 

1999–2000, when the generalist visit load (3,357) was 46% higher than for specialists 

(2,307). Over the same period, the visit load increased significantly for specialists but not

for generalists.
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Generalist and specialty physicians differed in their acceptance of new 

patients.

•	 Between 1999–2000 and 2009–2010, no significant change was observed in the percentages

of generalist physicians who said they would accept new patients with private insurance, 

Medicare, Medicaid, or self-payment (Figure 2). 

•	 Between 1999–2000 and 2009–2010, the percentage of specialty physicians accepting new 

Medicaid patients declined 9% (from 78% to 71%); specialists accepting new Medicare 

patients declined 3% (from 93% to 90%); those accepting new private insurance patients 

declined 4% (from 94% to 90%); and those accepting new self-pay patients declined 2% 

(from 96% to 94%).

•	 In both 1999–2000 and 2009–2010, generalist physicians were less likely to accept new 

Medicare patients and Medicaid patients than were specialty physicians.

Figure 2. Percentage of physicians accepting new patients, by type of insurance and physician specialty: United States, 

1999–2000 and 2009–2010 

1

1999–2000 difference between generalist and specialty physicians is statistically significant (p < 0.05). 2

2009–2010 difference between generalist and specialty physicians is statistically significant (p < 0.05). 3

Trend is statistically significant (p < 0.05). 

NOTE: Generalist physicians include family and general practitioners, internists, and pediatricians; specialty physicians include all other specialties. 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey.

0 20 40

Percent of physicians Percent of physicians

8060 100

2009–2010

Generalist physicians Specialty physicians 1999–2000

Self-pay1,2

Private

insurance1

Medicare1,2

Medicaid1,2

0 20 40 60 80 100

Self-pay3

Private

insurance3

Medicare3

Medicaid3

69

65

75

73

88

89

87

89

96

94

90

94

93

90

78

71
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In 2009–2010, generalists spent more time providing direct patient care 

and were more likely than specialists to see patients during evening and 

weekend hours. 

•	 In 2009–2010, a greater percentage of generalist physicians (70%) spent 31 hours or more 

per week providing direct patient care than did specialty physicians (61%) (Figure 3). 

•	 A greater percentage of generalist physicians worked evening and weekend hours (40%) 

than did specialty physicians (19%) in 2009–2010. 

Figure 3. Percentage of physicians providing direct patient care 31 hours or more per week, and percentage working 

evening and weekend hours, by specialty: United States, 2009–2010 

NOTES: All differences between generalist and specialty physicians are statistically significant (p < 0.05). Generalist physicians include family and general 

practitioners, internists, and pediatricians; specialty physicians include all other specialties.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey. Percent of physicians

Generalist physician Specialty physician

0

20

40

60

80

Provides direct patient care 31 hours Works evening or weekend hours

or more per week

70

61

40

19
NCHS Data Brief ■ No. 105 ■ September 2012

■  5  ■

In 2009–2010, generalist physicians had shorter wait times for an 

appointment and were more likely to set aside time for same-day 

appointments compared with specialty physicians.

•	 A greater percentage of generalist (55%) than specialty (43%) physicians reported that 

patients waited less than a week to get an appointment for a routine medical examination 

(Figure 4). 

•	 In 2009–2010, generalist physicians were more likely to set aside time for same-day 

appointments (82%) than were specialty physicians (49%). 

•	 Generalist physicians reported a higher percentage of same-day appointments among their 

daily visits (27%) than did specialty physicians (7%). 

Figure 4. Percentage of physicians by time to get an appointment, whether practice sets aside time for same-day 

appointments, and percentage of same-day appointments, by specialty: United States, 2009–2010 

1

Excludes physicians who did not provide routine medical examinations (14% of specialty physicians).

NOTES: All differences between generalist and specialty physicians are statistically significant (p < 0.05). Generalist physicians include family and general

practitioners, internists, and pediatricians; specialty physicians include all other specialties. 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey. Percent of physicians

Generalist physician Specialty physician

55

43

82

49

27

7

0

20

40

60

80

100

Percent of same-day 

appointments among

daily visits

In practice that sets aside time

for same-day appointments

Less than 1 week to get

appointment for routine 

medical exam1
NCHS Data Brief ■ No. 105 ■ September 2012

■  6  ■

Summary

In 2009–2010, the per capita supply of generalist physicians was lower than that of specialty 

physicians. At the same time, the annual volume of visits per generalist physician exceeded 

the corresponding volume per specialty physician by 30%. Both patterns were also noted in 

1999–2000. The larger volume of visits to generalist physicians occurred at the same time 

that generalists reported a lower likelihood of accepting new Medicare and Medicaid patients 

compared with specialty physicians. Previous research found that cuts in Medicaid physician fees 

led to statistically significant reductions in the number of visits for Medicaid patients compared 

with privately insured patients (4). Medicaid and Medicare reimbursement rates may have been 

associated with the 9% and 3% declines in percentages of specialty physicians accepting new 

Medicaid and Medicare patients, respectively, between 1999–2000 and 2009–2010 (5). 

