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The University of Southern California has conducted a series of 24 surveys of the professional activities of physicians and surgeons in the United States. The surveys encompass more than 10,000 respondents representing 65.8% of all practising physicians in the United States and its territories. Using a specially‐developed “log‐diary” recording instrument, these physicians reported data on the care they provided during hundreds of thousands of encounters with their patients. This article provides an exposition of the study's unique methodology, presents illustratative data for 5 of the 24 specialities surveyed (cardiology, family practice, general internal medicine, orthopaedic surgery and psychiatry), and discusses the study's relevance and implications for medical education.

INTERSCAL is a program for subject-computer interactive multidimensional scaling. The program analyzes subsets of judgments of similarity as they are given and picks out dimension-defining stimuli; this capability allows for a great reduction in the number of judgments. Program features and options are described.

The Division of Research in Medical Education and of the University of Southern California, with the cooperation and assistance of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, has conducted a national study of the professional activities of neurological surgeons in the United States. One of a series of 24 surveys of medical and surgical specialties, the survey obtained information on patient workloads, the allocation of physician time, the characteristics of patients and the circumstances under which they were seen, patient diagnoses, and the care that was provided--including whether an operation was performed. This paper provides a selection of the findings deemed most relevant to manpower issues in neurosurgery. A later paper will examine regional differences in patient care, including the frequency with which selected surgical procedures are used for different clinical conditions.

Interactive Scaling with Individual Subjects (ISIS) developed by Young & Cliff [1972], is a method involving interaction between subject and computer in real time to determine which judgments made by the subject are critical to the definition of a dimensional structure. The procedure is based on the mathematical fact that it is possible to define a space ofR dimensions in terms of only the interpoint distances between all stimuli being scaled and a subset of (R+1) of these stimuli. For errorless judgments, any subset of (R + 1) stimuli is appropriate. However, fallible data require that the subset consist of stimuli that are maximally dissimilar, and the ISIS procedure is designed to obtain such an optimum subset (a “basis”).

• Results of a national survey of nonfederal otorhinolaryngologists regarding their practices provide the following portrait of the typical physician who specializes in otorhinolaryngology: male, between 35 and 45 years old, engaged in solo practice in a metropolitan area in the southern part of the country. He works a 46-hour week, devoting most of his time to patient care. During a typical week, he sees 113 patients, mostly outside the hospital. Half of his patients are male; although their average age is 35, one fourth of his patients are under 15 years. Every third patient is new to him; every other patient has been referred. He spends almost 15 minutes with each patient, many of whom he is seeing on a continuous basis for a problem involving the ear. He prescribes medications in roughly half of all encounters; every tenth patient requires surgery. He rates the majority of the problems he encounters as chronic, and of minor to moderate severity and urgency—for which he provides services of limited complexity or less. He seldom refers his patients. (Arch Otolaryngol105:610-620, 1979)

A series of recent studies (Cliff, 1968, 1969; Cliff, Bradley, and Girard, 1970) describe a mathematical model for the cognitive processes involved in an individual's endorsements (or nonendorsements) of personality inventory items. In this model, the inventory items are assumed to occupy positions in a multidimensional space of subjective meaning, and the probability of endorsement is assumed to be some mathematical funotion of these positions.

This research centers around a family of models designed to describe individuals' responses to personality inventory responses. The models are all alternative ways of relating the individual's degree of endorsement of the items to their locations on dimensions of semantic meaning as he perceives them. In the present study, the relationships among individuals' responses to adjective check list items and multidimensional scaling analyses of similarity judgments of the same items were studied. For each individual, a multiple correlation was computed between his endorsement of the items and their locations on dimensions. The median R, corrected for the number of predictors, was .81 in the case of "candid" endorsements and .92 for endorsements under a faking set. These correlations are comparable to the consistencies in endorsement across repetitions of the same items. Implications for a personality measurement theory are discussed.

✓ This paper reports a national study of physicians in 24 medical and surgical specialties, and reveals the opinions of neurosurgeons and their professional colleagues with regard to the adequacy of the supply of neurosurgical manpower. Among neurosurgeons, 30.4% believe the supply to be excessive, 60.1% think it is about right, 7.5% believe that there is a shortage, and 2.0% have no opinion. Neurologists' opinions do not differ significantly from those of neurosurgeons, but physicians and surgeons in 22 other specialties are significantly less likely to regard the supply as excessive, and are more likely to perceive a shortage. Primary care physicians, as a group, are most likely to perceive a shortage, and least likely to indicate an excess. Among the 24 specialties studied, 9.3% of physicians believe the supply of neurosurgeons to be excessive, 55.1% think it is about right, 22.9% believe that there is a shortage, and 12.8% have no opinion.

