Rural and urban physicians: Does the content of their Medicare practices differ?

Rural and urban areas have significant differences in the availability of m edical technology, medical practice structures and patient populations. Thi s study uses 1994 Medicare claims data to examine whether these differences are associated with variation in the content of practice between physician s practicing in rural and urban areas. This study compared the number of pa tients, outpatient visits, and inpatient visits per physician ill the diffe rent specialties, diagnosis clusters, patient age and sex, and procedure fr equency and type for board-certified rural and urban physicians in 12 ambul atory medical specialties. Overall, 14.4 percent of physicians in the 12 sp ecialties practiced exclusively ill rural Washington, with great variation by specialty. Rural physicians were older and less likely to be female than urban physicians. Rural physicians saw larger numbers of elderly patients and had higher volumes of outpatients visits than their urban counterparts. For all specialty groups except general surgeons and obstetrician-gynecolo gists, the diagnostic scope of practice was specialty-specific and similar for rural and urban physicians. Rural general surgeons had more visits for gastrointestinal disorders, while rural obstetrician-gynecologists had more visits out of their speciality domain (e.g., hypertension, diabetes) than their urban counterparts. The scope of procedures for rural and urban physi cians in most specialties showed more similarities than differences. While the fund of knowledge and outpatient procedural training needed by most rur al and urban practitioners to care for the elderly is similar, rural genera l surgeons and obstetrician-gynecologists need training outside their tradi tional specialty areas to optimally care for their patients.