Table 5.
Use of Hospitalists and Office-Based Primary Care Physicians’ Direct Patient Care Time Per Week, By Primary Care Specialty
| Overall | General Internal Medicine | Family Practice | General Pediatrics | |||||
|---|---|---|---|---|---|---|---|---|
| Coefficient (SE)* | p value | Coefficient (SE)* | p value | Coefficient (SE)* | p value | Coefficient (SE)* | p value | |
| Percentage of hospitalized patients treated by a hospitalist | ||||||||
| 0 % | (ref) | (ref) | (ref) | (ref) | ||||
| 1–25 % (low) | 0.41(2.07) | 0.84 | 2.71 (4.26) | 0.53 | 0.45 (1.41) | 0.75 | 1.38 (2.47) | 0.58 |
| 26–75 % (medium) | −1.41 (2.02) | 0.48 | −2.69 (4.02) | 0.50 | 0.51 (2.02) | 0.80 | 3.57 (2.66) | 0.18 |
| 76–100 % (high) | −0.87 (1.93) | 0.65 | −2.32 (4.53) | 0.61 | 0.32 (1.38) | 0.82 | −1.16 (2.01) | 0.56 |
| Physician characteristics | ||||||||
| Male | −2.80 (1.86) | 0.13 | −8.47 (5.64) | 0.13 | −1.60 (1.27) | 0.21 | −0.14 (1.75) | 0.94 |
| White, non-Hispanic | 1.36 (1.36) | 0.32 | 4.35 (3.01) | 0.15 | 3.54 (1.53) | 0.02 | 0.03 (2.55) | 0.99 |
| International medical graduates | 0.45 (1.34) | 0.74 | −3.64 (2.37) | 0.13 | 4.59 (2.05) | 0.03 | 2.10 (2.95) | 0.48 |
| Years in practice | ||||||||
| 1–10 years | 0.08 (1.67) | 0.96 | 5.14 (4.28) | 0.23 | 0.16 (1.35) | 0.90 | −2.76 (2.42) | 0.25 |
| 11–20 years | −1.90 (1.24) | 0.13 | 2.77 (3.47) | 0.42 | −1.54 (1.23) | 0.21 | −5.82 (1.87) | < 0.001 |
| 21+ years | (ref) | (ref) | (ref) | (ref) | ||||
| Time spent on email or phone conversation with other physicians a day | ||||||||
| 0–1 h | (ref) | (ref) | (ref) | (ref) | ||||
| 1+ hour | 3.27 (1.78) | 0.07 | 10.68 (5.31) | 0.05 | 1.18 (1.07) | 0.27 | 1.99 (1.80) | 0.27 |
| Compensation linked to productivity | −0.92 (1.04) | 0.38 | 0.79 (3.05) | 0.80 | −2.07 (1.33) | 0.12 | −1.91 (1.66) | 0.25 |
| Malpractice concern, agree/agree strongly | −0.80 (1.17) | 0.49 | 2.14 (3.05) | 0.48 | −1.82 (1.23) | 0.14 | 0.91 (1.67) | 0.59 |
| Percent of patients having chronic conditions | 0.09 (0.04) | 0.02 | 0.08 (0.12) | 0.48 | 0.0031 (0.0288) | 0.92 | 0.10 (0.06) | 0.12 |
| Practice characteristics | ||||||||
| Type | ||||||||
| Solo or 2 physicians | −1.09 (3.05) | 0.72 | −7.94 (6.38) | 0.21 | 1.12 (3.15) | 0.72 | 2.56 (4.64) | 0.58 |
| Group ≥ 3 physicians | −3.16 (2.73) | 0.25 | −9.01 (5.13) | 0.08 | 1.14 (2.99) | 0.70 | −1.04 (4.03) | 0.80 |
| HMO | (ref) | (ref) | (ref) | (ref) | ||||
| Medical school | 0.60 (4.06) | 0.88 | −17.18 (10.76) | 0.11 | 6.74 (5.74) | 0.24 | 7.02 (7.82) | 0.37 |
