291:
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.
339:
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.
220:
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
2065:
2095:
2105:
2085:
2075:
269:
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.
268:
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
219:
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
140:
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
244:
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
338:
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
290:
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
70:
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.
299:
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
286:
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.
240:
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.
300:
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
248:
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.
149:
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
182:
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.
31:
50:
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
1171:
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".
214:
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
205:
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.
675:
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".
314:"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."
712:"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"
1085:
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?".
326:"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."
178:, 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
245:
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.
1281:
1233:
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).
1234:
2144:
282:
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
357:"Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: A registry-based observational study in Norway"
1054:
532:
Fendrick A, Hirth R, Chernew M (1996). "Differences between generalist and specialist physicians regarding
Helicobacter pylori and peptic ulcer disease".
1594:
1935:
87:
945:"Over and under-utilization of cyclooxygenase-2 selective inhibitors by primary care physicians and specialists: the tortoise and the hare revisited"
308:"Worker numbers and quality are positively associated with immunization coverage, outreach of primary care, and infant, child and maternal survival."
1534:
311:"The quality of doctors and the density of their distribution have been shown to correlate with positive outcomes in cardiovascular diseases."
485:"Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction"
1834:
304:(WHO) has identified worsening trends in access to PCPs and other primary care workers, both in the developed and the developing nations:
118:
as PCPs for the care of women and have allowed certain subspecialists to assume PCP responsibilities for selected patient types, such as
90:). To become primary care physicians, medical school graduates then undertake a postgraduate training in primary care programs, such as
1970:
1312:
317:"There are currently 57 countries with critical shortages equivalent to a global deficit of 2.4 million doctors, nurses and midwives."
2088:
2139:
405:
320:"In many countries, the skills of limited yet expensive professionals are not well matched to the local profile of health needs."
83:
187:
111:
1960:
1394:
881:
1940:
1584:
1220:
1564:
1993:
301:
1055:"The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation's Health Care"
457:
1785:
1707:
1702:
1622:
1382:
1061:
1235:"On The Front Lines Of Care: Primary Care Doctors' Office Systems, Experiences, And Views In Seven Countries"
1765:
1739:
1357:
1305:
179:
2129:
2008:
1894:
1867:
1840:
1792:
1746:
1441:
1275:
323:"...all countries suffer from maldistribution characterized by urban concentration and rural deficits."
141:
definitive care, with less of a focus on chronic conditions and limited provision for continuing care.
753:"Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival"
2028:
1988:
1855:
1669:
1664:
1644:
1579:
1431:
329:"Growing gaps will exert even greater pressure on the outflow of health workers from poorer regions."
283:
191:
159:
60:
2149:
2134:
2108:
2050:
2033:
1692:
1409:
237:
137:
2094:
1998:
1955:
1945:
1734:
1687:
1654:
1649:
1399:
1377:
1042:
Family
Medicine Residency Positions and Number Filled by U.S. Medical School Graduates, 1994-2006
922:
462:
202:
175:
79:
63:
is still used. With the advent of nurses as PCPs, the term PCP has also been expanded to denote
560:"Summaries for patients. Comparing the quality of diabetes care by generalists and specialists"
2068:
1950:
1920:
1899:
1862:
1845:
1760:
1724:
1714:
1609:
1529:
1473:
1436:
1421:
1362:
1329:
1298:
1257:
1189:
1140:
1102:
1023:
974:
914:
872:
823:
774:
733:
692:
657:
622:
581:
541:
514:
386:
167:
107:
1770:
1755:
1632:
1507:
1463:
1249:
1181:
1132:
1094:
1013:
1005:
964:
956:
906:
862:
854:
843:"Differences between generalists and specialists: knowledge, realism, or primum non nocere?"
813:
805:
794:"Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care?"
764:
723:
684:
649:
612:
576:
571:
559:
504:
496:
376:
368:
174:. More complex and time-intensive diagnostic procedures are usually obtained by referral to
99:
2098:
2043:
1904:
1889:
1872:
1812:
1807:
1751:
1729:
1426:
1372:
1352:
994:"Which journals do primary care physicians and specialists access from an online service?"
155:
131:
95:
91:
1207:
858:
640:
Lewis C, Clancy C, Leake B, Schwartz J (1991). "The counseling practices of internists".
500:
1158:
1041:
601:"The generalist role of specialty physicians: is there a hidden system of primary care?"
