280:
emphasis on life-style changes and preventative measures, often poorly covered by health insurance or not at all. In 2004, the median income of specialists in the US was twice that of PCPs, and the gap is widening. Discontent by practicing primary care internists is discouraging trainees from entering primary care; in a 2007 survey of 1,177 graduating US medical students, only 2% planned to enter a general internal medicine career, and lifestyle was emphasized over the higher subspecialty pay in their decision. Primary care practices in the United States increasingly depend on foreign medical graduates to fill depleted ranks.
328:
the US spends two to three times as much per capita. Arrangements for after-hours care were almost twice as common in the
Netherlands, Germany and New Zealand as in Canada and the United States, where patients must rely on emergency facilities. Other major disparities include automated systems to remind patients about follow-up care, give patients test results or warn of harmful drug interactions. There were differences as well among primary care doctors, regarding financial incentives to improve the quality of care.
2054:
2084:
209:
of the patient to collaborate with referral specialists, coordinate the care given by varied organizations such as hospitals or rehabilitation clinics, act as a comprehensive repository for the patient's records, and provide long-term management of chronic conditions. Continuous care is particularly important for patients with medical conditions that encompass multiple organ systems and require prolonged treatment and monitoring, such as
2094:
2074:
2064:
258:
agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication". Similarly, a separate study found that specialists were less discriminating in their choice of journal reading.
257:
The dissemination of information to generalists compared to specialists is complicated. Two studies found specialists were more likely to adopt COX-2 drugs before the drugs were recalled by the FDA. One of the studies went on to state "using COX-2s as a model for physician adoption of new therapeutic
208:
requirements. In many countries residents are registered as patients of a (local) family doctor and must contact that doctor for referral to any other physician. They act as "gatekeepers", who regulate access to more costly procedures or specialists. Ideally, the primary care physician acts on behalf
129:
are sometimes counted as primary care physicians. Emergency physicians see many primary care cases, but in contrast to family physicians, pediatricians and internists, they are trained and organized to focus on episodic care, acute intervention, stabilization, and discharge or transfer or referral to
233:
Studies of the quality of preventive health care find the opposite results: primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists, were more likely to receive influenza vaccination. In health promotion
327:
A survey of 6,000 primary care doctors in seven countries revealed disparities in several areas that affect quality of care. Differences did not follow trends of the cost of care; primary care physicians in the United States lagged behind their counterparts in other countries, despite the fact that
279:
Causes parallel the evolutionary changes occurring in the US medical system: payment based on quantity of services delivered, not quality; aging of the population increases the prevalence and complexity of chronic health conditions, most of which are handled in primary care settings; and increasing
59:
A core element in general practice is continuity that bridges episodes of various illnesses. Greater continuity with a general practitioner has been shown to reduce the need for out-of-hours services and acute hospital admittance. Furthermore, continuity by a general practitioner reduces mortality.
288:
Developing countries face an even more critical disparity in primary care practitioners. The Pan
American Health Organization reported in 2005 that "the Americas region has made important progress in health, but significant challenges and disparities remain. Among the most important is the need to
20:
275:
chose primary care, but by 2006, over 80% became specialists. A survey
Research by the University of Missouri-Columbia (UMC) and the U.S. Department of Health and Human Services predicts that by 2025 the United States will be short 35,000 to 44,000 adult care primary care physicians.
229:
provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care. However, the studies examine the quality of care in the domain of the specialists. In addition, they need to account for clustering of patients and physicians.
289:
extend quality health care to all sectors of the population.... Experience over the last 27 years shows that health systems that adhere to the principles of primary health care produce greater efficiency and better health outcomes in terms of both individual and public health." The
237:
Exceptions may be diseases that are so common that primary care physicians develop their own expertise. A study of patients with acute low back pain found the primary care physicians provided equivalent quality of care but at lower costs than orthopedic specialists.
138:
A set of skills and scope of practice may define a primary care physician, generally including basic diagnosis and treatment of common illnesses and medical conditions. Diagnostic techniques include interviewing the patient to collect information on the present
171:
and, with the participation of the patient, formulates a plan including (if appropriate) components of further testing, specialist referral, medication, therapy, diet or life-style changes, patient education, and follow up results of treatment.
39:
who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the
1160:
Hauer, KE; Durning, SJ; Kernan, WN; Fagan, MJ; Mintz, M; O'Sullivan, PS; Battistone, M; Defer, T; et al. (2008-09-10). "Factors
Associated With Medical Students' Career Choices Regarding Internal Medicine".
