September 1986

Division of Physician-Provider Time Between Ambulatory and In-Bed Patients in the Various Medical Specialties

Author Affiliations

San Francisco

Arch Intern Med. 1986;146(9):1859. doi:10.1001/archinte.1986.00360210257047

To the Editor.  —Dr Leibowitz's graphic presentation of "one physician's appraisal" of specialist time in ambulatory and inpatient settings "may assist others... in seeing the basic differences in the actual site for care of patients under existing, traditional patterns."1 He calls attention to the movement of patient care to the ambulatory setting, a trend which has accelerated recently under the prospective payment system and more competitive health care marketplace. Such a depiction may be useful in discussing a variety of topics including undergraduate medical education reform, graduate medical education financing, and physician reimbursement reform. However, his presentation is entirely subjective and bears closer scrutiny before it is accepted verbatim.For example, he suggests that anesthesiologists spend only 1% of their time with ambulatory patients. In fact, in 1982 and 1984, 11% and 14%, respectively, of anesthesiologists' total professional time was spent in the ambulatory setting (Committee on Manpower, American

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