55:. In the past, the equivalent term was 'general practitioner' in the US; however in the
1930:
1884:
1697:
1627:
1446:
1018:
993:
969:
944:
867:
842:
818:
793:
509:
484:
381:
75:
56:
688:
411:
17:
2123:
2013:
1802:
1797:
1659:
1599:
1502:
960:
195:
52:
926:
2078:
2018:
2003:
1829:
1554:
1404:
1389:
1335:
458:"Did Your Doctor Disappear Without a Word? A Noncompete Clause Could Be the Reason"
225:
216:
163:
127:
115:
435:
Interpreting the Volume-Outcome
Relationship in the Context of Health Care Quality
355:
Sandvik, Hogne; Hetlevik, Øystein; Blinkenberg, Jesper; Hunskaar, Steinar (2022).
201:
A recent United States survey, found that 45 percent of primary care doctors were
1877:
1822:
1719:
1574:
1549:
1367:
1040:
American
Academy of Family Physicians, National Resident Matching Program data:
769:
752:
728:
711:
1965:
1157:
Medical Group
Management Association Physician Compensation Survey, 1998–2005:
1060:(Press release). The American College of Physicians. 2006-01-30. Archived from
1009:
653:
1850:
1817:
1589:
1539:
1524:
1519:
1512:
1497:
1487:
1098:
809:
103:
1185:
617:
600:
2038:
1780:
1775:
1639:
1617:
1492:
1456:
1253:
433:
119:
47:
30:
1261:
1193:
1144:
1106:
1027:
978:
918:
876:
827:
585:
518:
483:
Majumdar S, Inui T, Gurwitz J, Gillman M, McLaughlin T, Soumerai S (2001).
390:
372:
256:
The more experience the primary care physician has with a specific disease.
778:
737:
696:
661:
626:
545:
1544:
1321:
356:
221:
151:
1136:
710:
Carey T, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D (1995).
2023:
1483:
1451:
1344:
910:
1123:
Bodenheimer, Thomas (2006-08-31). "Primary care - Will It Survive?".
751:
Kitahata M, Koepsell T, Deyo R, Maxwell C, Dodge W, Wagner E (1996).
123:
894:
252:
Factors associated with quality of care by primary care physicians:
1208:
Regional Declaration on the New Orientations of Primary Health Care
186:
Primary care physicians also counsel and educate patients on safe
171:
166:, such as interpreting results of blood or other patient samples,
29:
1294:
599:
Rosenblatt R, Hart L, Baldwin L, Chan L, Schneeweiss R (1998).
895:"Factors associated with celecoxib and rofecoxib utilization"
259:
Physician group affiliation with networks of multiple groups.
943:
De Smet BD, Fendrick AM, Stevenson JG, Bernstein SJ (2006).
1290:
27:
US term for medical professional providing first-line care
992:
McKibbon KA, Haynes RB, McKinlay RJ, Lokker C (2007).
410:. National Academies Press. p. 27. Archived from
190:, self-care skills and treatment options, and provide
1159:
Median Compensation for Selected Medical Specialties
1981:
1919:
1680:
1608:
1563:
1472:
1343:
1328:
1206:Pan American Health Organization (September 2005):
893:Rawson N, Nourjah P, Grosser S, Graham D (2005).
938:
936:
1306:
8:
1280:: CS1 maint: multiple names: authors list (
236:Studies that compare the knowledge base and
34:A patient having his blood pressure measured
407:Primary Care: America's Health in a New Era
1595:Reproductive endocrinology and infertility
1340:
1313:
1299:
1291:
1118:
1116:
998:Journal of the Medical Library Association
1936:Bachelor of Medicine, Bachelor of Surgery
1017:
968:
866:
817:
768:
727:
616:
575:
508:
380:
158:and other health details, followed by a
577:10.7326/0003-4819-136-2-200201150-00003
347:
1273:
7:
2145:Family medicine in the United States
2074:
1835:Physical medicine and rehabilitation
949:Journal of General Internal Medicine
859:10.1046/j.1525-1497.2001.016006422.x
847:Journal of General Internal Medicine
798:Journal of General Internal Medicine
501:10.1046/j.1525-1497.2001.016006351.x
2084:
1125:The New England Journal of Medicine
361:British Journal of General Practice
1971:Medical Scientist Training Program
25:
162:. Many PCPs are trained in basic
2103:
2093:
2083:
2073:
2064:
2063:
961:10.1111/j.1525-1497.2006.00463.x
456:Andrews, Michelle (2019-03-15).