203:
A primary care physician is usually the first medical practitioner contacted by a patient because of factors such as ease of communication, accessible location, familiarity, and increasingly issues of cost and
194:
to not inform patients when they moved on to another practice. This is a problem in rural areas, which may forbid doctors from setting up new or competing practices in areas where physicians are scarce.
664:
Turner B, Amsel Z, Lustbader E, Schwartz J, Balshem A, Grisso J (1992). "Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex".
303:"In health systems, (primary care) workers function as gatekeepers and navigators for the effective, or wasteful, application of all other resources such as drugs, vaccines and supplies."
701:"The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project"
1074:
Jack M. Colwill, James M. Cultice and Robin L. Kruse, JM; Cultice, JM; Kruse, RL (2008-04-29). "Will
Generalist Physician Supply Meet Demands Of An Increasing And Aging Population?".
315:"Richer countries face a future of low fertility and large populations of elderly people, which will cause a shift towards chronic and degenerative diseases with high care demands."
167:, with special training with a technology or increased experience and patient volume that make a risky procedure safer for the patient. After collecting data, the PCP arrives at a
234:
counseling, studies of self-reported behavior found that generalists were more likely than internal medicine specialists to counsel patients and to screen for breast cancer.
1222:
Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Jordon Peugh, and Kinga Zapert, C; Osborn, R; Huynh, PT; Doty, M; Peugh, J; Zapert, K (1999-11-02).
1223:
271:
In the United States, the number of medical students entering family practice training dropped by 50% between 1997 and 2005. In 1998, half of internal medicine
346:"Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: A registry-based observational study in Norway"
1043:
521:
Fendrick A, Hirth R, Chernew M (1996). "Differences between generalist and specialist physicians regarding
Helicobacter pylori and peptic ulcer disease".
934:"Over and under-utilization of cyclooxygenase-2 selective inhibitors by primary care physicians and specialists: the tortoise and the hare revisited"
297:"Worker numbers and quality are positively associated with immunization coverage, outreach of primary care, and infant, child and maternal survival."
1270:
300:"The quality of doctors and the density of their distribution have been shown to correlate with positive outcomes in cardiovascular diseases."
2133:
1221:
474:"Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction"
293:(WHO) has identified worsening trends in access to PCPs and other primary care workers, both in the developed and the developing nations:
107:
as PCPs for the care of women and have allowed certain subspecialists to assume PCP responsibilities for selected patient types, such as
79:). To become primary care physicians, medical school graduates then undertake a postgraduate training in primary care programs, such as
1583:
306:"There are currently 57 countries with critical shortages equivalent to a global deficit of 2.4 million doctors, nurses and midwives."
1924:
76:
1523:
394:
309:"In many countries, the skills of limited yet expensive professionals are not well matched to the local profile of health needs."
1823:
870:
1959:
1301:
1209:
2128:
72:
176:
100:
1044:"The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation's Health Care"
446:
2077:
1949:
1383:
1050:
1224:"On The Front Lines Of Care: Primary Care Doctors' Office Systems, Experiences, And Views In Seven Countries"
1929:
1573:
1553:
312:"...all countries suffer from maldistribution characterized by urban concentration and rural deficits."
130:
definitive care, with less of a focus on chronic conditions and limited provision for continuing care.
742:"Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival"
1982:
318:"Growing gaps will exert even greater pressure on the outflow of health workers from poorer regions."
290:
1774:
1696:
1691:
1611:
1371:
1754:
1728:
1031:
Family
Medicine Residency Positions and Number Filled by U.S. Medical School Graduates, 1994-2006
1073:
52:
is still used. With the advent of nurses as PCPs, the term PCP has also been expanded to denote
1346:
1294:
549:"Summaries for patients. Comparing the quality of diabetes care by generalists and specialists"
168:
2118:
1997:
1883:
1856:
1829:
1781:
1735:
1430:
1264:
832:"Differences between generalists and specialists: knowledge, realism, or primum non nocere?"
783:"Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care?"
565:
548:
163:. More complex and time-intensive diagnostic procedures are usually obtained by referral to
2017:
1977:
1844:
1658:
1653:
1633:
1568:
1420:
272:
180:
148:
49:
983:"Which journals do primary care physicians and specialists access from an online service?"
8:
2138:
2123:
2097:
2039:
2022:
1681:
1398:
1196:
847:
629:
Lewis C, Clancy C, Leake B, Schwartz J (1991). "The counseling practices of internists".
489:
226:
126:
1147:
1030:
590:"The generalist role of specialty physicians: is there a hidden system of primary care?"
