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Primary care vs. specialty care clinic

Discussion in 'General Residency Issues' started by sdnetrocks, 09.01.05.

  1. sdnetrocks

    sdnetrocks Senior Member

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    SDN 7+ Year Member

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    After just a few rotations, I've noticed a huge difference in the ways that primary clinics and specialty clinics work.

    In my experience, the primary care clinic is usually jammed with patients that are assigned short appointments. This clinic is usually well-staffed with allied helath personnel (MAs, RNs, NPs, etc.), and the patient is handled by scores of people before the attending walks in. The interaction with the attending is very focused and brief, and the visit is wrapped up by allied health, while the attending runs off to see the next of ~30 patients that day.

    In contrast, the scheduling in the specialty clinic tends to be very loose, with generous appointments (30-45-60 minutes). There is little allied health, and in fact, the attending may be the only medical professional the patient sees (calling the patient in from waiting room, taking vital signs, etc.). The visit is very relaxed and leisurely, and the patient has plenty of time to describe all of their concerns, whether they are relevant or not. There is ample time to answer questions, and the patient feels satisfied with the amount of time and attention from the doctor. The attending may see 10 patients maximum in a day.

    The ironic thing is that the physician in scenario #2 is likely the one to have the larger income!

    Are my impressions of primary and specialty care clinics generally true, or am I being led astray by a sampling error? And, basically, is it just that specialists charge more for their appointments than generalists?
  2. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    Physician SDN Published Author SDN 10+ Year Member
    One thing that heavily impacts all this is billing (just like everything else in medicine). Primary care docs are poorly reimbursed and have to increase their volume and efficiency to compensate. Their only source of billing is from the office visits. Specialists, on the other hand, generate much of their billing from procedures which have traditionally billed higher. For that reason they are not forced (as much) to pack the clinic schedule. Primary docs live off their clinics and specialists live off procedures. The specialists run a clinic to support thier procedural work. That's a big part of the difference.

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