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The median operative workload of seven general surgeons comprising the general surgical staff of a prepaid group practice of 158,000 enrollees was 9.9 hernia equivalents (HE) a week. The value was over three times that of a previously studied population of 19 general surgeons in fee-for-service community practice, and approximated a consensus standard of a full surgical workload. The median complexity of operations was 1.00 HE, similar to the community practice, and evidence suggested the most complex operation were handled by6 the surgeons with the most training. 23.6% of operations were performed on an ambulatory basis. The results suggest that the prepaid group practice under study possesses administrative mechanisms to efficiently utilize both general surgeons and the resources devoted to general surgery.

Health maintenance organizations.