Family medicine outpatient encounters are more complex than those of cardiology and psychiatry

David Katerndahl, Robert Wood, Carlos Roberto Jaén

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background: Comparison studies suggest that the guideline-concordant care provided for specific medical conditions is less optimal in primary care compared with cardiology and psychiatry settings. The purpose of this study is to estimate the relative complexity of patient encounters in general/family practice, cardiology, and psychiatry settings. Methods: Secondary analysis of the 2000 National Ambulatory Medical Care Survey data for ambulatory patients seen in general/family practice, cardiology, and psychiatry settings was performed. The complexity for each variable was estimated as the quantity weighted by variability and diversity. Results: There is minimal difference in the unadjusted input and total encounter complexity of general/family practice and cardiology; psychiatry's input is less complex. Cardiology encounters involved more input quantitatively, but the diversity of general/family practice input eliminated the difference. Cardiology also involved more complex output. However, when the duration of visit is factored in, the complexity of care provided per hour in general/family practice is 33% more relative to cardiology and 5 times more relative to psychiatry. Conclusions: Care during family physician visits is more complex per hour than the care during visits to cardiologists or psychiatrists. This may account for a lower rate of completion of process items measured for quality of care.

Original languageEnglish (US)
Pages (from-to)6-15
Number of pages10
JournalJournal of the American Board of Family Medicine
Issue number1
StatePublished - Jan 2011


  • Family practice
  • Nonlinear dynamics
  • Quality of care
  • Specialization
  • Systems theory

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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