| Hospital-based | −0.33 (3.36) | 0.92 | −8.27 (5.97) | 0.17 | 2.12 (3.38) | 0.53 | 6.26 (6.44) | 0.33 |
| Other | 0.98 (3.44) | 0.78 | −14.39 (8.93) | 0.11 | 7.65 (4.11) | 0.06 | −6.50 (4.56) | 0.16 |
| Size | ||||||||
| 1–100 physicians | (ref) | (ref) | (ref) | (ref) | ||||
| 101+ physicians | 0.97 (1.88) | 0.61 | −0.85 (3.70) | 0.82 | 2.30 (2.15) | 0.29 | 1.47 (2.89) | 0.61 |
| Use of IT | 1.50 (1.36) | 0.27 | −1.49 (3.12) | 0.63 | 1.66 (1.04) | 0.11 | 3.40 (1.88) | 0.07 |
| Source of practice revenue | ||||||||
| Percent from Medicare | −0.03 (0.04) | 0.51 | −0.13 (0.13) | 0.32 | −0.06 (0.04) | 0.09 | 0.02 (0.09) | 0.83 |
| Percent from Medicaid | 0.0044 (0.0399) | 0.91 | −0.0017 (0.0699) | 0.98 | −0.0025 (0.0457) | 0.96 | 0.06 (0.04) | 0.09 |
| Percent from capitated or other prepaid basis | −0.02 (0.03) | 0.46 | −0.06 (0.05) | 0.30 | −0.04 (0.03) | 0.27 | 0.0015 (0.0387) | 0.97 |
| Market characteristics | ||||||||
| Geographic region | ||||||||
| Rural | −0.07 (1.97) | 0.97 | −2.59 (4.77) | 0.59 | 1.58 (1.60) | 0.32 | 4.87 (3.88) | 0.21 |
| HPSA | 0.82 (1.39) | 0.55 | 1.37 (2.88) | 0.63 | 0.38 (1.10) | 0.73 | −2.15 (1.69) | 0.20 |
| Socioeconomic | ||||||||
| Median household income, $ | 0.000022 (0.000067) | 0.75 | −0.00028 (0.00021) | 0.17 | 0.000136 (0.000049) | 0.01 | −0.000037 (0.000075) | 0.62 |
| Percent of uninsured | −0.10 (0.14) | 0.47 | −0.46 (0.36) | 0.20 | 0.08 (0.10) | 0.41 | −0.01 (0.17) | 0.96 |
| Population density, people/mi2 | 0.00016 (0.00012) | 0.18 | 0.000039 (0.000179) | 0.83 | −0.0000098 (0.0001198) | 0.94 | 0.00022 (0.00017) | 0.19 |
| Health care resources and utilization | ||||||||
| Total hospitalists per 100,000 population | 0.10 (0.10) | 0.28 | 0.28 (0.21) | 0.18 | 0.03 (0.07) | 0.70 | −0.12 (0.12) | 0.30 |
| Total admissions per 1,000 population | 0.01 (0.02) | 0.74 | 0.08 (0.07) | 0.24 | −0.01 (0.01) | 0.27 | −0.01 (0.02) | 0.53 |
| Total ED visits per 1,000 population | −0.0066 (0.0059) | 0.26 | −0.04 (0.02) | 0.08 | 0.00017 (0.00281) | 0.95 | 0.0032 (0.0008) | 0.69 |
| Total outpatient days per 1,000 population | 0.00049 (0.00036) | 0.17 | 0.0014 (0.0009) | 0.12 | 0.00046 (0.0003) | 0.12 | −0.000056 (0.000665) | 0.93 |
| Percent of Medicare managed care penetration | −0.04 (0.04) | 0.43 | −0.20 (0.13) | 0.12 | −0.0013 (0.0464) | 0.98 | 0.10 (0.06) | 0.10 |
*Results from an ordinary least squares regression
HMO health maintenance organization; IT information technology; HPSA health professional shortage area; ED emergency department