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A National Study of Internal Medicine and Its Specialties: II. Primary Care in Internal Medicine
- ROBERT C. MENDENHALL, M.S.;
- ALVIN R. TARLOV, M.D.;
- ROGER A. GIRARD, Ph.D.;
- JANET K. MICHEL, M.S.; and
- STEPHEN E. RADECKI, M.A.
Abstract
A nationwide study of practitioners in 24 medical and surgical specialties was conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. In this second report of a series presenting findings for internal medicine, general internal medicine and 10 subspecialties of internal medicine are compared using a care classification scheme designed for the study. On the basis of characteristics of the individual patient encounter, this care classification scheme distinguishes several dimensions associated with the concept of primary care. Five empirically derived types of care rather than a simple "primary" or "non-primary" dichotomy are described, and the distributions of each type for the 11 subspecialties examined are noted. Types of care (according to the care classification) are examined by the time per patient, the complexity of physician services, the severity and chronicity of problems, and the degree of specialization associated with providing different types of care. Estimates of the number of annual encounters, and the number of annual encounters for three of the five types of care, with the proportion of each accounted for by each subspecialty, are given.
Article and Author Information
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▸From the Division of Research in Medical Education, University of Southern California School of Medicine, Los Angeles, California; and the Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
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The study's advisors during the pilot-testing years (1973 to 1975) who made conceptual, substantive, and analytical contributions were William D. Holden, M.D., Case Western Reserve University, Cleveland; Philip R. Lee, M.D., University of California, San Francisco; Edward C. Rosenow, Jr, M.D., American College of Physicians, Philadelphia; C. H. William Ruhe, M.D., American Medical Association, Chicago; and Vernon E. Wilson, M.D., Vanderbilt University, Nashville.
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The following personnel from the sponsoring agencies made important contributions to the care classification algorithm: Linda H. Aiken, Ph.D., and Robert J. Blendon, Sc.D., of The Robert Wood Johnson Foundation, Princeton, New Jersey; and Robert F. Knouss, M.D., and Daniel N. Masica, M.D., of the Bureau of Health Manpower, Hyattsville, Maryland.
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The following project staff members assisted in this study: John S. Lloyd, Ph.D., study design; George P. De Florio, M.P.H., coordinator of analysis; Beverly Schlimme, reports coordinator; Martin Massoglia, programmer; Angela Crew, typist.
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Grant support: Grant 2050 from The Robert Wood Johnson Foundation, and contracts 231-75-0616, 231-77-0115, and 232-78-0160 from the Department of Health, Education, and Welfare, Health Resources Administration, Division of Medicine.
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▸Requests for reprints should be addressed to Robert C. Mendenhall; University of Southern California School of Medicine, Division of Research in Medical Education; 210 Keith Administration Building, 2025 Zonal Avenue; Los Angeles, CA 90033.
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- Received May 14, 1979.
- Accepted June 11, 1979.
- © 1979 American College of Physicians
