What exactly is primary care?

[killswitch1968]

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From what I've been reading, Primary is composed of:
Obs/Gyn, Family Medicine, and Pediatrics.

Then there are internists and their subspecialties.

Here's where I get confused. What about Dermatologists, Cardiologists, are they considered "specialists"? Aren't pediatricians specialists?

Where do GPs fit into this scene?

Thanks a bunch

 

[Scrubbs]

Primary Care is generally considered Pediatrics, Internal Medicine (without specialty), Ob/Gyn, and Family Med (combo of all 3). These are your general "I got sick so I went to the doctor" folks.

All the other specialties (e.g. Surgery, Ortho, Derm, Rads, EM, ENT, Ophtho, etc) are specialists. Things like Cardiology, GI, Nephrology, Oncology are specialties that require a fellowship after an Internal Medicine or Peds residency.

Yes, Peds is a specialty, in the sense that they only see kids. But, they are primary care because they care for your everyday illnesses and well-child stuff. You can do a fellowship after peds, just like you can specialize after Internal Med.

 

[Apollyon]

I still, to this day, can't get my head around why EM isn't primary care. For a signifigant percentage of the US population, their regular care is in EDs. These are the same people who, if they went to clinic, would not follow through on the gazillion referrals and subspecialty clinic visits that would be proffered.

 

[R U SED 8]

Originally posted by Apollyon
I still, to this day, can't get my head around why EM isn't primary care. For a signifigant percentage of the US population, their regular care is in EDs. These are the same people who, if they went to clinic, would not follow through on the gazillion referrals and subspecialty clinic visits that would be proffered.

My hunch is that the phrase "primary care" has more to do with the physician than the specialty. You're right that gobs of people seek regular care in EDs, but in theory the ERs are supposed to treat those acute cases that can't wait for the "regular" doc., and thereby EMs have no long-term interest in the patient. The FPs, IMs, OB/GYNs and Peds are docs who have (supposedly) built relationships with their patients and can addresses their well-care visits in addition to any pathology.

 

[Brewster]

I agree with RUSED8, but just to my own spin on it...

I feel that "primary care" is about long-term relationships with patients and about caring for chronic as well as acute illness. Also, I feel that a very important (almost fundamental) aspect of primary care is preventative medicine.

The ER is equipped to deal with acute problems (or acute exacerbations of chronic problems) but is not really in a position to deal with chronic issues or prevention.

 

[docB]

The ER is equipped to deal with acute problems (or acute exacerbations of chronic problems) but is not really in a position to deal with chronic issues or prevention.

Right on! The majority of us in EM don't want the lable of primary care even though we do a ton of it (reluctantly). Fact is we're not set up to do it well and most of us don't. Now, having aknowledged this, the flip side of the coin is that it is out and out wrong for the PMDs out there to abuse the ED by using us as thier after hours and overflow clinics. A PMD telling a patient with poorly controlled diabetes to go to the ER because he doesn't have time to see him is analogous to me saying "I'm too busy to intubate you, go see your primary doc."

 

[killswitch1968]

So what are GPs then?

 

[Brewster]

My understand is that GP (general practitioner) is someone who has completed medical school, done 1-2 years of residency, passed USMLE 1-3, has a medical license, but has not a completed a residency and is not board certified in any specialty.

So, for purposes of clarification:
Internal medicine/pediatrics/FP are all "specialties" despite the fact that they are the "primary care" fields. However in this day and age most people mean derm/ortho/cardiology/etc when they say "specialist."
All states that I am aware of require you to complete 1-2 years of post-graduate training (length varies by state) and pass USMLE 1-3 in order to obtain a medical license. Once you have a medical license, you can quit residency and hang up a shingle if you really want to.

However, most would advise again this. It might be ok for rural areas, but you are going to have a really hard time competing with board eligible/board certified specialists if you do this.

 

[DrMom]

Originally posted by Brewster
My understand is that GP (general practitioner) is someone who has completed medical school, done 1-2 years of residency, passed USMLE 1-3, has a medical license, but has not a completed a residency and is not board certified in any specialty.

However, most would advise again this. It might be ok for rural areas, but you are going to have a really hard time competing with board eligible/board certified specialists if you do this.

All very true. Also, some older docs call themselves GPs, but are basically old-school FP (from before standard residencies).

Today, it really isn't a good idea to forgo the residency & become a GP. Not only will you have a hard time competing with board certified FP & IM docs, but also the managed care insurance companies aren't usually willing to enter into contracts with you. That can severely limit the # of patients who can choose you as their Dr.

 

[killswitch1968]

Originally posted by Brewster
"you can quit residency and hang up a shingle"

What the heck is hanging up a shingle?

 

[DrMom]

Originally posted by killswitch1968
What the heck is hanging up a shingle?

starting your practice.

 

[dobonedoc]

Being the child of a health care administrator, I was raised with terms like HMO, PPO, capitation, and Primary care.

Trying to remember what we spoke about around the table, it goes something like this:

Primary Care got its start with the development of HMOs. They were the physicians a patient could see without a referal, and would, in turn, give the referals to see the specialists. They were viewed as "Gate Keepers," in an effort to keep HMO members from going to the Orthopedic surgeon every time they bumped their toe.

Though insurance plans vary, the typical PCPs include FP, General Internal Medicine, Peds, OB/Gyn, and in some cases Psych.


As for your original question: "What is primary care?"
My answer is: "Painful and Boring!"

Good Luck!