Physician practice variation in assignment of return interval

Background: Recent shifts in reimbursement toward capitation makes appointm ent availability a significant resource and stimulates us to understand pri mary care physician (hereafter referred to as "provider") behavior concerni ng appointment assignment. The results of prior studies suggest significant provider variability in this area. Objective: To examine the influences on assigning patient revisit intervals in the ambulatory setting. Methods: Survey regarding general care issues of hypothetical diabetic and hypertensive patients seen in an ambulatory setting was given to 62 provide rs in the Internal Medicine Program at the Tulane University Internal Medic ine Residency Program and outpatient clinics, New Orleans, La. Measurements evaluated included survey responses for demographics (sex, year of birth, year of graduation from medical school, and level of training) and practice style (decision to change therapy, order tests, and recommended return app ointment interval in weeks) variables. Results: The response rate was 89% (56 providers). Most respondents were me n (n = 39). Wide variation was noted in assignment of reappointment interva l with mean return intervals for the scenarios ranging from 2.2 to 20.5 wee ks. Significant influences on provider practice included patient stability (P < .001), the decision to change therapy (P = .001), and the decision to order tests (P = .001). All correlated with an earlier return appointment. Some providers exhibited test-ordering tendencies across scenarios. Sex was a significant provider in dependent variable and was not influenced by oth er study variables. Female providers assigned earlier reappointment interva ls for their patients. Conclusions: Wide variation exists among practitioners with similar trainin g background and practice setting. Bs expected, patient stability was a maj or determinant of assigned return interval. Test-ordering behaviors may con sume appointments inappropriately and may be a productive area for efforts to reduce provider variability. The influence of the provider's sex on sche duling follow-up appointments warrants further investigation.