Pr. Katz et al., MEDICAL-PRACTICE WITH NURSING-HOME RESIDENTS - RESULTS FROM THE NATIONAL PHYSICIAN PROFESSIONAL ACTIVITIES CENSUS, Journal of the American Geriatrics Society, 45(8), 1997, pp. 911-917
OBJECTIVE: The study describes the prevalence of medical nursing home
practice. Further, it examines the extent to which physician character
istics and local county health care resources predict nursing home inv
olvement. This information is relevant to evaluating and devising stra
tegies that address the future provision of medical care in institutio
nalized long-term care. DESIGN: A cross-sectional survey. SETTING: A n
ational sample of all licensed practicing physicians was obtained from
a special Professional Activities (PPA) survey conducted by the Ameri
can Medical Association (AMA) in 1991. PARTICIPANTS: Respondents were
21,578 physicians involved in direct patient care. MEASURES: The typic
al number of hours spent weekly caring for nursing home patients was o
btained from the PPA survey, and physician demographics were obtained
from the AMA Masterfile. County health care resources were obtained fr
om the National Institutes of Health Area Resources File. RESULTS: Mos
t (77%) physicians reported spending no measurable time caring for nur
sing home patients. In all disciplines, a majority of physicians with
a nursing home practice spent less than 2 hours per week with patients
. Logistic regressions indicted that family practitioners and internis
ts were most likely to have a nursing home practice, but general pract
itioners were most likely to spend more time in practice. Only 15% of
specialists reported having a nursing home practice. Prevalence of pra
ctice was greatest among solo practitioners and physicians in partners
hips and least among academic and hospital-based physicians and physic
ians in group practice or employed by the government. Most county of p
ractice resources were not associated or were modestly associated with
nursing home practice, but having a nursing home practice became much
more likely as the number of nursing home residents increased and hos
pital beds decreased. A pattern was found for nursing home practice to
be slightly less likely as the county's per capita income and the pro
portion of proprietary nursing facilities increased. CONCLUSIONS: With
increasing numbers of older and frailer residents, nursing homes will
continue to be integral components of the future healthcare system. H
owever, physicians currently spend minimal time caring for nursing hom
e patients, with physician characteristics best predicting involvement
. Questions remain about the future of nursing home medical practice a
nd how to best recruit, staff, and train future cadres of physicians t
o provide sufficient quality care for nursing home patients in an evol
ving health care system.