44:. In the past, the equivalent term was 'general practitioner' in the US; however in the
1987:
1944:
1934:
1723:
1676:
1643:
1638:
1388:
1366:
1007:
982:
958:
933:
911:
856:
831:
807:
782:
498:
473:
451:
370:
191:
164:
68:
677:
400:
2083:
2057:
1939:
1909:
1888:
1851:
1834:
1749:
1713:
1703:
1598:
1518:
1462:
1425:
1410:
1351:
1318:
1287:
1246:
1178:
1129:
1091:
1012:
963:
949:
903:
861:
812:
763:
722:
681:
646:
611:
570:
530:
503:
375:
156:
96:
915:
2067:
1759:
1744:
1621:
1496:
1452:
1238:
1170:
1121:
1083:
1002:
994:
953:
945:
895:
851:
843:
802:
794:
753:
712:
673:
638:
601:
560:
493:
485:
447:"Did Your Doctor Disappear Without a Word? A Noncompete Clause Could Be the Reason"
365:
357:
88:
424:
Interpreting the Volume-Outcome
Relationship in the Context of Health Care Quality
344:
Sandvik, Hogne; Hetlevik, Øystein; Blinkenberg, Jesper; Hunskaar, Steinar (2022).
190:
A recent United States survey, found that 45 percent of primary care doctors were
2087:
2032:
1893:
1878:
1861:
1801:
1796:
1740:
1718:
1415:
1361:
1341:
144:
120:
84:
80:
1029:
American
Academy of Family Physicians, National Resident Matching Program data:
758:
741:
717:
700:
1919:
1873:
1686:
1616:
1435:
1146:
Medical Group
Management Association Physician Compensation Survey, 1998–2005:
1049:(Press release). The American College of Physicians. 2006-01-30. Archived from
998:
642:
64:
45:
1087:
798:
2112:
2002:
1791:
1786:
1648:
1588:
1491:
1174:
606:
589:
184:
41:
1242:
422:
2007:
1992:
1818:
1543:
1393:
1378:
1324:
1250:
1182:
1133:
1095:
1016:
967:
907:
865:
816:
574:
507:
472:
Majumdar S, Inui T, Gurwitz J, Gillman M, McLaughlin T, Soumerai S (2001).
379:
361:
245:
The more experience the primary care physician has with a specific disease.
214:
205:
152:
116:
104:
767:
726:
685:
650:
615:
534:
1866:
1811:
1708:
1563:
1538:
1356:
345:
1125:
699:
Carey T, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D (1995).
1954:
1839:
1806:
1578:
1528:
1513:
1508:
1501:
1486:
1476:
92:
899:
2027:
1769:
1764:
1628:
1606:
1481:
1445:
1112:
Bodenheimer, Thomas (2006-08-31). "Primary care - Will It Survive?".
740:
Kitahata M, Koepsell T, Deyo R, Maxwell C, Dodge W, Wagner E (1996).
108:
36:
883:
241:
Factors associated with quality of care by primary care physicians:
1533:
1310:
1197:
Regional Declaration on the New Orientations of Primary Health Care
210:
140:
343:
175:
Primary care physicians also counsel and educate patients on safe
155:, such as interpreting results of blood or other patient samples,
2012:
1472:
1440:
1333:
931:
19:
588:
Rosenblatt R, Hart L, Baldwin L, Chan L, Schneeweiss R (1998).
112:
884:"Factors associated with celecoxib and rofecoxib utilization"
698:
248:
Physician group affiliation with networks of multiple groups.
160:
980:
932:
De Smet BD, Fendrick AM, Stevenson JG, Bernstein SJ (2006).
663:
1279:
739:
881:
471:
16:
US term for medical professional providing first-line care
587:
628:
1159:
981:
McKibbon KA, Haynes RB, McKinlay RJ, Lokker C (2007).
399:. National Academies Press. p. 27. Archived from
179:, self-care skills and treatment options, and provide
420:
392:
1148:
Median Compensation for Selected Medical Specialties
520:
1195:Pan American Health Organization (September 2005):
322:
882:Rawson N, Nourjah P, Grosser S, Graham D (2005).
