Having a primary care doctor and getting routine care and health screening services from such a provider has been linked with improved overall health and longevity in an increasing number of studies. For example, a 2019 case study in the journal JAMA Internal Medicine noted that people living in U.S. counties with a higher number of primary care physicians had longer life expectancies. The study noted that each 10 additional primary care physicians per 100,000 people was associated with a 51.5-day increase in life expectancy.
Those findings support the notion that primary care providers play a very important role in the health of their patients.
But primary care isn’t always one monolithic form of care — there are some variations and specializations within the field. And knowing more about the different types of primary care physicians available could help you better select the right provider for your situation.
Types of Primary Care Providers
Dr. Chris Jaeger is vice president of care redesign and chief innovation officer at Pacific Business Group on Health, a nonprofit organization that aims to improve quality while moderating costs across the U.S. health system. He says the following five categories of primary care providers make up the constellation of primary caregivers. You may well work with one or more during your lifetime as your health needs change:
For many people, the concept of a primary care physician conjures up images of the family practitioner — one doctor who can provide primary care for every member of the family, no matter their age.
Dr. Richard Seidman, chief medical officer of L.A. Care Health Plan, the largest publicly operated health plan in the U.S., says that being able to work with the whole family “is unique to family medicine physicians.” He notes that a family medicine doctor can be “very appealing to some families and is sometimes a better fit in smaller communities that can’t support two or more physicians to cover patients of all ages.”
To be able to provide this full-spectrum range of care, family medicine physicians “complete three years of training covering patients of all ages, including women’s health care,” Seidman says.
Dr. Sophia Tolliver, clinical assistant professor of family medicine at the Ohio State University Wexner Medical Center in Columbus, adds that family medicine physicians can provide “women’s health examinations like pelvic exams and cervical cancer screenings — usually in the outpatient setting.” In addition, “some family medicine physicians also work in the inpatient hospital setting,” where they may “manage and deliver pregnant women.”
Internal Medicine Physicians
Internal medicine doctors typically work with adults and may also see geriatric patients. This care is typically rendered in a hospital setting, Tolliver says, “although they can practice in an outpatient setting as well. They usually don’t follow children or provide women’s health services.”
Also called internists, internal medicine physicians specialize in diagnosing, treating and preventing disease in adult patients. They must complete a three-year residency and may also have additional training in a subspecialty such as neurology, endocrinology, dermatology, rheumatology or another field.
The primary difference between an internist and a family medicine doctor is that an internal medicine physician would need additional training to treat children and may not handle women’s health. But they may be more specialized in another area, such as managing diabetes or another chronic condition.
Jaeger notes that when someone uses the term “primary care doctor,” most of us think of a provider who works with adults. But pediatricians shouldn’t be overlooked because “the preventive care and especially childhood immunizations they provide are critically important.”
Pediatric practitioners work with children up to 18 years of age and occasionally continue working with a patient into young adulthood. Experts on child development, pediatricians are well positioned to react when a child isn’t meeting developmental milestones or develops certain diseases or conditions that tend to occur more frequently in children, such as chickenpox or earaches.
Tolliver notes that many pediatricians work in an outpatient setting, but “some pediatricians practice inpatient medicine and take care of children in the hospital.” There’s also a “hybrid specialty,” called medicine/pediatrics or med/peds, “who are physicians who have trained in both adult and pediatric medicine,” she explains.
These providers specialize in women’s health, including common primary care for women of childbearing years, such as routine pelvic exams, conducting Pap smears and counseling about family planning. “Some women of childbearing age elect to use their OB-GYN physician as their primary care physician,” Seidman notes.
Much like a pediatrician takes special care of babies, children and teenagers, at the other end of the age spectrum, geriatricians are well-versed in the specific health needs of older adults.
Geriatricians are internists who have additional training in the specific health needs of older adults and understand the complexities of how the body changes with age. They serve an important primary care role in monitoring for common conditions that increase in prevalence with age and they help seniors manage chronic diseases such as diabetes, Parkinson’s disease, osteoporosis and memory loss.
