To study the utilization of surgeons in a prepaid group setting, the operative work loads, of seven general surgeons comprising the general surgical staff of a prepaid group practice of 158,000 enrollees were determined. The median weekly work load, 9.9 hernia equivalents per week, was over three times that of a previously studied population of 19 general surgeons in fee-for-service community practice (3.1 hernia equivalents) and approximated a previously elaborated consensus standard of a full weekly surgical work load (10 hernia equivalents). The median complexity of inpatient, ambulatory and all operations was 1.14, 0.16, and 1.00 hernia equivalents, respectively. Evidence suggested that the most complex operations were handled by the most highly trained surgeons; 23.8 per cent of operations were performed on an ambulatory basis. The results suggest that the prepaid group practice under study is able to utilize efficiently both general surgeons and the resources devoted to general surgery. (N Engl J Med 291:759–763, 1974). THE central role suggested for prepaid group practice in the continuing evolution of the American health-care system argues that the impact of this form of organization on the productivity of that system be thoroughly evaluated.1,2 A comparative analysis of the utilization of internists in prepaid group and fee-for-service settings showed no measureable productivity differences between the two modes of practice.3 To investigate the influence of a prepaid group setting on the utilization of surgeons, the volume, the distribution, and the composition of the surgical work loads of seven general surgeons who comprise the entire general surgical staff of a prepaid.
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