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Previous Volume 341:1980-1985 December 23, 1999 Number 26 Next

	Full Text PDF Editorial by Grumbach, K. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Strategies to control medical costs and improve the quality of care often translate into decisions affecting the range of services primary care physicians provide to patients, which patients are referred for specialty care, and the points in disease processes at which referrals are made. This study focused on physicians' assessments of changes in the scope of care provided by primary care physicians and their assessments of the appropriateness of the scope of the care that primary care physicians are expected to provide.

Methods We analyzed data from the 1996–1997 Community Tracking Study Physician Survey. Telephone interviews were conducted with 12,385 physicians (reflecting a response rate of 65 percent) who were drawn from a representative random sample of physicians providing direct patient care in the continental United States and not employed by the federal government. The analysis was based on responses from the 7015 primary care physicians and 5092 specialists who had been in practice for at least two years.

Results Thirty percent of the primary care physicians and 50 percent of the specialists reported that the scope of care provided by primary care physicians had increased during the previous two years. Twenty-four percent of the primary care physicians and 38 percent of the specialists reported that the scope of care expected to be provided by primary care physicians was greater than it should be. According to multivariate analysis, primary care physicians other than general or family practitioners (i.e., pediatricians and general internists), those who were in one- or two-physician practices, those who received revenues from capitation, and those who served as gatekeepers for their patients' care were significantly more likely to report that the scope of care they were expected to provide was greater than it should be.

Conclusions The finding that nearly one in four primary care physicians reported that the scope of care they were expected to provide was greater than it should be arouses concern about the potential impact of changes in the delivery of health care. The associations we found between financial and administrative aspects of managed care and physicians' concern about the scope of care they provide to their patients deserve careful consideration.

Source Information

From the Kansas Health Institute, Topeka (R.F.S.); the Center for Studying Health System Change, Washington, D.C. (M.C.R., P.K.); and the Institute for Health Policy, Massachusetts General Hospital–Partners HealthCare System and the Departments of Medicine and Health Care Policy, Harvard Medical School, Boston (D.B.).

Address reprint requests to Dr. St. Peter at Kansas Health Institute, 100 S.E. Ninth St., Third Fl., Topeka, KS 66612-1212, or at rstpeter{at}khi.org.

Full Text of this Article

Related Letters:

The Scope of Practice in Primary Care
Buxeda M., Shepard M. A., Hensel W. A., St. Peter R. F., Reed M. C., Kemper P., Grumbach K.
Extract | Full Text  
N Engl J Med 2000; 342:1453-1454, May 11, 2000. Correspondence

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