Typically, patients are advised to consider switching to a geriatrician once they’ve turned 65 or when their medical needs demand a more age-focused management approach. Geriatricians work in both outpatient and inpatient settings, and some work with nursing homes and other long-term care facilities to treat the people living there.
No matter where you see a geriatrician, working with this type of primary care provider can be a powerful means of staying healthy well into your golden years.
A Team Approach
Jaeger also notes that while in popular parlance primary care providers are often thought of as doctors or physicians — and many are — they aren’t the only health care professionals who can provide this type of care.
“Advanced primary care is team-based and patient-centric,” he notes, and in many practices, it’s not just a single doctor, but a whole group of providers who can offer the right care when needed.
Nurse practitioners or advanced practice nurses and physician assistants are playing an ever increasing role in providing primary care services to patients, particularly as a shortage of primary care physicians is anticipated in the coming years.
These team members work closely together and with physicians to provide continuity of care that puts patients at the center of the practice. Primary care is “longitudinal, with relationships of the patient with team members for their needs — the team knows the patients,” Jaeger says.
“It’s whole-person and integrated care,” he adds, meaning that primary care providers can address everything from colds and flu to behavioral health, mental health and social factors that could be impacting health.
This holistic and ongoing approach to primary care “provides much of the care, and usually better and more cost-effectively,” than if patients were trying to refer themselves to specialists rather than working with a primary care team and their network of specialists as needed, Jaeger says.
Tolliver agrees that primary care provides “a special opportunity for patients and physicians to develop long-term clinical relationships focused on the health of the patient, prevention of disease and promotion of overall well-being. I encourage everyone to follow with a primary care doctor to monitor their overall health and wellness.”
Selecting the Right Doctor
When it comes time to choose a doctor or primary care practice, find out what your insurance will cover first, says Michael Urban, senior lecturer and program director of the doctorate of occupational therapy program at the School of Health Sciences at the University of New Haven in West Haven, Connecticut.
“Most insurance plans have a search function for doctors who are in their network,” he says, and you can start there to find primary care options that are in network and conveniently located.
He also recommends looking beyond basic coverage to determine how much it will cost to see the doctor you’re considering. “Look at your plan. What are your copays, deductibles, etc. for seeing your primary care provider? If you have a high-deductible plan,” which are common and force the patient to meet a certain level of out-of-pocket expenditure before insurance coverage kicks in, “you then want to think about asking the primary care provider’s rates to determine how much you will have to pay for out of pocket.”
For each provider you’re considering, make a comparison list to determine which one provides the best value with the least hassle to get to the office when urgent needs crop up. Consider questions such as whether you can drive to the office and if there’s on-site parking — is it free? Those questions can help you develop a fuller picture of what exactly it’ll cost to visit the doctor, which can add up if you end up going frequently.
Urban also recommends checking with “the doctor’s licensing board to see their record. Do they have licensure actions currently pending or a high record of them in the recent past?” These disciplinary actions could be a red flag that the doctor isn’t as good as another option. You can search for the doctor via the Federation of State Medical Boards’ DocInfo website, which provides access to the disciplinary history of doctors in every state if such history exists.
You should also find out which hospital the practice or doctor is affiliated with, along with other practical considerations such as their opening hours and what procedures are in place if you have an urgent need outside of those hours. How long will you need to wait to get an appointment for routine care versus emergency needs?
When you do meet with a new doctor, Urban says you should “trust your own instincts. When it comes down to it, you are your best judge of what you need. If the answers you’re finding don’t seem right, then maybe look around.”
And, as with all things medical, a little bit of prevention goes a long way when looking for the right primary care doctor. “Don’t wait to find a primary care provider when you’re sick, as it’s good to have your first visit be a wellness check so (the doctor can) get to know the healthy you.”
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