Practice style differences between family physicians and internists

Because an estimated 70 percent of all medical care expenditures are generated by physicians, evaluation of specialty practice styles is essential to learn what changes in policies governing physician training, service delivery, and patterns of medical practice would promote cost containment.

We examined the 1981 and 1985 National Ambulatory Medical Care Survey for seven primary care diagnoses to compare practice style differences between family physicians and internists and to look for changes in family physicians' practice styles between 1981 and 1985.

Family physicians referred fewer patients in 1985 and spent 3 to 10.5 minutes less per patient encounter than internists. Clinical laboratory testing, electrocardiogram (ECG) ordering, and radiographic examinations differed significantly between the two groups in 1981 and 1985 for some diagnoses. In 1981, family physicians did Papanicolaou smears 2.2 times more often than internists during general medical examinations; however, in 1985, there was no difference. Between 1981 and 1985, family physicians ordered significantly more laboratory tests and ECGs for some diagnoses but had no change in the number of radiographs ordered or referrals. For six diagnoses, they spent more time with a patient encounter in 1985 than in 1981.

Family physicians and internists appear to be more alike in practice style, but significant differences remain. These differences, as well as changing practice styles of family physicians, have implications for training and health care resource distribution.