Should Your Primary Care Physician be a Generalist or a Specialist? New Study Sheds Light on Benefits vs Costs


JAGS graphicJournal of the American Geriatrics Society Research Summary

Your primary care provider (PCP) is usually your first medical contact when you’re ill. Beyond taking care of you when you’re sick, PCPs help coordinate your health care and make sure you’re up-to-date with your check-ups, tests, and immunizations.

Typically, PCPs are family medicine practitioners, general internists, pediatricians (for children) and geriatricians (for older adults). Some health plans, such as health maintenance organizations (HMOs), require you to choose a PCP whom you must see first before being referred to specialists when necessary. These PCPs play a special role in coordinating your care.

However, other plans—including traditional Medicare and most preferred provider organizations (or PPOs), don’t require you to see a PCP before seeking more specialized care. As a result, many people may see a specialist as their main doctor rather than a PCP who would act as “gatekeeper.”

Recently, researchers studied which option provided the best outcomes for older adults: Seeing a PCP or seeing a specialist for most of a person’s outpatient care (care you receive outside a hospital). The research team published their findings in the Journal of the American Geriatrics Society.

The researchers studied data from nearly 4 million Medicare beneficiaries over the age of 65 who had at least two or more chronic conditions. The researchers compared the number of hospitalizations the participants experienced, as well deaths and total medical costs for the people who saw PCPs versus the people who saw specialists without a PCP “gatekeeper.”

According to study findings:

  • More than 30 percent of older adults with multiple chronic conditions used a specialist as their main doctor. These people had less continuity of care—the term for making sure your healthcare professionals are coordinating your ongoing health management—and made more outpatient visits to more healthcare providers.
  • All hospitalizations and costs were higher among the group who mostly saw specialists.
  • People who saw PCPs saw fewer doctors and also had fewer hospitalizations and lower costs.

The researchers concluded that that the health outcomes of older adults who use PCPs, compared with the outcomes of those whose main doctors were specialists, are about the same. However, the costs of seeing specialists rather than PCPs tend to be higher, due to more testing and hospitalizations. This certainly doesn’t mean that specialist care isn’t important for many people in many different situations; it simply means that working with a PCP as your first or main healthcare contact may contribute to higher quality, more person-centered care.

“Make sure you know which of your doctors is in the quarterback role, helping to coordinate your care. One way to do that is to ask him or her, ‘Are you the person I should have all my other doctors send my records to?’” advises study co-author Julie P.W. Bynum, MD, MPH, Associate Professor, Geisel School of Medicine at Dartmouth; Associate Professor, Medicine and Community & Family Medicine; and Associate Professor of The Dartmouth Institute for Health Policy & Clinical Practice (TDI).

This summary is from “Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty.” It appears online ahead of print in the April 2017 issue of the Journal of the American Geriatrics Society. The study authors are Julie P.W. Bynum, MD, MPH; Chiang-Hua Chang, PhD; Andrea Austin, PhD; Don Carmichael, MDiv; and Ellen Meara, PhD.

7 thoughts on “Should Your Primary Care Physician be a Generalist or a Specialist? New Study Sheds Light on Benefits vs Costs

  1. Good to know the difference on what is the general people chooses between Generalist or Specialist. Meaning, it’s all about your needs or what type of condition you are having. Having a health insurance is really beneficial when the time comes for medical treatment.

  2. You article had some really good insight as to what kind of primary care physician to see. I noticed you mentioned seeing a generalist might give better continuity of care in addition to being less expensive. I’ll definitely keep this in mind for the future since I’ll be moving to a new state and will need to find a PCP for myself.

  3. I appreciate it when you said that some health organizations prefer that the person sees a PCP first before being referred to a specialist that. If that is the case, then it really is vital that I have a PCP to work with for my situation. After all, there are times when my condition does not really require that I see a specialist. At least, by having a doctor, I can make better and proper choices.

  4. I understand it when you said that some medical or health plans require the person to see a PCP first before they get in touch with a specialist. To be honest, I do think that unless the person is a bit too old or is chronically ill, it is a good idea to visit a family doctor first. Anyway, since there is no one in the house that is chronically ill, I think it makes sense that I look for a family doctor. Surely that is easier to find than a specialist.

  5. It’s good to know more about having the right doctor. I like how you said that not using a specialist means you’ll get more continuity of care. It makes sense that we should have a general doctor around for all of our health issues.

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