Changes in primary medical care delivery, 1975-1979: findings from the physician capacity utilization surveys

Data from two national telephone surveys of office-based primary care physicians are used to examine changes in patterns of care delivery between 1975 and 1979 in metropolitan and nonmetropolitan areas. Aspects of care delivery considered include physician availability, average physician workload, qualitative attributes of the care delivered, physicians' policies toward acceptance of new patients and fees. Physician availability relative to population increased in metropolitan areas but was unchanged in nonmetropolitan areas. The average number of office visits provided per week declined for physicians in all areas, offsetting to some extent the increase in physician availability; average weekly office visit rates declined most in nonmetropolitan areas. Most of the indicators of the qualitative attributes of care examined suggest that access to primary care physicians increased in both metropolitan and nonmetropolitan areas, though not substantially. Fees increased in real terms in all areas. Relatively fewer physicians were refusing to accept new patients in 1979 than in 1975. The possibility that specialists are providing more primary care in nonmetropolitan areas is considered as a possible explanation for the improvement in qualitative attributes of care delivered by primary care physicians in nonmetropolitan areas despite the decline in per capita office visits provided by primary care physicians in those areas.