334:Lagging quality of care measures
2104:
792:Friedberg; et al. (2007).
130:acting as PCPs for patients on
1961:Doctor of Osteopathic Medicine
1395:Oral and maxillofacial surgery
432:Institute of Medicine (2000).
404:Institute of Medicine (1996).
74:All physicians first complete
1:
689:10.1016/S0749-3797(18)30838-9
59:and other countries the term
1941:Bachelor of Medical Sciences
1708:Neurosurgical anesthesiology
264:Dissemination of information
1219:World Health Organization:
841:Turner BJ, Laine C (2001).
770:10.1056/NEJM199603143341106
729:10.1056/NEJM199510053331406
2166:
1010:10.3163/1536-5050.95.3.246
654:10.7326/0003-4819-114-1-54
438:. National Academies Press
210:Role in health care system
2059:
1099:10.1377/hlthaff.27.3.w232
810:10.1007/s11606-007-0234-0
302:World Health Organization
1895:Transplantation medicine
1786:Clinical neurophysiology
1703:Obstetric anesthesiology
1623:Interventional radiology
1383:Digestive system surgery
1223:Retrieved 30 August 2006
1221:World Health Report-2006
1210:Retrieved 30 August 2006
1186:10.1001/jama.300.10.1154
1161:Retrieved 30 August 2006
1044:Retrieved 30 August 2006
618:10.1001/jama.279.17.1364
2140:Health care occupations
1766:Intensive care medicine
1740:Mass gathering medicine
1585:Maternal–fetal medicine
1254:10.1377/hlthaff.25.w555
203:contractually obligated
122:caring for people with
1358:Cardiothoracic surgery
373:10.3399/BJGP.2021.0340
180:differential diagnosis
65:primary care providers
40:primary care physician
35:
18:Primary-care physician
2009:Personalized medicine
1868:Reproductive medicine
1793:Occupational medicine
1747:Evolutionary medicine
33:
2029:Traditional medicine
1989:Alternative medicine
1856:Addiction psychiatry
1670:Transfusion medicine
1665:Medical microbiology
1580:Gynecologic oncology
1432:Reproductive surgery
160:physical examination
138:Emergency physicians
102:in some countries),
61:general practitioner
2051:History of medicine
2034:Veterinary medicine
1841:Preventive medicine
1693:Adolescent medicine
1535:Infectious diseases
1137:10.1056/NEJMp068155
1999:Molecular oncology
1956:Doctor of Medicine
1946:Master of Medicine
1863:Radiation oncology
1735:Emergency medicine
1688:Addiction medicine
1655:Clinical chemistry
1650:Clinical pathology
1442:Transplant surgery
1400:Orthopedic surgery
1378:Colorectal surgery
534:Am J Gastroenterol
463:The New York Times
168:electrocardiograms
36:
2117:
2116:
1951:Master of Surgery
1915:
1914:
1900:Tropical medicine
1846:Prison healthcare
1761:Hospital medicine
1725:Disaster medicine
1715:Aviation medicine
1530:Hospital medicine
1437:Surgical oncology
1422:Pediatric surgery
1416:
1363:Endocrine surgery
1180:(10): 1154–1164.
911:10.1345/aph.1E298
804:(10): 1385–1392.
570:(2): I-42. 2002.
278:Declining numbers
145:Scope of practice
108:internal medicine
16:(Redirected from
2157:
2107:
2106:
2097:
2087:
2086:
2077:
2076:
2067:
2066:
1771:Medical genetics
1756:General practice
1633:Nuclear medicine
1508:Gastroenterology
1464:Vascular surgery
1414:
1341:
1315:
1308:
1301:
1292:
1286:
1285:
1279:
1271:
1269:
1268:
1239:
1230:
1224:
1217:
1211:
1204:
1198:
1197:
1168:
1162:
1155:
1149:
1148:
1120:
1111:
1110:
1093:(3): w232–w241.
