Women's Primary Care in the United States: A Study of Practice Variation Among Physician Specialties

Objective: To evaluate specialty-specific variation in ambulatory health care utilization and preventive service delivery for women in the nonelderly population of the United States. Design: Descriptive analysis of a cross-sectional sample of the U.S. population. Data Source: 1989 and 1990 National Ambulatory Medical Care Survey. Measurements: Office-based visits for women ages 15 to 64 years, excluding visits for obstetric care. Utilization and practice variation is examined among three physician specialty groups, family/general practitioners, internists, and gynecologists. Results: Striking variation in office-based visit rates exists among these specialties based on age, race, geographic region, and method of payment. Women seeking care for six common medical conditions were more likely to have visited a family/general practitioner than either an internist or gynecologist. General medical examinations and gynecologic care were rendered largely by gynecologists. Internists and family/general practitioners were less likely than gynecologists to report a Pap smear, pelvic examination, and breast examination as part of a general medical examination. Conclusions: Women have a variety of nonobstetric therapeutic and preventive ambulatory health care needs. Age-pecific and region-specific variation suggest a difference in the primary care that women in the country receive. It also appears that primary care physicians are providing similar services, at different rates and with indeterminate effectiveness. Determination of the variation in costs and outcomes of women's primary health care among these different physician specialty groups, deserves further investigation.