Medical telephone calls in which clinical and/or counseling services are provided to patients or their families account for onefifth of all physician-patient contacts in the United States. Among primary care specialties, telephone calls account for 19.4% of all patient encounters in family/general practice, 24.6% in general internal medicine, 28.5% in pediatrics, and 19.6% in obstetrics/gynecology. 1 Research on the role of telephone calls in primary care has focused on the potential adjunctive role of telephone care in patient management: the degree to which telephone consultation serves as the sole management for certain problems, e.g., acute, self-limiting conditions, as opposed to merely a prelude to an office visit. A review of a number of studies of telephone calls in primary care revealed that "close to 70% of the medical calls are managed solely by use of telephone."2 The ability to deal with problems solely by telephone is somewhat greater for physicians in private practice (aided by their greater familiarity with the patient and his/her family) than compared with house officers.3 While experience gained during residency training has not been shown to affect the proportion of problems handled solely by telephone,4 the average length of those calls does decrease.5

A major feature of a national survey of medical and surgical specialties is the development and application of an algorithm for classifying patient care services provided by physicians. The care classification reflects much of prevailing opinion regarding what constitutes primary and nonprimary care. The classification system provides a powerful tool for the analysis of patient care services, since it is based on conditions of access to care, the physician's role in providing the care, measures associated with continuity of care, and a proxy measure of comprehensiveness of care. Furthermore, it is based on the recordings by physicians of actual patient-encounter characteristics and is not operationally dependent on physician characteristics or propensities. (JAMA241:2180-2185, 1979)

The University of Southern California is conducting a national survey of physicians involving the collection and analysis of detailed data on the activities and practice characteristics of generalists, medical specialists, and surgical specialists of different types. This is the first of a series of reports on the survey and provides an overview of the survey's background, purposes, and general research methods. Basic features of the research methods include the development of a survey instrument capable of obtaining different types of practice data from physicians in most specialties and practice arrangements, the sampling of the physician population to ensure that sufficient data are obtained from physicians in most specialties and practice arrangements, and the creation and application of a scheme for classifying patient-care services provided by physicians along dimensions related to primary care. ( JAMA 240:848-852, 1978)

A nationwide study of 24 medical and surgical specialties has been conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. This article is the first in a series reporting findings for general internal medicine and 10 subspecialties of internal medicine. Populations for these 11 specialties are defined and enumerated, and the specialties are compared in terms of demographic and geographic distribution. Practice comparisons are presented based on characteristics such as workload, allocation of professional time, location of encounters with patients, distribution of primary problem diagnoses, and projections of annual patient encounters. Forthcoming specialty-specific articles will present highly detailed information for general internal medicine and for the subspecialties of cardiology, gastroenterology, pulmonary disease, allergy, hematology, endocrinology, nephrology, medical oncology, rheumatology, and infectious diseases.

A nationwide study of practitioners in 24 medical and surgical specialties was conducted by the University of Southern California School of Medicine, Division of Research in Medical Education. In this second report of a series presenting findings for internal medicine, general internal medicine and 10 subspecialties of internal medicine are compared using a care classification scheme designed for the study. On the basis of characteristics of the individual patient encounter, this care classification scheme distinguishes several dimensions associated with the concept of primary care. Five empirically derived types of care rather than a simple "primary" or "non-primary" dichotomy are described, and the distributions of each type for the 11 subspecialties examined are noted. Types of care (according to the care classification) are examined by the time per patient, the complexity of physician services, the severity and chronicity of problems, and the degree of specialization associated with providing different types of care. Estimates of the number of annual encounters, and the number of annual encounters for three of the five types of care, with the proportion of each accounted for by each subspecialty, are given.

The survey instrument used in the national study of physician activities conducted by the University of Southern California, Division of Research in Medical Education, is a log-diary in which physicians kept a record of their actual professional activities. The log-diary focused on use of physician time and patient encounters and employed numerical coding of activities and patient encounters in a highly structured format. Compared with instruments used in similar studies, this log-diary appears to gather a greater breadth and depth of information about physician practice patterns. (JAMA240:1160-1168, 1978)

• A nationwide study of the practice activities of dermatologists reports that dermatology is a predominantly outpatient specialty, with 97% of patient encounter occurring outside of the hospital. The average dermatologist cares for approximately 7,000 patients a year and functions almost exclusively as a specialist, with only 2.2% of his cases related to nondermatologic problems. The dermatologist performs a type of primary care, however, with seven out of ten patients being self-referred. Eighty-seven percent of dermatologic encounters can be categorized into 25 disease conditions. This study serves to increase the understanding of how the dermatologist cares for his patients. ( Arch Dermatol 114:1456-1462, 1978)