A trend?
Other specialists crowd primary care picture, study says
|
George Fryer
Jr., Ph.D.: |
Who's eating up primary care in your state? A new study suggests that a good chunk of it is being bitten off by physicians whose main specialty is not primary care.
This is the case in Colorado, where specialists outside primary care fields are providing as much as a third of the primary care medical services, according to a study by the Robert Graham Center in Washington. The study, "Specialist Physicians Providing Primary Care Services in Colorado," was published in the March/April Journal of the American Board of Family Practice.
Graham Center analyst George Fryer Jr., Ph.D., the study's lead author, said the results raise questions about the level of training and experience of the subspecialists providing primary care.
"The significant amount of primary care services provided by nonprimary care specialists should be taken into consideration when researchers and policy-makers are looking at workforce needs," Fryer said. "Are there enough primary care physicians available to meet the need? Our research suggests not."
The study identified as specialists those physicians whose main specialties were other than family medicine, general practice, general internal medicine or general pediatrics.
The research found that of the 47.9 weekly hours that specialists averaged in direct patient care, 12.5 hours were devoted to primary care activity -- defined as preventive care, routine physicals and treatment of common ailments.
About a third of the specialists devoted at least one-quarter of their time to primary care, and 26 percent spent half or more of their direct patient care time in primary care. The authors figured that specialists provided 33.5 percent of the primary care services in Colorado.
Other recent research revealed that the care specialists provide outside their field of specialization is of lower quality than that provided by primary care physicians. Patients may not be receiving the best possible primary care from the nonprimary care specialists, Fryer said. The Graham Center study did not directly measure quality but opens the door to studies on the quality differential, he added.
The research showed that the specialists providing primary care tended to be female, rural, either under 35 or over 64, and not board-certified. Further, osteopathic specialists were more likely to provide primary care services than allopathic specialists. Physicians in emergency medicine and obstetrics-gynecology were the most numerous specialists providing primary care.
The survey did not explore whether specialists' provision of primary care reflected professional choice or a need to fill available clinical time.
"Our study suggests that family physicians provide a service for which there is substantial demand," Fryer said. "By contrast, demand for the services of some specialists is not sufficient to assure robust patient caseloads.
"Our results suggest that specialists may be in oversupply."
To reach writer J. Michael Brodie, e-mail mbrodie@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2004 by
American Academy of Family Physicians.