Intended for healthcare professionals


Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys

BMJ 2007; 334 doi: (Published 14 June 2007) Cite this as: BMJ 2007;334:1261
  1. Andrew B Bindman, professor1,
  2. Christopher B Forrest, professor2,
  3. Helena Britt, associate professor and director3,
  4. Peter Crampton, professor4,
  5. Azeem Majeed, professor5
  1. 1Division of General Internal Medicine, University of California San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA
  2. 2Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Abramson 1335, Philadelphia, PA 19104, USA
  3. 3Australian GP Statistics and Classification Centre, University of Sydney, Westmead Hospital, 2145 NSW, Australia
  4. 4University of Otago, Department of Public Health, Wellington School of Medicine and Health Sciences, PO Box 7343, Wellington, New Zealand
  5. 5Department of Primary Care and Social Medicine, Imperial College London, London
  1. Correspondence to: A B Bindman abindman{at}
  • Accepted 9 April 2007


Objectives To compare mix of patients, scope of practice, and duration of visit in primary care physicians in Australia, New Zealand, and the United States.

Design Comparison of three comparable cross sectional surveys performed in 2001-2. Physicians completed a questionnaire on patients' demographics, diagnoses, and duration of visit.

Setting Primary care practice.

Participants 79 790 office visits in Australia, 10 064 in New Zealand, and 25 838 in the US.

Main outcome measures Diagnostic codes were mapped to the Johns Hopkins expanded diagnostic clusters. Scope of practice was defined as the number of expanded diagnostic clusters accounting for 75% of all managed problems related to morbidity. Exposure to primary care was calculated from duration of visits recorded by the physician, and reports on rates of visits to primary care for each country.

Results In each country, primary care physicians managed an average of 1.4 morbidity related problems per visit. In the US, 46 expanded diagnostic clusters accounted for 75% of problems managed compared with 52 in Australia, and 57 in New Zealand. Correlations in the frequencies of managed health problems between countries were high (0.87-0.97 for pairwise comparisons). Though primary care visits were longer in the US than in New Zealand and Australia, the per capita annual exposure to primary care physicians in the US (29.7 minutes) was about half of that in New Zealand (55.5 minutes) and about a third of that in Australia (83.4 minutes) because of higher rates of visits to primary care in these countries.

Conclusions Despite differences in the supply and financing of primary care across countries, many aspects of the clinical practice of primary care physicians are remarkably similar in Australia, New Zealand, and the US.


  • We thank Robin Osborn and her staff at the Commonwealth Fund who encouraged and believed in the value of this international collaboration, Arpita Chattopadhyay for her assistance in developing the program for running the bootstrap analysis, and Glenna Auerback for her editorial assistance. We thank Lisa Valenti for assisting with the analysis of the BEACH data, and Peter Davis, Antony Raymont, Roy Lay-Yee, and the NatMedCa research team for access to their data.

  • Contributors: All authors contributed to conception, design, analysis, interpretation of data, and drafting and final approval of the article. ABB is guarantor.

  • Funding: Commonwealth Fund. BEACH 2001-2 was funded by the Australian Government Department of Health and Ageing, AstraZeneca (Australia), Aventis Pharma, Roche Products, Janssen-Cilag, and Merck Sharp and Dohme (Australia). The NatMedCa survey was funded by the Health Research Council of New Zealand. The National Ambulatory Medical Care Survey is administered and maintained by the National Center for Health Statistics of the US Department of Health and Human Services.

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Accepted 9 April 2007
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