The Value & Scope of Primary Care

Research shows that countries that emphasize primary care have better health outcomes at lower costs. As the United States struggles to improve health care delivery, it is clear that primary care providers, especially family physicians, are key to a more effective system.

Primary Care Defined

The Institute of Medicine defines primary care as “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.” According to the 20th report of the Council on Graduate Medical Education (COGME) on Advancing Primary Care(, research shows that health care outcomes and costs in the United States are strongly linked to the availability of primary care physicians. Patients with access to a regular primary care physician have lower overall health care costs than those without one, and health outcomes improve. 

Research shows that preventive care, care coordination for the chronically ill, and continuity of care – all hallmarks of primary care medicine – can achieve better health outcomes and cost savings. With the passage of the Affordable Care Act in 2010, health care reform is moving in a direction that puts primary care at the forefront of the U.S. health care system through the implementation of measures that:

  • Increase patient access to health care insurance coverage,
  • Incentivize the provision of preventive health care services and align health care provider payments with patient health outcomes, and
  • Increase the primary care physician workforce.

Simply put, primary care is the backbone of the health care system. Utilizing primary care physicians puts an emphasis on the physician-patient relationship by shifting the focus from physician-centered care to patient-centered care.

Scope of Family Medicine

Of the primary care specialties (family medicine, general internal medicine, and pediatrics), family physicians provide the most care, managing nearly one-fourth of all primary care visits. Given the scope of family medicine, this comes as no surprise.

Family medicine is a three-dimensional specialty, incorporating:

  1. Knowledge
  2. Skill
  3. Process

At the center of the process element is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured, and maintained that distinguishes family medicine from all other specialties.

Family physicians integrate the biological, clinical, and behavioral sciences to provide continuing and comprehensive health care. Unlike pediatricians, who only provide care for children, and internists, who only provide care for adults, family medicine encompasses all ages, sexes, each organ system, and every disease entity. Family physicians also pay special attention to their patients’ lives within the context of family and the community. While there are similarities between family medicine and the other primary care specialties, family physicians have an unprecedented opportunity to have an impact on the health of an individual patient over that person’s entire lifetime.

Demand for Family Physicians

The case for maintaining an adequate family physician workforce is strong. Studies reveal that:

  • Family medicine reduces health care costs and increases health care quality.
  • Family physicians are geographically distributed across the country more equitably than physicians from any other specialty.
  • Family physicians are geographically and financially more accessible to disadvantaged populations that lack access to quality health care than other primary care physicians, which in turn helps to reduce health disparities.
  • Individuals who regularly visit a family physician are more likely to receive preventive services, better management of chronic illnesses, and decreased chance of premature death.

Recruitment data indicate that family physicians are in demand. According to Merritt, Hawkins & Associates, family physicians have been the most recruited physicians for hospitals, medical groups, and health care organizations for eight years in a row (see table).

Family Medicine2013-2014: 7142012-2013: 6242011-2012: 631
2010-2011: 532
Internal Medicine2013-2014: 2352012-2013: 1942011-2012: 2352010-2011: 295
Hospitalist2013-2014: 2312012-2013: 1782011-2012: 1552010-2011: 160
Psychiatry2013-2014: 2062012-2013: 1682011-2012: 1682010-2011: 133
Nurse Practitioner
2013-2014: 1282012-2013: 692011-2012: 232010-2011: N/A
Pediatrics2013-2014: 922012-2013: 87
2011-2012: 702010-2011: 64
Emergency Medicine
2013-2014: 892012-2013: 1112011-2012: 1062010-2011: 92
OB/GYN2013-2014: 702012-2013: 772011-2012: 812010-2011: 80
Physician Assistant
2013-2014: 612012-2013: 502011-2012: 222010-2011: N/A
Neurology2013-2014: 612012-2013: 712011-2012: 412010-2011: 79
General Surgery
2013-2014: 582012-2013: 742011-2012: 1302010-2011: 69
Orthopedic Surgery
2013-2014: 582012-2013: 572011-2012: 1052010-2011: 104
2013-2014: 542012-2013: 372011-2012: 512010-2011: 32
Hematology/Oncology2013-2014: 502012-2013: 452011-2012: 532010-2011: 35
Otolaryngology2013-2014: 322012-2013: 402011-2012: 402010-2011: 31
Cardiology2013-2014: 322012-2013: 382011-2012: 462010-2011: 26
Urology2013-2014: 292012-2013: 262011-2012: 572010-2011: 56
Neurosurgery2013-2014: 202012-2013: 232011-2012: 122010-2011: 7
Pulmonology2013-2014: 182012-2013: 242011-2012: 682010-2011: 32
Endocrinology2013-2014: 172012-2013: 222011-2012: 162010-2011: 14