What most Americans used to refer to as a “general practitioner”, “family doctor” or “internist” is now called a primary care physician (PCP). This term has become more popular since the advent of managed care, in which many health insurance plans do not provide coverage for services provided by a medical specialist unless a primary care physician has made a referral first. While this practice may seem inconvenient, there are several good, common-sense reasons for it.
The PCP plays several important “coordinator” and “gatekeeper” roles in this arrangement. It is almost always more effective and less costly for a patient to see their primary care physician first so that the PCP can direct and coordinate care with the patient’s overall health in mind. It’s also more efficient, since patients themselves are less likely to know which specialist can best diagnose and treat their problem and since specialized care is usually significantly more expensive. In the United States, MDs (medical doctors), DOs (osteopaths) and DCs (chiropractors) are generally recognized as “first-contact” healthcare providers, with the training necessary to diagnose and treat a range of health concerns and to make referrals to other medical specialists as appropriate.
So what exactly does a PCP do? A PCP can perform basic diagnoses and treatments of common medical conditions and illnesses, such as sinus infections, stomach problems and skin rashes. They take a thorough medical history, perform physical exams and can order and interpret basic diagnostic tests such as blood tests, urine tests and x-rays. They can also treat such chronic conditions as allergies, asthma, high blood pressure and diabetes. Beyond this general scope of practice, a PCP will usually refer patients requiring more complicated tests and procedures to a specialist.
Most PCPs can provide their patients with screening tests, physicals, women’s health services (including prescribing birth control), immunizations, and counseling on healthy lifestyle behaviors. Depending on your condition, your PCP will discuss different treatment options with you and provide advice about the best specialists to see. In particular, studies have shown that PCPs are better than specialists at providing effective preventive health care. For example, patients seeing a PCP were more likely to receive a preventive flu vaccination than those seeing a specialist. And women were more likely to go for a mammogram on the advice of their PCP.
The number of PCPs is currently in decline, as more physicians are training to become specialists. The number of medical students who enrolled in training as primary physicians in the US dropped by half between 1997 and 2005. Specialists tend to earn more than PCPs due to more extensive training and expertise, which helps to pay off the staggering debts incurred by the high cost of medical school. The median income of specialist physicians in 2004 was approximately twice that of PCPs, and the gap is growing larger all the time. The US has been looking to students graduating from foreign medical schools to help fill the need for more PCPs in the US.
According to Dr. Steven Berk, Dean of the School of Medicine at Texas Tech University, “The doctor shortage is worse than most people think. The population is getting older, so there’s a greater need for primary care physicians. At the same time, physicians are getting older, too, and they’re retiring earlier.”
Most observers believe that the new Affordable Care Act will put an additional strain on the primary care system. For this reason, additional funds have been appropriated for increasing the primary care workforce by training more doctors, nurses, nurse-practitioners and physician assistants. It also includes more loans and scholarships for physicians to enter general medicine and gives priority educational training positions to those entering primary care and general surgery. This will hopefully help to stem the loss of PCPs from the health system in which they are so sorely needed.
