Having a primary care doctor, as well as getting routine care and health screening services, 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 were 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.
What Is a Primary Care Doctor?
“Being a primary care physician means cultivating a trusting relationship with your patient,” says Dr. Melissa See, site medical director with AltaMed Health in South Gate, California. “Through this trusted relationship the PCP and patient are better able to collaborate in navigating through important health decisions and challenges throughout every stage of life. Being a primary care physician means you’re the trusted resource for your patients to turn to for guidance on medical decisions that are ultimately informed by a patient’s past medical history and current medical issues.”
Dr. Seuli Bose Brill, associate professor of medicine and section chief internal medicine and pediatrics at the Ohio State University College of Medicine in Columbus, says “a PCP is usually the portal of entry for addressing health care needs, be it preventive care, acute illness treatment or chronic disease management.”
“You can expect to have a PCP provide you with ongoing care over time, rather than a one-time interaction you would experience in an urgent care or ER setting,” Brill adds. “For this reason, a PCP generally tends to be (the) doctor who knows you best, allowing the physician to deliver care that holistically aligns with your goals and needs.”
But primary care isn’t 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.
Dr. Katrina Miller Parrish, chief quality and information executive at L.A. Care Health Plan, the largest publicly operated health plan in the U.S., says that primary care “focuses on prevention and screening according to evidence-based guidelines.” And these individuals aren’t always doctors. “A good term to use is primary care provider, which includes nurse practitioners or physician assistants” to the widely known primary care physician term. These advanced-practice caregivers can extend the reach of a physician and work closely with the team to provide care to patients.
Types of Primary Care Doctors
Not all PCP doctors have the same focus areas or specialties, and they typically fall into five main categories. You may well work with one or more of these providers during your lifetime as your health needs change:
For many people, the concept of a primary care physician conjures up images of the family practitioners — 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, 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 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.
“Family medicine covers ‘cradle to grave,'” Parrish adds. “Family doctors care for every age, every member of the family and can deliver babies and work in intensive care settings. We also have a focus on looking at the family as an interdependent unit.” In other words, “what happens with the grandmother affects the grandchild. The risks of the aunt could affect the mother, whether physically or mentally.”
Therefore, these general practitioners aim to work with the entire family to support not just the individual, but the family’s health as a whole.
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
What is an internist? Well, they’re internal medicine doctors that typically work with adults age 18 and older and may also see geriatric patients. Internal medicine physicians specialize in diagnosing, treating and preventing disease in adult patients. They differ from a family medicine practitioner in terms of the “scope of training and scope of practice,” See says.
Internist care is typically rendered in a hospital setting, Tolliver says, and this hospital focus is reflected in the training these providers receive. “Required internal medicine training centers on common general medical conditions, but also includes significant experience in each of the internal medicine subspecialties, such as endocrinology, rheumatology and infectious diseases and cardiology.”
“Trainees must also gain adequate experience in psychiatry, dermatology, ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, palliative medicine, sleep medicine, geriatrics and rehabilitation medicine to comprehensively care for adults,” Tolliver adds.
Internal medicine training includes “a heavy emphasis on inpatient and intensive hospital care,” See says, and this type of physician would need additional training to treat children. They may not handle women’s health, but they may be more specialized in another area, such as managing diabetes or another chronic condition.
When someone uses the term “primary care doctor,” most people think of a provider who works with adults. But pediatricians shouldn’t be overlooked because they provide important preventive care such as childhood immunizations.
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 recognize and react when a child isn’t meeting developmental milestones or develops certain diseases that tend to occur more frequently in children, such as chickenpox or earaches.
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 internal medicine-pediatrics, or med-peds. These providers “are trained to evaluate both children and adults in the inpatient and outpatient setting,” Tolliver says.
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.
However, these providers may be less able to address health concerns that are not related specifically to women’s health such as a sinus infection or digestive problems.
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
These days, primary care is often a team-based and patient-centric endeavor. In many practices, it’s not just a single doctor or provider, but a whole team of caregivers who can offer the right help 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 in a more cost-effective way, as they tend to bill at a lower rate than a physician. These providers typically can prescribe medications.
Considering Costs and Licensing
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?
Urban also notes that waiting until you’re sick to find a provider isn’t the best way to go about it. Start the search before you need a doctor so they can get to know you when you’re well and before you have a more urgent health need.
Selecting the Right Doctor
Once you’ve selected a doctor you think might be a good option, call the office. “See what you think about the way they answered the phone, or the phone menu — did it make you feel welcomed?” Parrish asks.
Set an appointment and take a moment to consider whether it was easy to get and whether they had any requirements before you come in.
After you meet the provider, take stock of the session. “If you’re not happy with your first choice of provider, switch,” Parris says. “Don’t settle. And don’t stop until you find the right one for you. There’s no way you will be honest and consistent with your care unless you trust and want to work with your provider.”
She continues, “this is a very important decision and can make or break your success in all aspects of your health care. If you don’t feel comfortable with the provider you’re assigned to or started seeing, make the change. Note the reasons why you’re not comfortable and address those issues in your next choice of provider. This relationship should be comfortable and supportive to your health needs in the way you want to address them. I have had patients who did not want to use medicines or could only have limited physical exams and I worked to make sure they got the education, support and care they needed, no matter what.”
Urban adds that 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.”
Helping you access the care you need in a way that makes you feel comfortable should be the provider’s goal, Tolliver says. “For me, being a primary care provider means providing compassionate, culturally appropriate health care and prevention strategies across the lifespan of the patient.”
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Everything About Primary Care Physicians vs. Internists vs. Family Physicians originally appeared on usnews.com
Update 05/23/22: This story was published at an earlier date and has been update with new information.