General internists and other generalist physicians have traditionally cared for their patients both in the clinic and in the hospital. Over the past decade, hospitalists have been highlighted as undermining the role of generalist physicians in hospital care, but broader trends in generalist physician inpatient and outpatient activity have not been examined. The objective of this work was to identify trends in the volume of inpatient and outpatient care by generalist physicians in the United States since 1980.
This was a retrospective analysis of the numbers of generalist physicians, generalist physician inpatient and outpatient encounter volume, and encounters per physician using data from the AMA Masterfile, National Hospital Discharge Survey, and National Ambulatory Medical Care Survey. Generalist physicians were defined as office‐ and hospital‐based general internists, family practitioners, and general practitioners. Inpatient and outpatient encounters were measured in clinic visits and hospital‐days (admissions x length of stay), both total annually and per generalist physician per day.
Since 1980, the number of generalist physicians has increased by twofold, whereas hospital encounters measured in patient‐days have fallen by one third, largely because of decreased hospital length of stay. The number of inpatient encounters per generalist physician per day fell from 7 to 2. These trends predate and are unaffected by the growth of hospitalists. One limitation of this work is that we cannot identify attending specialty for hospital encounters or physician time allocated to nonclinical activities. However, parallel analyses examining the probability of hospitai admission following clinic visits with generalist physicians show highly similar results and are not subject to this limitation.
The role of hospital care in generalist physician practice has declined steadily since 1980, largely because of increases in the number of generalist physicians in the face of declining total generalist hospital encounters. The declining role of hospital care in generalist practice reflects trends unrelated to the growth of hospitalists. Indeed, the growth of hospitalists may be understood as a natural response to the declining efficiency of having generalist physicians, who are increasing focused on outpatient care.
D. Meltzer, RWJ Foundation, research funding; J. Chung, RWJ Foundation, research funding; David Meltzer, AHRQ, Research Funding; J. Chung, AHRQ, research funding.
To cite this abstract:Meltzer D, Chung J. Declining Activity of Generalist Physicians in Hospital Care in the United States: 1980‐2005. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 68. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/declining-activity-of-generalist-physicians-in-hospital-care-in-the-united-states-19802005/. Accessed March 28, 2020.