Ambulatory Medical Care

Abstract

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.

Differences Between Internists and Family Practitioners in the Diagnosis and Management of the Same Patient With Coronary Heart Disease

“…Family practitioners included CHD in their differential diagnosis, but were significantly more likely to rank a psychosocial cause above CHD, express more certainty with that formulation, and recommend psychosocial and behavioral interventions. These findings are consistent with those from other studies (Cherkin et al, 1987; Noren et al, 1980; Smith & McWhinney, 1975) and are likely driven by the differing levels of certainty on the primary diagnosis of CHD (Lutfey, Link, Grant, Marceau, & McKinlay, 2009). …”

“…That variations may also occur within a medical specialty, for example between general internists and family practitioners within primary care, has received little attention. What occurs at the level of primary care is important for several reasons; a) it is the gateway to the healthcare system, crucially determining the course of many diseases, costs and patient outcomes; b) it is where the vast majority of illness in society is presented and cared for; c) it may be the point of origin for the generation and amplification of many reported disease disparities; (McKinlay et al, 2007; McKinlay, Potter, & Feldman, 1996) and d) it may also be the point of origin for ever increasing costs of health care, given the suggestion that the most expensive piece of medical technology may be a physicians’ pen (Gawande, 2009; Noren, Frazier, Althman, & DeLozier, 1980). …”

“…Internists reportedly perform more detailed physical examinations and order more laboratory tests which contributes to-increasing health care costs, although it has been suggested internists may also encounter sicker patients with more complicated medical problems (Conry, Pace, & Main, 1991; Kravitz et al, 1992). Family practitioners appear to ask more questions concerning a patient’s emotional status and life situation (Cherkin et al, 1987; Noren et al, 1980; Smith & McWhinney, 1975). …”

Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study

“…Despite the limited literature on PCP-related variation in screening, the existing evidence about differing quality of preventive health care among PCPs [15-18] suggests that similar differences in quality of CRC screening may contribute to underuse of screening in some populations. One study, which included analyses on CRC testing by PCP specialty, found that patients receiving their usual routine care from family/general practitioners were less likely to have had CRC testing than those receiving care from a general internists [18].…”