A primary care physician, or PCP, is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. A PCP generally does not specialize in the treatment of specific organ systems, such as neurology, cardiology, or pulmonology, nor perform surgery. The term "PCP" is most commonly used in the United States. A primary care physician can be described by training, skill and scope of practice, role in the health care system, and the usual setting in which care is delivered. Primary care physicians are declining in numbers in many developed countries. The Doctor by Samuel Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ... In biology, an organ is a group of tissues which perform some function. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... Cardiology is the branch of medicine dealing with disorders of the heart and blood vessels. ... In medicine, pulmonology (aka pneumology) is the specialty that deals with diseases of the lungs and the respiratory tract. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ...

Defining primary care physicians

Certain clinicians, most commonly those trained in family practice, general practice, pediatrics and internal medicine are referred to as primary care physicians. Some HMOs consider gynecologists as PCPs for the care of women, and have allowed certain subspecialists to assume PCP responsibilities for selected patient types, such as allergists caring for people with asthma and nephrologists acting as PCPs for patients on kidney dialysis. Some experts and groups have included nurse practitioners, physician assistants and naturopathic physicians, by broadening the term to primary care practitioners. A general practitioner (GP) or family physician (FP) is a physician who provides primary care. ... A general practitioner (GP) or family physician (FP) is a physician who provides primary care. ... Clinical Examination Pediatrics (also spelled paediatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents (from newborn to age 16-21, depending on the country). ... Doctors of internal medicine (internists) are medical specialists who focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. ... A Health Maintenance Organization (HMO) is a type of Managed Care Organization (MCO) that provides a form of health insurance coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. ... The shamefulness associated with the examination of female genitalia has long inhibited the science of gynaecology. ... An allergy or Type I hypersensitivity is an immune system malfunction whereby a persons body is hypersensitised to react immunologically to typically nonimmunogenic substances. ... A nephrologist is a physician who has been trained in the diagnosis and management of kidney disease, kidney transplantation, therapy of high blood pressure, and dialysis. ... It has been suggested that Renal anomalies and Renal plasma threshold be merged into this article or section. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... // A nurse practitioner (NP) is a registered nurse who has completed advanced education (generally a minimum of a masters degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. ... In the United States, Physician Assistants (PAs) are non-physician clinicians licensed to practice medicine with a physicians supervision. ... Naturopathic medicine (also known as naturopathy) is a school of medical philosophy and practice that seeks to improve health and treat disease chiefly by assisting the bodys innate capacity to recover from illness and injury. ...

Scope of practice

A set of skills and scope of practice may define a primary care physician, generally including basic diagnosis and non-surgical treatment of common illnesses and medical conditions. ^[1] Diagnostic techniques include interviewing the patient to collect information on the present symptoms, prior medical history and other health details, followed by a physical examination. Many PCPs are trained in basic medical testing, such as interpreting results of blood or other patient samples, electrocardiograms, or x-rays. More complex and time-intensive diagnostic procedures are usually obtained by referral to specialists, due to either special training with a technology, or increased experience and patient volume that renders a risky procedure safer for the patient. ^[2] After collecting data, the PCP arrives at a differential diagnosis and, with the participation of the patient, formulates a plan including (if appropriate) components of further testing, specialist referral, medication, therapy, diet or life-style changes, patient education, and follow up results of treatment. Primary care physicians also counsel and educate patients on safe health behaviors, self-care skills and treatment options, and provide screening tests and immunizations. The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ... The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... A medical test is any kind of diagnostic procedure performed for health reasons. ... “QRS” redirects here. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... For the Italian comics character with this name, see Lo Sconosciuto Most general, a specialist is a person which are able to solve some predefined class of problems. ... In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patients symptoms. ... Behavior change is a declared objective of many health interventions. ... Screening, in medicine, is a strategy used to identify disease in an unsuspecting population. ... Immunization (AmE) or Immunisation (BE) has a number of meanings: In medicine immunization is the process by which an individual is exposed to a material that is designed to prime his or her immune system against that material. ...