Although generalist physicians’ annual visit loads were higher compared with specialty 

physicians, access to generalist care in 2009–2010 was more available than access to specialty 

care by several measures. Generalist physicians were more likely than specialty physicians to 

spend more hours per week providing direct patient care; treat patients in their offices during 

evening and weekend hours; report shorter waiting periods for patients to get an appointment for 

a routine medical examination; and have practices that set aside time for same-day appointments. 

Further research is needed to monitor the supply of generalist physicians, particularly at state and 

local levels (6).

Data sources and methods

All estimates are from NAMCS, an annual, nationally representative survey of visits to 

nonfederal office-based physicians, excluding pathologists, anesthesiologists, and radiologists. 

The sampling frames for the 2009 and 2010 NAMCS were constructed from master files of the 

American Medical Association (AMA) and the American Osteopathic Association (AOA); the 

sampling frame for community health centers was obtained from the federal Health Resources 

and Services Administration. The average 2009–2010 response rate was 60% (unweighted). More 

details about NAMCS methodology are available elsewhere (7). 

The physician estimates presented in this report reflect physicians who participated in NAMCS 

by providing data on a sample of their office visits. Note that NAMCS physician estimates (8–10) 

are lower than comparable AMA–AOA estimates because each year, about one-third of the 

NAMCS physician sample is found to be out of scope when contacted by interviewers (7).

Data for sampled physicians were collected during an induction interview. In cases where 

physicians worked at multiple offices, whether the physician worked evening or weekend hours 

was reported for the office where most visits occurred. Estimates for 2009–2010 exclude missing 

data for the following items: 

• For new patients, which types of payment do you accept: private insurance (6.3%), 

Medicare (3.7%), Medicaid (2.9%), or self-pay (3.0%)?

• Do you see patients in the office during the evening or on weekends? (1.4%)

• Does your practice set aside time for same-day appointments? (3.5%)
NCHS Data Brief ■ No. 105 ■ September 2012

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• What is the percentage of daily visits that are same-day appointments? (1.4%)

• On average, about how long does it take to get an appointment for a routine medical exam? 

(1.1%)

• What hours were spent providing direct patient care during the last full week of practice? 

(3.4%)

Note that time spent providing direct patient care does not include time spent doing administrative 

and nonclinical activities. Estimates for 1999–2000 exclude missing data for the following items: 

For new patients, which types of payment do you accept: private insurance (1.8%), Medicare 

(2.1%), Medicaid (3.0%), or self-pay (2.0%)? 

Data analyses were performed using the statistical packages SAS version 9.2 (SAS Institute, Cary, 

N.C.) and SUDAAN version 9.0 (RTI International, Research Triangle Park, N.C.). Differences in 

practice characteristics were examined using t tests for differences at the p = 0.05 level. 

About the authors

Esther Hing and Susan Schappert are with the Centers for Disease Control and Prevention’s 

National Center for Health Statistics, Division of Health Care Statistics. 

References

1. Carrier E, Yee T, Stark LB. Matching supply to demand: Addressing the U.S. primary care 

workforce shortage. Policy Analysis No. 7. Washington, DC: National Institute for Health Care 

Reform, Center for Studying Health System Change. 2011.

2. Colwill JM, Cultice JM, Kruse RL. Will generalist physician supply meet demands of an 

increasing and aging population? Health Affairs 27(3):w232–41. 2008.

3. Staiger DO, Auerbach DI, Buerhaus PI. Comparison of physician workforce estimates and 

supply projections. JAMA 302(15):1674–80. 2009.

4. Decker SL. Changes in Medicaid physician fees and patterns of ambulatory care. Inquiry 

46(3):291–304. 2009.

5. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy. 

2010. 

6. Cunningham PJ. State variation in primary care physician supply: Implications for health 

reform Medicaid expansions. Research Brief No. 19. Washington, DC: Center for Studying 

Health System Change. 2011.

7. National Center for Health Statistics. 2005–2010 NAMCS physician trend file 

documentation. Public use data file documentation. Available from: ftp://ftp.cdc.gov/pub/Health_

Statistics/NCHS/Dataset_Documentation/NAMCS/namphydoc0510.pdf.

8. Burt CW, Schappert SM. Ambulatory care visits to physician offices, hospital outpatient 

departments, and emergency departments: United States, 1999–2000. National Center for Health 

Statistics. Vital Health Stat 13(157). 2004.
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9. Hing E, Burt CW. Characteristics of office-based physicians and their 

practices: United States, 2003–04. National Center for Health Statistics. Vital 

Health Stat 13(164). 2007.

10. Hing E, Burt CW. Characteristics of office-based physicians and their 

practices: United States, 2005–2006. National Center for Health Statistics. 

Vital Health Stat 13(166). 2008.

Suggested citation

Hing E, Schappert SM. Generalist and 

specialty physicians: Supply and access, 

2009–2010. NCHS data brief, no 105. 

Hyattsville, MD: National Center for Health 

Statistics. 2012.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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