each morning on the first house call or hospital visit, ... Fort William Port Arthur ...... Russell Sage Foundation, New York, 1961. ... (BritL.h. Medical Journal, June 5, 1915.) Reciprocal relations of course have already been established between ...
Canad. Med. Ass. J. July 24, 1965, vol.93
SELLERS:
r' PATIENT '....ARE
The Influences of Group and Independent General Practice on Patient Care: A Comparative Study in Ontario E. M. SELLERS, M.D.,* Toronto
ABSTRACT When the practices of four general practitioners, members of multispecialist-general practitioner salaried groups (clinic doctors) were compared with those of four independent general practitioners (solo practitioners), it was noted that: group practice patients had more office laboratory investigation and greater in-hospital consultation and referral. On the other hand, independent practitioners' patients seemed to receive more personal attention from the doctor, a fuller explanation of diagnosis and treatment during office hours, more drug samples and more laboratory investigation in hospital. Group and independent practices are similar with respect to the rate of follow-up visits, the volume of preventive medicine, the number of radiographs and special procedures, the total number of drugs ordered, and the in-hospital formal written consultation rate and office consultation rate. The similarities between two types of practice may be a result of the interaction of group and independent practice in the same community. It is concluded that the team approach to medical care is not incompatible with independent practice.
SOMMAIRE On a 6tudi6 deux groupes d'omnipraticiens: l'un compos6 de quatre g.n6ralistes et multisp6cialistes faisant partie d'un groupe en tant que salari6s; l'autre comportant quatre g6n6ralistes ind6pendants. Il ressort de cette 6tude comparative que les malades soign.s par le premier groupe avaient plus d'analyses de laboratoire au bureau des m&lecins et si hospitalis6s, recevaient plus de consultations o.i 6taient r6f&6s li des confreres. Par contre, les malades soignt.s par les g6n6ralistes ind6pendants semblaient recevoir plus de marques de l'int6r.t personnel de leur m&lecin, plus d'explications sur le diagnostic et le traitement dans son propre bureau, un plus grand nombre d'6chantillons de m6dicaments, et leurs analyses .taient le plus souvent faites li l'h6pital. Les deux groupes se comparent .troitement en ce qui concerne le nombre de visites subs.quentes, l'importance accord6e li la m.decine preventive, le nombre d'examens radiologiques et * les examens sp&iaux, la quantit6 de m6dicaments prescrits, le nombre de consultations donn.es par 6crit li l'h6pital sur formule officielle et le nombre de consultations au bureau. Les similitudes constat.es entre les deux types de pratique m.dicale peuvent r.sulter de 1'interaction des deux groupes dans la meme coliectivit.. On estime que le travail d.6qulpe n'est en rien incompatible avec la pratique ind6pendante.
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148 SEIm.s: PAn.r CARE the basis for evaluating general practice in North America. In Canada, Clute's "The General Practitioner"8 is the only comparable study. Both of the last-named studies found a relationship between higher standing in medical school and increased amount of residency and internship, and improved quality of medical care. Because of the problems related to the proper execution of these studies outlined above, neither has escaped criticism. Today, with an ever-decreasing number of general practitioners,9 the trend to specialization, the introduction of health care insurance, the increasing expense of newer diagnostic methods, and the increasing awareness of the value of preventive medicine, the organization of medical practice becomes most important. Team effort as a pattern of practice is one approach to these changing needs'0 and there is a marked trend toward this form of practice in North America. A United States Public Health Service (U.S.P.H.S.) survey in 1959" indicated that the number of groups and participating physicians had increased over 300% since 1946. One in every 10 physicians in active practice in 1959 was a member of a group. In the United States, of the physicians who graduated in 1950,29% of those who were engaged in general practice worked in partnerships or group practices.'2 There is no reason to suppose that such a trend does not exist in Canada. Team effort may exist in many forms: hospital groups, partnerships, multispecialist clinics, specialist-general practitioner groups, and less formal arrangements among independent practitioners. With so many forms of group practice it is not surprising that it remains to be determined which of these arrangements results in the best medical care. The advantages and disadvantages of group practice for the doctor have been described;7'8' 13 however, the impact of group practice on the health of the community has not been surveyed and merits investigation. 5ilver,'4 in his study of one group of medical specialists, was able to demonstrate an improvement" in the health, housing and nutritional levels of a random sample of patients participating in a prepaid insurance scheme as compared with uninsured controls. Other United States studies15' 16 have indicated the beneficial relationship between organization of practice, quality of medical care and health level. In this context it is appropriate to review the findings of previous studies that have compared the quality of care between group and independent practice. Despite the usage by Clute and Peterson of the term "group" to include an association of two or more doctors, their results have an important bearing on this study. Peterson's findings may be summarized thus: (1) The qualitative rank for "group" physicians is 3.4 versus 2.5 for "solo" practitioners (p