Role in the health care system

A primary care physician is usually the first medical practitioner contacted by a patient, due to factors such as ease of communication, accessible location, familiarity, and increasingly issues of cost and managed care requirements. Many health maintenance organizations position PCPs as "gatekeepers", who regulate access to more costly procedures or specialists. Ideally, the primary care physician acts on behalf of the patient to collaborate with referral specialists, coordinate the care given by varied organizations such as hospitals or rehabilitation clinics, act as a comprehensive repository for the patients records, and provide long-term management of chronic conditions. Continuous care is particularly important for patients with medical conditions that encompass multiple organ systems and require prolonged treatment and monitoring, such as diabetes and hypertension. Managed care is a concept in U.S. health care. ... A health maintenance organization (HMO) is a prepaid health plan. ... This article is about the disease that features high blood sugar. ... This article or section does not cite its references or sources. ...

Health care setting

PCPs provide the majority of services at the primary level of care, an entry point to a system that includes secondary care (by community hospitals) and tertiary care (by medical centers and teaching hospitals), also referred to an ambulatory care setting versus inpatient care. Many primary care physicians follow their patients in a variety of health care settings, such as offices, hospitals, critical care units, long-term facilities, and at home. A PCP may supervise a non-physician health professional, such as a nurse practitioner or physician assistant. A physician visiting the sick in a hospital. ... Medical Center was a drama that ran on CBS from 1969 to 1976. ... A Teaching hospital is a hospital which provides medical training. ... // A nurse practitioner (NP) is a registered nurse who has completed advanced education (generally a minimum of a masters degree) and training in the diagnosis and management of common medical conditions, including chronic illnesses. ... In the United States, Physician Assistants (PAs) are non-physician clinicians licensed to practice medicine with a physicians supervision. ...

Studies of the quality of care provided by primary care physicians

Studies that compare the knowledge base and quality of care provided by generalists versus specialists usually find that the specialists are more knowledgeable and provide better care ^[3][4]. However, these studies examine the quality of care in the domain of the specialists. In addition, these studies need to account for clustering of patients and physicians ^[5].

Studies of the quality of preventive health care find the opposite results - primary care physicians perform best. An analysis of elderly patients found that patients seeing generalists, as compared to patients seeing specialists, were more likely to receive influenza vaccination^[6]. In health promotion counseling, a studies of self-reported behavior found that generalists were more likely than internal medicine specialists to counsel patients ^[7] and to screen for breast cancer ^[8].

Exceptions may be diseases that are so common that primary care physicians develop their own expertise. A study of patients with acute low back pain found the primary care physicians provided equivalent quality of care, but at lower costs that orthopedic specialists ^[9]. The more experience the primary care physician has with a specific disease, the better their care will be ^[10].

The dissemination of information to generalists compared to specialists is complicated ^[11]. Two studies found specialists were more likely to adopt COX-2 drugs before the drugs were recalled by the FDA ^[12][13]. One of the studies went on to state "using COX-2s as a model for physician adoption of new therapeutic agents, specialists were more likely to use these new medications for patients likely to benefit but were also significantly more likely to use them for patients without a clear indication" ^[13].

In summary, each type of physician has strengths, especially when practicing in areas of their expertise and experience. Accordingly, one study found the best care after myocardial infarctions was when both a specialist and a generalist cared for a patient ^[14]. Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...