1082:
1076:
1075:
1073:
1072:
1066:
1059:
1051:
1045:
1038:
1032:
1031:
1021:
989:
983:
982:
972:
940:
931:
930:
899:Ann Pharmacother
890:
884:
880:
870:
838:
832:
831:
821:
789:
783:
782:
772:
748:
742:
741:
731:
707:
701:
700:
672:
666:
665:
637:
631:
630:
620:
596:
590:
589:
579:
556:
550:
549:
529:
523:
522:
512:
489:J Gen Intern Med
480:
474:
473:
471:
470:
453:
447:
446:
444:
443:
429:
423:
422:
420:
419:
401:
395:
394:
384:
367:(715): e84–e90.
352:
188:health behaviors
100:general practice
21:
2165:
2164:
2160:
2159:
2158:
2156:
2155:
2154:
2120:
2119:
2118:
2113:
2055:
2044:Chief physician
1977:
1922:
1911:
1905:Travel medicine
1890:Sports medicine
1873:Sexual medicine
1813:Palliative care
1808:Pain management
1752:Family medicine
1730:Diving medicine
1676:
1604:
1566:
1559:
1475:
1468:
1427:Plastic surgery
1373:General surgery
1353:Cardiac surgery
1334:
1332:
1324:
1319:
1289:
1272:
1266:
1264:
1237:
1232:
1231:
1227:
1218:
1214:
1205:
1201:
1170:
1169:
1165:
1156:
1152:
1122:
1121:
1114:
1084:
1083:
1079:
1070:
1068:
1064:
1057:
1053:
1052:
1048:
1039:
1035:
991:
990:
986:
942:
941:
934:
892:
891:
887:
840:
839:
835:
791:
790:
786:
750:
749:
745:
709:
708:
704:
674:
673:
669:
639:
638:
634:
611:(17): 1364–70.
598:
597:
593:
558:
557:
553:
531:
530:
526:
482:
481:
477:
468:
466:
455:
454:
450:
441:
439:
431:
430:
426:
417:
415:
403:
402:
398:
354:
353:
349:
345:
336:
297:
295:Maldistribution
280:
275:
266:
238:quality of care
234:
232:Quality of care
212:
192:screening tests
164:medical testing
156:medical history
147:
132:kidney dialysis
96:family practice
92:family medicine
28:
23:
22:
15:
12:
11:
5:
2163:
2161:
2153:
2152:
2147:
2142:
2137:
2132:
2122:
2121:
2115:
2114:
2112:
2111:
2101:
2091:
2081:
2071:
2060:
2057:
2056:
2054:
2053:
2048:
2047:
2046:
2036:
2031:
2026:
2021:
2016:
2011:
2006:
2001:
1996:
1991:
1985:
1983:
1982:Related topics
1979:
1978:
1976:
1975:
1974:
1973:
1963:
1958:
1953:
1948:
1943:
1938:
1933:
1931:Medical school
1927:
1925:
1917:
1916:
1913:
1912:
1910:
1909:
1908:
1907:
1897:
1892:
1887:
1885:Sleep medicine
1882:
1881:
1880:
1870:
1865:
1860:
1859:
1858:
1848:
1843:
1838:
1832:
1827:
1826:
1825:
1815:
1810:
1805:
1800:
1795:
1790:
1789:
1788:
1778:
1773:
1768:
1763:
1758:
1749:
1744:
1743:
1742:
1732:
1727:
1722:
1717:
1712:
1711:
1710:
1705:
1698:Anesthesiology
1695:
1690:
1684:
1682:
1678:
1677:
1675:
1674:
1673:
1672:
1667:
1662:
1657:
1652:
1647:
1637:
1636:
1635:
1630:
1628:Neuroradiology
1625:
1614:
1612:
1606:
1605:
1603:
1602:
1597:
1592:
1587:
1582:
1577:
1571:
1569:
1565:Obstetrics and
1561:
1560:
1558:
1557:
1552:
1547:
1542:
1537:
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1390:Neurosurgery
1276:cite journal
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1567:gynaecology
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1330:Specialties
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2150:Pediatrics
2135:Physicians
2124:Categories
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1590:Obstetrics
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1488:Immunology
1267:2006-11-06
1238:(abstract)
1071:2006-08-30
469:2019-03-18
442:2006-08-30
418:2006-08-30
343:References
273:Challenges
120:allergists
104:pediatrics
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1923:education
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1776:Narcology
1640:Pathology
1618:Radiology
1493:Angiology
1457:Andrology
284:residents
114:consider
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