Friday 12 October 2012

What are Primary Care Specialties?

There is often confusion regarding what constitutes primary care and what is a primary care physician. This I likely because there is no universal definition of this term and different governing, executing agencies have their own working definitions of primary care. Applicants who are interested in pursuing graduate medical education need to able to identify which residency training is primary care and which is not. Also one must be careful to distinguish primary care training from "primary care track" graduate medical training programs. 

Definition of primary care

Agency for health care research and quality (AHRQ) defines primary care using the Institute of Medicine (IOM) definition which states that, primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. This definition while useful does not directly define who is or is not a primary care physician. Does a pediatrician fit the above definition? Does a psychiatrist fit the above definition? Superficially they do seem to fit and there for the issue as to what are the core primary care specialties is important.

Extending this concept a little further, Centers for Medicare and Medicaid services (CMS) provides a definition which says, A physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine for whom primary care services accounted for at least 60 percent of the allowed charges under Part B for the practitioner in a prior period as determined appropriate by the Secretary. Thus FM, IM and pediatrics are primary care specialties. Geriatrics, which is a fellowship after IM is also thus part of IM. 
What about other specialties?

This leaves out a subset of physicians who may provide a service that may seem like primary care but are not defined as primary care providers. Some organizations also include gynecologists as primary care providers for women because they provide primary care services to that segment of population. Are psychiatrists providing primary care to cater to mental health? As it stands, family medicine and GPs are trained to evaluate and treat basic mental health issues, and referral is required for those issues that need specialization. Thus to that effect, psychiatry is not considered primary care. State boards often include their own definitions of what constitutes a primary care physician. For example, Texas medical board indicates that physicians are those who indicate that they have a primary specialty of General Practice, Family Practice/Medicine, Internal Medicine, Pediatrics, Obstetrics and/or Gynecology, or Geriatrics, and are a sub-set of Direct Patient Care Physicians.

What about the numbers of existing primary care provider? In 2010, there were approximately 209,000 practicing primary care physicians in the U.S., according to research commissioned by the Agency for Healthcare Research and Quality (AHRQ). Of the 624,434 physicians in the United States who spend the majority of their time in direct patient care, slightly less than one-third are specialists in primary care. With in primary care 24% are pediatricians, 31% are trained in internal medicine and 45% are trained in family medicine [1].

Hopefully this article will help clarify, what constitutes a primary care provider as far as residency application is concerned. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter. Also Scroll below  for the most popular articles this week!


1. Primary Care Workforce Facts and Stats No. 1: The Number of Practicing Primary Care Physicians in the United States. AHRQ Publication No. 12-P001-2-EF, October 2011. Agency for Health Care Policy and Research, Rockville, MD.]

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