Ambulatory Medical Care: A Comparison of Internists and Family-General Practitioners

We analyzed data from the National Ambulatory Medical Care Survey to compare the style of practice of two primary-care providers, general internists and family-general practitioners. Whereas internists spent 18.4 minutes with the average patient, family-general practitioners spent 13.0 minutes. Whereas internists used laboratory tests in 73 per cent of visits and x-ray tests in 53 per cent, family-general practitioners used these studies in 34 and 19 per cent of visits. Internists provided instructions regarding health problems in 17.8 per cent of visits, and family-general practitioners in 12.4 per cent. The two provider groups did not differ in terms of therapy for emotional problems, both providing it in a relatively low proportion of visits (3 per cent). Whether by choice or necessity, family-general practitioners spent less time examining and instructing patients, and they ordered fewer laboratory and x-ray studies. The implications of these differences for the cost and quality of primary care need further study. (N Engl J Med 302:11–16, 1980) PATIENTS encounter ambulatory-care services with greater frequency than any other component of the health-care delivery system. The average patient visits a physician as an outpatient three to five times yearly. 1 , 2 Yet, in spite of the magnitude of this phase of medical care, data on the nature of ambulatory care are very limited. In April, 1973, the National Center for Health Statistics initiated the National Ambulatory Medical Care Survey (NAMCS), an ongoing study intended "to provide statistically valid data on the public's use of ambulatory medical care services in physicians' offices." 3 We compare ambulatory-care services provided by general internists (excluding subspecialists) . . .