Challenges for primary care

Declining numbers

Shortages of primary care physicians are an increasing problem in many developed countries. In the United States, the number of medical students entering family practice training dropped by 50% between 1997 and 2005. ^[15] In 1998, half of internal medicine residents chose primary care, but by 2006, over 80% became specialists or hospitalists. ^[16] Causes parallel the evolutionary changes occurring in the US medical system: payment based on quantity of services delivered, not quality; aging of the population increases the prevalence and complexity of chronic health conditions, most of which are handled in primary care settings; and increasing emphasis on life-style changes and preventative measures, often poorly covered by health insurance or not at all. ^[17] In 2004, the median income of specialists in the US was twice that of PCPs, and the gap is widening. ^[18] Primary care practices in the United States increasingly depend on foreign medical graduates to fill depleted ranks. ^[17] Residency is a stage of postgraduate medical training in North America and leads to eligibility for board certification in a primary care or referral specialty. ... Hospital medicine is the general medical care of hospitalized patients. ...

Maldistribution

Developing countries face an even more critical disparity in primary care practitioners. The Pan American Health Organization reported in 2005 that "...the Americas region has made important progress in health, but significant challenges and disparities remain. Among the most important is the need to extend quality health care to all sectors of the population...Experience over the last 27 years shows that health systems that adhere to the principles of primary health care produce greater efficiency and better health outcomes in terms of both individual and public health..." ^[19] The World Health Organization (WHO) has identified worsening trends in access to PCPs and other primary care workers, both in the developed and the developing nations: ^[20] The World Health Organization (WHO) is a specialized agency of the United Nations that acts as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ...

• "Worker numbers and quality are positively associated with immunization coverage, outreach of primary care, and infant, child and maternal survival"
• "The quality of doctors and the density of their distribution have been shown to correlate with positive outcomes in cardiovascular diseases"
• "In health systems, (primary care) workers function as gatekeepers and navigators for the effective, or wasteful, application of all other resources such as drugs, vaccines and supplies"
• "there are currently 57 countries with critical shortages equivalent to a global deficit of 2.4 million doctors, nurses and midwives"
• "In many countries, the skills of limited yet expensive professionals are not well matched to the local profile of health needs"
• "...all countries suffer from maldistribution characterized by urban concentration and rural deficits"
• "Richer countries face a future of low fertility and large populations of elderly people, which will cause a shift towards chronic and degenerative diseases with high care demands"
• "Growing gaps will exert even greater pressure on the outflow of health workers from poorer regions"

Lagging quality of care measures

A survey of 6,000 primary care physicians in seven countries revealed disparities in several areas that affect quality of care.^[21] Differences did not follow trends of the cost of care; primary care physicians in the United States lagged behind their counterparts in other countries, despite the fact that the US spends two to three times as much per capita. Arrangements for after-hours care were almost twice as common in the Netherlands, Germany and New Zealand as in Canada and the United States, where patients must rely on emergency facilities. Other major disparities include automated systems to remind patients about follow-up care, give patients test results or warn of harmful drug interactions. There were differences as well among primary care doctors, regarding financial incentives to improve the quality of care.

See also

• Emergency department
• Health maintenance organization
• Medicine
• Orphan patient
• Primary care

The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... A Health Maintenance Organization (HMO) is a type of Managed Care Organization (MCO) that provides a form of health insurance coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. ... medicines, see medication and pharmacology. ... Within any system for health care, there is often a problem with supply of health care providers and/or access to them. ... Primary care may be provided in community health centres. ...