2110:
927:
925:
252:
1295:
198:
1269:: CS1 maint: multiple names: authors list (
974:
922:
875:
823:
225:Studies that compare the knowledge base and
23:A patient having his blood pressure measured
1111:
829:
774:
733:
692:
657:
541:
465:
396:Primary Care: America's Health in a New Era
1584:Reproductive endocrinology and infertility
1302:
1288:
1107:
1105:
987:Journal of the Medical Library Association
622:
581:
514:
1925:Bachelor of Medicine, Bachelor of Surgery
1006:
957:
855:
806:
780:
757:
716:
605:
564:
497:
369:
147:and other health details, followed by a
18:
1102:
566:10.7326/0003-4819-136-2-200201150-00003
444:
2111:
1283:
2134:Family medicine in the United States
2063:
1824:Physical medicine and rehabilitation
938:Journal of General Internal Medicine
848:10.1046/j.1525-1497.2001.016006422.x
836:Journal of General Internal Medicine
787:Journal of General Internal Medicine
490:10.1046/j.1525-1497.2001.016006351.x
266:
133:
2073:
1114:The New England Journal of Medicine
350:British Journal of General Practice
13:
1960:Medical Scientist Training Program
283:
220:
14:
2150:
151:. Many PCPs are trained in basic
2092:
2082:
2072:
2062:
2053:
2052:
950:10.1111/j.1525-1497.2006.00463.x
445:Andrews, Michelle (2019-03-15).
323:Lagging quality of care measures
2093:
1215:
1202:
1189:
1153:
1140:
1067:
1036:
1023:
781:Friedberg; et al. (2007).
119:acting as PCPs for patients on
1950:Doctor of Osteopathic Medicine
1384:Oral and maxillofacial surgery
438:
421:Institute of Medicine (2000).
414:
393:Institute of Medicine (1996).
386:
337:
63:All physicians first complete
1:
678:10.1016/S0749-3797(18)30838-9
331:
261:
48:and other countries the term
1930:Bachelor of Medical Sciences
1697:Neurosurgical anesthesiology
1309:
253:Dissemination of information
7:
1208:World Health Organization:
830:Turner BJ, Laine C (2001).
759:10.1056/NEJM199603143341106
718:10.1056/NEJM199510053331406
10:
2155:
999:10.3163/1536-5050.95.3.246
643:10.7326/0003-4819-114-1-54
427:. National Academies Press
199:Role in health care system
2048:
1970:
1908:
1669:
1597:
1552:
1461:
1332:
1317:
1088:10.1377/hlthaff.27.3.w232
799:10.1007/s11606-007-0234-0
291:World Health Organization
1884:Transplantation medicine
1775:Clinical neurophysiology
1692:Obstetric anesthesiology
1612:Interventional radiology
1372:Digestive system surgery
1212:Retrieved 30 August 2006
1210:World Health Report-2006
1199:Retrieved 30 August 2006
1175:10.1001/jama.300.10.1154
1150:Retrieved 30 August 2006
1033:Retrieved 30 August 2006
607:10.1001/jama.279.17.1364
2129:Health care occupations
1755:Intensive care medicine
1729:Mass gathering medicine
1574:Maternal–fetal medicine
1243:10.1377/hlthaff.25.w555
192:contractually obligated
111:caring for people with
1347:Cardiothoracic surgery
362:10.3399/BJGP.2021.0340
169:differential diagnosis
54:primary care providers
29:primary care physician
24:
1998:Personalized medicine
1857:Reproductive medicine
1782:Occupational medicine
1736:Evolutionary medicine
22:
2018:Traditional medicine
1978:Alternative medicine
1845:Addiction psychiatry
1659:Transfusion medicine
1654:Medical microbiology
1569:Gynecologic oncology
1421:Reproductive surgery
149:physical examination
127:Emergency physicians
91:in some countries),
50:general practitioner
2040:History of medicine
2023:Veterinary medicine
1830:Preventive medicine
1682:Adolescent medicine
1524:Infectious diseases
1126:10.1056/NEJMp068155
1988:Molecular oncology
1945:Doctor of Medicine
1935:Master of Medicine
1852:Radiation oncology
1724:Emergency medicine
1677:Addiction medicine
1644:Clinical chemistry
1639:Clinical pathology
1431:Transplant surgery
1389:Orthopedic surgery
1367:Colorectal surgery
523:Am J Gastroenterol
452:The New York Times
157:electrocardiograms
25:
2106:
2105:
1940:Master of Surgery
1904:
1903:
1889:Tropical medicine
1835:Prison healthcare
1750:Hospital medicine
1714:Disaster medicine
1704:Aviation medicine
1519:Hospital medicine
1426:Surgical oncology
1411:Pediatric surgery
1405:
1352:Endocrine surgery
1169:(10): 1154–1164.
900:10.1345/aph.1E298
793:(10): 1385–1392.
559:(2): I-42. 2002.
267:Declining numbers
134:Scope of practice
97:internal medicine
2146:
2096:
2095:
2086:
2076:
2075:
2066:
2065:
2056:
2055:
1760:Medical genetics
1745:General practice
1622:Nuclear medicine
1497:Gastroenterology
1453:Vascular surgery
1403:
1330:
1329:
1304:
1297:
1290:
1281:
1280:
1275:
1274:
1268:
1260:
1258:
1257:
1228:
1219:
1213:
1206:
1200:
1193:
1187:
1186:
1157:
1151:
1144:
1138:
1137:
1109:
1100:
1099:
1082:(3): w232–w241.
