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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.

RECENTLY I had occasion to use the sta¬ tistics published by the Public Health Service in its Health Manpower Source Book series. In the course of examining these data I gained the impression that over the past 20 years or so changes among the several States in relative supply of physicians followed some fairly definite geographic patterns. The find¬ ings on more intensive investigation are the sub¬ ject of this note. The data to be covered in this analysis are taken from the 1st and 10th sections of the Health Manpower Source Book {1$). The Public Health Service obtained the initial infor¬ mation about each physician in the country from pertinent editions of the American Med¬ ical Directory and, for 1959, from punchcards supplied by the American Medical Association. This presentation is based on all physicians in the United States classified in the Health Man¬ power Source Book as "active non-Federal," exclusive of those in Alaska, Hawaii, and the District of Columbia. "Active" refers to physi¬ cians engaged in some kind of medical practice, including hospital service, teaching, and ad¬ ministration. Physicians classified as Federal employees include medical officers on active duty with the Army, Navy, Air Force, Public Health Service, and Veterans Administration; these physicians are excluded from the study. The trends to be examined are those between 1940 and 1959. Since some interesting shifts occurred in the fifties as compared with those Dr. Altman is professor of medical care statistics9 Graduate