Primary care physician

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A primary care physician (US; UK "general practitioner" or "GP") is the doctor who is predominantly responsible for a patient's health. One of the tasks of the primary care physician is coordinating the many facets of a patient's health care and chronic diseases.[1]. Generalists physicians are more tolerant of being responsible for breadth of knowledge than are subspecialists.[2]

Most common reasons to see a primary care physician

Most common reasons for an office visit:[3]

  • Cough
  • Knee symptoms
  • Stomach and abdominal pain,
  • Symptoms referable to throat
  • Back symptoms
  • Earache, or ear infection
  • Skin rash
  • Shoulder symptoms
  • Vision dysfunctions

Most common reasons for a visit to the Emergency department:[4]

  • Stomach and abdominal pain
  • Chest pain and related symptoms
  • Fever
  • Headache, pain in head
  • Back symptoms
  • Shortness of breath
  • Cough
  • Pain, site not referable to a specific body system
  • Vomiting
  • Symptoms referable to throat

(include earache for visits by patients under 15 years old)

Studies of the quality of care provided by primary care physicians

Availability of primary care physicians in the physician workforce is associated with favorable clinical outcomes[5] and less regional variation in medical procedures.[6]

Studies that compare the knowledge base and quality of care provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care. [7][8][9] However, these studies examine the quality of care in the domain of the specialists. In addition, these studies need to account for clustering of patients and physicians. [10]

Studies of the quality of preventive health care find the opposite results - primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists, were more likely to receive influenza vaccination. [11] In health promotion counseling, a study of self-reported behavior found that generalists were more likely than internal medicine specialists to counsel patients [12] and to screen for breast cancer. [13] Likewise, generalists are more accurate in selecting patients for screening for cervical cancer.[14]

Exceptions may be diseases that are so common that primary care physicians develop their own expertise:

  • A study of patients with acute low back pain found the primary care physicians provided equivalent quality of care, but at lower costs that orthopedic specialists. [15] Another study found that orthopedics surgeons may be less aware of current knowledge than primary care physicians.[16]
  • Regarding the treatment of pain in general, two studies found specialists were more likely to adopt cyclooxygenase 2 inhibitor drugs before the drug rofecoxib was withdrawn by its manufacturers because of its unanticipated adverse effects [17][18]. One of the studies went on to state:
"using COX-2s as a model for physician adoption of new therapeutic agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication".[18]

The highest quality care may occur with primary care physicians and specialists collaborate.[21][22]

Factors associated with quality of care by primary care physicians include:

  • The more experience the primary care physician has with a specific disease. [23]
  • Physician group affiliation with networks of multiple groups.[24]

Studies of the consequences of lack of primary care

When patients lose their primary care physician, have increased healthcare costs[25].

Markers of high quality in primary care

Use of electronic health records.[26][27]

Team-based, or collaborative care.[28]

Longer visit length.[29] However, over time, the number of items discussed during each visit has risen more than the length of a visit.[30]

Frequency of visits when medical problems are not controlled.[31]

Physicians with higher text scores in training may deliver better health care.[32]

Job satisfaction

A qualitative survey of internal medicine doctors in the United States found three sources of satisfaction from medical practice:[33]

  1. realizing a fundamental change in perspective via an experience with a patient
  2. making a difference made in someone's life
  3. connecting with patients

Part-time practice is associated with increased satisfaction.[34]


The increasing number of items to discuss during a patient visit is a problem[30] in spite of the increasing length of visits[29]. There is insufficient time to address:

Longer visits are associated with greater quality.[29]

Primary care physicians may be more likely to leave practice than specialists.[37]

Conflict of interest

Primary care physicians practicing in fee-for-service plans may be more susceptible to conflict of interest in their ordering of medical services.[38]

Collapse of primary care in the United States

The number of physicians entering primary care in the United States is dropping, probably in part due to making less income for the amount on time spend with patients.[39]

In addition, non-physicians may replace much of the work of primary care physicians.[40][41] This disruption has been predicted by Clayton Christensen in his book, The Innovator’s Prescription: A Disruptive Solution for Healthcare[42]

Alternative financial compensation models have been proposed.[43] These models include the medical home[44], ambulatory intensive caring unit, and retainer model of compensation has been proposed to solve this problem (also called concierge medicine).[45]


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See also