1071:
1065:
1064:
1062:
1061:
1055:
1048:
1040:
1034:
1027:
1021:
1020:
1010:
978:
972:
971:
961:
929:
920:
919:
888:Ann Pharmacother
879:
873:
869:
859:
827:
821:
820:
810:
778:
772:
771:
761:
737:
731:
730:
720:
696:
690:
689:
661:
655:
654:
626:
620:
619:
609:
585:
579:
578:
568:
545:
539:
538:
518:
512:
511:
501:
478:J Gen Intern Med
469:
463:
462:
460:
459:
442:
436:
435:
433:
432:
418:
412:
411:
409:
408:
390:
384:
383:
373:
356:(715): e84–e90.
341:
177:health behaviors
89:general practice
2154:
2153:
2149:
2148:
2147:
2145:
2144:
2143:
2109:
2108:
2107:
2102:
2044:
2033:Chief physician
1966:
1911:
1900:
1894:Travel medicine
1879:Sports medicine
1862:Sexual medicine
1802:Palliative care
1797:Pain management
1741:Family medicine
1719:Diving medicine
1665:
1593:
1555:
1548:
1464:
1457:
1416:Plastic surgery
1362:General surgery
1342:Cardiac surgery
1323:
1321:
1313:
1308:
1278:
1262:
1261:
1255:
1253:
1226:
1220:
1216:
1207:
1203:
1194:
1190:
1158:
1154:
1145:
1141:
1110:
1103:
1072:
1068:
1059:
1057:
1053:
1046:
1042:
1041:
1037:
1028:
1024:
979:
975:
930:
923:
880:
876:
828:
824:
779:
775:
738:
734:
697:
693:
662:
658:
627:
623:
600:(17): 1364–70.
586:
582:
547:
546:
542:
519:
515:
470:
466:
457:
455:
443:
439:
430:
428:
419:
415:
406:
404:
391:
387:
342:
338:
334:
325:
286:
284:Maldistribution
269:
264:
255:
227:quality of care
223:
221:Quality of care
201:
181:screening tests
153:medical testing
145:medical history
136:
121:kidney dialysis
85:family practice
81:family medicine
17:
12:
11:
5:
2152:
2142:
2141:
2136:
2131:
2126:
2121:
2104:
2103:
2101:
2100:
2090:
2080:
2070:
2060:
2049:
2046:
2045:
2043:
2042:
2037:
2036:
2035:
2025:
2020:
2015:
2010:
2005:
2000:
1995:
1990:
1985:
1980:
1974:
1972:
1971:Related topics
1968:
1967:
1965:
1964:
1963:
1962:
1952:
1947:
1942:
1937:
1932:
1927:
1922:
1920:Medical school
1916:
1914:
1906:
1905:
1902:
1901:
1899:
1898:
1897:
1896:
1886:
1881:
1876:
1874:Sleep medicine
1871:
1870:
1869:
1859:
1854:
1849:
1848:
1847:
1837:
1832:
1827:
1821:
1816:
1815:
1814:
1804:
1799:
1794:
1789:
1784:
1779:
1778:
1777:
1767:
1762:
1757:
1752:
1747:
1738:
1733:
1732:
1731:
1721:
1716:
1711:
1706:
1701:
1700:
1699:
1694:
1687:Anesthesiology
1684:
1679:
1673:
1671:
1667:
1666:
1664:
1663:
1662:
1661:
1656:
1651:
1646:
1641:
1636:
1626:
1625:
1624:
1619:
1617:Neuroradiology
1614:
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1993:Nanomedicine
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1475: /
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1379:Neurosurgery
1265:cite journal
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1709:Dermatology
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1539:Pulmonology
1357:Eye surgery
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165:specialists
2139:Pediatrics
2124:Physicians
2113:Categories
1840:Psychiatry
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1819:Phlebology
1807:Pediatrics
1634:Anatomical
1599:Diagnostic
1579:Obstetrics
1529:Nephrology
1514:Hematology
1509:Geriatrics
1502:Hepatology
1487:Cardiology
1477:Immunology
1256:2006-11-06
1227:(abstract)
1060:2006-08-30
458:2019-03-18
431:2006-08-30
407:2006-08-30
332:References
262:Challenges
109:allergists
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2028:Physician
1912:education
1770:Neurology
1765:Narcology
1629:Pathology
1607:Radiology
1482:Angiology
1446:Andrology
273:residents
103:consider
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2058:Category
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1465:medicine
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