Blog | Wednesday, September 8, 2010

QD: News Every Day--Primary care doctors see fewer acute-care patients


Only 42% of acute care visits are to primary care doctors, reports Health Affairs.

Americans made 1.09 billion outpatient visits each year from 2001 to 2004, (321 visits per 1,000 people per month) with slightly more than a third of the 354 million visits per year for primary care. General and family practitioners managed 22%; general internists, 10%; pediatricians, 13%; subspecialists, 20%; hospital outpatient departments, 7%; and emergency departments, 28%.

Emergency departments most frequently saw patients for stomach and abdominal pain, chest pain and fever. General practitioners more frequently saw coughs and other throat-related symptoms. Specialists saw patients for vision problems, knees and other joints such as the hands/fingers or shoulders, and for stomach problems.

More than 95% of office-based visits occurred on weekdays, as did 89% to hospital outpatient departments. But in the emergency department, 30% of visits occurred on weekends and 37% on weekdays after office hours.

Researchers pointed out that two-thirds of ambulatory visits are for nonacute care, much less than in the past. Hectic s schedules make same-day access difficult, and patient volume means primary care doctors are prone to steer more patients toward specialists.

While health care reform is encouraging the development of the patient-centered medical home, the definition of one does not mandate same-day scheduling, evening or weekend availability, or a timeframe to return after-hours phone calls. Other emerging models such as accountable care organizations and retail clinics remain to be evaluated.

More likely to have an impact on reducing emergency department use are adding 15,000 new providers to federally qualified community health centers, as well as higher reimbursement for primary care.

Hiring and pay comparisons
Physician recruiters The Delta Company released quarterly data showing that internal medicine placements receive higher overall compensation than hospitalists, despite a slightly lower starting salary. For internal medicine hires, average starting compensation was $197,636, sign on bonus was $22,241 and total annual compensation was $265,545. For hospitalists, the figures were $199,666, $15,909 and $256,133. "Total annual compensation" data reflects average yearly compensation at full production excluding benefits.