Patients often seek general medical care from specialists

A shortage of primary care physicians and patients’ belief that specialized doctors can better treat specific conditions may contribute to the finding, a report says.

By Christine S. Moyer — Posted Sept. 7, 2012

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When adults have a fever, nasal congestion or a common condition such as asthma, many seek medical care from a specialist rather than a primary care physician. The percentage of patients visiting specialists for such care, however, has remained fairly steady over a decade.

In 2007, 43% of patients with such symptoms or illnesses visited a specialist, nearly unchanged from the 42% who did so in 1999, according to a research letter published online Aug. 20 in Archives of Internal Medicine (link). Specialists included internal medicine subspecialists, neurologists and obstetrician-gynecologists.

The number of patients seeking primary care from specialists “is remarkably higher than we expected,” said lead study author Minal S. Kale, MD. “It points to an ongoing issue with how our primary care is delivered.”

Possibly contributing to the findings is the belief by some patients that specialists are better able to treat specific conditions than general physicians, said Dr. Kale, a fellow in the division of internal medicine at Mount Sinai School of Medicine in New York.

Another factor could be that the nation’s shortage of primary care physicians is leading patients to obtain medical services from specialists. By 2020, there will be an estimated shortage of 45,000 primary care doctors, according to the Assn. of American Medical Colleges’ Center for Workforce Studies. AAMC officials attribute the widening gap to increased demands from the aging baby boomer generation and expansion of coverage to uninsured Americans under the health system reform law.

For the Archives study, researchers examined National Ambulatory Medical Care Survey data on how frequently patients 18 and older visited generalists and specialists for primary care services in 1999 and 2007. They looked at overall visits for primary care services, appointments for common symptoms and diseases, and visits for general checkups, such as annual physicals.

The study looked at data on 8,730 outpatient visits for primary care services in 1999. Of those visits, 59% were to primary care doctors, 9% to internal medicine subspecialists, 5% to ob-gyns and 27% to other specialists. In 2007, data on 12,229 visits for primary care showed that the proportion of patients who saw a generalist or specialized doctor did not change significantly from 1999.

When patients sought medical care for common symptoms and conditions, 58% went to a primary care physician in 1999 and 57% did so in 2007. Slightly more people visited generalists for a standard checkup — 66% in 1999 and 71% in 2007, data show.

More research is needed on why so many people seek primary care services from specialists and whether specialized care is appropriate in those situations, Dr. Kale said.

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