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Should your primary care physician be a generalist or specialist? New study explores

June 06, 2017

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).
-end-
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.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has -- or 75 years -- worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.

American Geriatrics Society

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