Robert C. Mendenhall

Effect of Patient Age on Duration of Medical Encounters With Physicians

The authors analyzed the USC/DRME Practice Study data to determine if the characteristics of physician patient encounters change with patient age. The only significant change observed was a decline in encounter time for patients 65 years of age and older compared with those 45 through 64 years of age. This decrease was significant for raw data and for data weighted for the number of physicians of various types and standardized for complexity of case mix in various age groups, also for both nonhospital and hospital encounters and for almost all classes of encounters. Three types of generalists and four types of medical subspecialists were studied; encounter times for all types were, for patients 65 and older, either the same as or less than those for patients 45 through 64. The observed phenomenon may reflect a conscious decision on the part of some physicians to allot less time to elderly patients.

Patient counseling by primary care physicians: Results of a nationwide survey.

The rate of patient counseling in primary care medicine is a pivotal element of inter-specialty differences in styles of care. Using national data on patient care provided in both ambulatory care settings and in the hospital, this study examines the use of counseling by general and family practitioners, pediatricians, internists, and obstetrician/gynecologists. The findings show substantial differences based on physician specialty, with highest rates of counseling for family practitioners and internists, and rates of patient education for these two specialties almost three times that for general practitioners. The data also show generally higher counseling rates for hospital care and for first encounters with patients, and a tendency for office-based pediatricians and solo general practitioners to use less patient counseling compared to their institution-based counterparts. Projections of annual visit rates for the United States show that general practice and internal medicine account for a disproportionate amount of patient counseling compared to other primary care specialties, based on patient volume.

Assessing the Utilization and Productivity of Nurse Practitioners and Physician's Assistants: Methodology and Findings on Productivity

This article describes the research design, survey instrument and methodology employed in a national study to assess the utilization and productivity of nurse practitioners and physician assistants (NP/PAs) in primary care settings. All practices (N = 455) used in the study employed formally trained NP/PAs who treated, or were eligible to treat, Medicare patients on an outpatient basis, and included a general practitioner, family practitioner or a general internist as the supervising physician. A matched group of comparison practices were subject to the same eligibility criteria except that they did not employ NP/PAs. A comprehensive diary-type instrument focusing on patient care was used to collect detailed data on each practitioner’s daily professional activities. Data are presented on the productivity of NPs, PAs and physicians as measured by seven basic variables related to patient volume, time in patient care and revenue generated. Numerous inter-and intraspecialty comparisons were made across various practice arrangements and across location variables such as rural vs. urban, remote vs. nonremote, and health care resource areas. Interpretations of the data indicate clearly that PAs are considerably more productive than NPs. However, although NPs spend more time with individual patients, the cause of this differential productivity was not revealed.

Manpower for obstetrics-gynecology

Abstract A cooperative study between the University of Southern California Division of Research in Medical Education and the American College of Obstetricians and Gynecologists represents one subset of a large-scale study of manpower supply in obstetrics-gynecology. A stratified random sample of all obstetrician-gynecologists was obtained from the American Medical Associations “Master File of Physicians.” A total of 879 respondents (56 per cent of the sample) completed a detailed, one-week log of practice activities and a self-descriptive questionnaire. This initial report describes these physicians by practice arrangement as related to age and geography. Practice work load is identified by encounter time per patient, work hours per day and week, and variations related to geographic location and population served. The descriptive findings may have important implications for manpower planning.

Manpower for obstetrics and gynecology: II. Characteristics of patients; their diagnoses and care

A further report from the cooperative manpower study of the University of Southern California American College of Obstetricians and Gynecologists has identified characteristics of patients and their diagnoses and classified types of patient-physician encounters. Obstetrician-gynecologists care for women mainly between the ages of 20 and 44, deal two thirds of the time with only five diagnostic categories in the office and 10 in the hospital, and provide primary care in 78.2% of all patient encounters.

Neurosurgery in the United States: a log-diary study

The Division of Research in Medical Education and of the University of Southern California, with the cooperation and assistance of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, has conducted a national study of the professional activities of neurological surgeons in the United States. One of a series of 24 surveys of medical and surgical specialties, the survey obtained information on patient workloads, the allocation of physician time, the characteristics of patients and the circumstances under which they were seen, patient diagnoses, and the care that was provided--including whether an operation was performed. This paper provides a selection of the findings deemed most relevant to manpower issues in neurosurgery. A later paper will examine regional differences in patient care, including the frequency with which selected surgical procedures are used for different clinical conditions.

Manpower for obstetrics-gynecology: III. Contributions to total female medical care☆

This final report from the cooperative manpower study of the University of Southern California and The American College of Obstetricians and Gynecologists describes the development of a female data file that outlines the care of women patients by all specialties. Obstetrician-gynecologists are compared to other specialists; they see 300,000 women per day in the United States and provide a wide range of care. Preventive care plays a larger role than in other major specialties, patient counseling and education are emphasized, and obstetric care is a major commitment. Nonetheless, acute and serious surgical and medical diagnoses are an important component of the practices of obstetrician-gynecologists.

The professional role of physician's assistants in adult ambulatory care practices.

This article describes the methodology and findings of a national survey of Physicians Assistants (PAs) in adult, ambulatory care practices. Data on patient care roles and other professional activities were collected for a three-day period via a comprehensive self-reporting, log-diary instrument. Completing the instrument were 356 (50.4%o) PAs. Survey results address thefollowing questions: What is the typical work week for PAs? How do PAs allocate their time in a professional day? What direct patient care services do PAs provide? How productive are PAs with respect to number of patients seen and dollar income generated? In general, the data are consistent with the PA role model of a primary health care professional who provides basic health care services with an emphasis on patient counseling and disease prevention.

AN ASSESSMENT OF THE CONTENT OF MEDICAL PRACTICE IN THE UNITED STATES: PROFILES OF PHYSICIANS IN FIVE SPECIALITIES

ABSTRACT The University of Southern California has conducted a series of 24 surveys of the professional activities of physicians and surgeons in the United States. The surveys encompass more than 10,000 respondents representing 65.8% of all practising physicians in the United States and its territories. Using a specially‐developed “log‐diary” recording instrument, these physicians reported data on the care they provided during hundreds of thousands of encounters with their patients. This article provides an exposition of the studys unique methodology, presents illustratative data for 5 of the 24 specialities surveyed (cardiology, family practice, general internal medicine, orthopaedic surgery and psychiatry), and discusses the studys relevance and implications for medical education.

Development of the study

Abstract This study provides, for the first time, data that furnish an estimate of present and future manpower needs for cardiologists in the fields of patient care, teaching and research within the United States. The data collected provide a description of the current practice of cardiology and identify deficiencies in existing training programs in cardiology. Further, this study projects the future activities of cardiologists, and thus will aid in planning training and experience for them. The data collected should be of value to individuals, hospitals, universities, governmental agencies and voluntary health agencies that are concerned with providing administrative, financial and educational support for training programs in cardiology and that require cardiologists for patient care, teaching and research activities.