Notes

1. ^ Institute of Medicine (1996). Primary Care: America's Health in a New Era. page 27: National Academies Press. Retrieved on 2006-08-30. 
2. ^ Institute of Medicine (2000). Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality. National Academies Press. Retrieved on 2006-08-30. 
3. ^ Majumdar S, Inui T, Gurwitz J, Gillman M, McLaughlin T, Soumerai S (2001). "Influence of physician specialty on adoption and relinquishment of calcium channel blockers and other treatments for myocardial infarction". J Gen Intern Med 16 (6): 351-9. PMID 11422631. 
4. ^ Fendrick A, Hirth R, Chernew M (1996). "Differences between generalist and specialist physicians regarding Helicobacter pylori and peptic ulcer disease". Am J Gastroenterol 91 (8): 1544-8. PMID 8759658. 
5. ^ (2002) "Summaries for patients. Comparing the quality of diabetes care by generalists and specialists". Ann Intern Med 136 (2): I42. PMID 11928735. 
6. ^ Rosenblatt R, Hart L, Baldwin L, Chan L, Schneeweiss R (1998). "The generalist role of specialty physicians: is there a hidden system of primary care?". JAMA 279 (17): 1364-70. PMID 9582044. 
7. ^ Lewis C, Clancy C, Leake B, Schwartz J (1991). "The counseling practices of internists". Ann Intern Med 114 (1): 54-8. PMID 1983933. 
8. ^ Turner B, Amsel Z, Lustbader E, Schwartz J, Balshem A, Grisso J. "Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex". Am J Prev Med 8 (2): 78-85. PMID 1599724. 
9. ^ Carey T, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D (1995). "The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project". N Engl J Med 333 (14): 913-7. PMID 7666878. 
10. ^ Kitahata M, Koepsell T, Deyo R, Maxwell C, Dodge W, Wagner E (1996). "Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival". N Engl J Med 334 (11): 701-6. PMID 8594430. 
11. ^ Turner B, Laine C (2001). "Differences between generalists and specialists: knowledge, realism, or primum non nocere?". J Gen Intern Med 16 (6): 422-4. PMID 11422641. 
12. ^ Rawson N, Nourjah P, Grosser S, Graham D (2005). "Factors associated with celecoxib and rofecoxib utilization". Ann Pharmacother 39 (4): 597-602. PMID 15755796. 
13. ^ ^{a b} De Smet B, Fendrick A, Stevenson J, Bernstein S (2006). "Over and under-utilization of cyclooxygenase-2 selective inhibitors by primary care physicians and specialists: the tortoise and the hare revisited". J Gen Intern Med 21 (7): 694-7. PMID 16808768. 
14. ^ Ayanian J, Landrum M, Guadagnoli E, Gaccione P (2002). "Specialty of ambulatory care physicians and mortality among elderly patients after myocardial infarction". N Engl J Med 347 (21): 1678-86. PMID 12444183. 
15. ^ American Academy of Family Physicians, National Resident Matching Program data: Family Medicine Residency Positions and Number Filled by U.S. Medical School Graduates, 1994-2006 Retrieved 30 August 2006
16. ^ The American College of Physicians (January 30, 2006). The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation's Health Care. Press release. Retrieved on 2006-08-30.
17. ^ ^{a b} Bodenheimer, Thomas (2006-08-31). "Primary care - Will It Survive?". The New England Journal of Medicine 355 (9): 861-864. Retrieved on 2006-08-31. 
18. ^ Medical Group Management Association Physician Compensation Survey, 1998 - 2005: Median Compensation for Selected Medical Specialties Retrieved 30 August 2006
19. ^ Pan American Health Organization (September 2005): Regional Declaration on the New Orientations of Primary Health Care Retrieved 30 August 2006
20. ^ World Health Organization: World Health Report-2006 Retrieved 30 August 2006
21. ^ Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Jordon Peugh, and Kinga Zapert (1999-11-02). "On The Front Lines Of Care: Primary Care Doctors' Office Systems, Experiences, And Views In Seven Countries". Health Affairs. Retrieved on 2006-11-06. 

For the Manfred Mann album, see 2006 (album). ... August 30 is the 242nd day of the year in the Gregorian Calendar (243rd in leap years), with 123 days remaining. ... For the Manfred Mann album, see 2006 (album). ... August 30 is the 242nd day of the year in the Gregorian Calendar (243rd in leap years), with 123 days remaining. ... A news release, press release or press statement is a written or recorded communication directed at members of the news media for the purpose of announcing something claimed as having news value. ... For the Manfred Mann album, see 2006 (album). ... August 30 is the 242nd day of the year in the Gregorian Calendar (243rd in leap years), with 123 days remaining. ... For the Manfred Mann album, see 2006 (album). ... August 31 is the 243rd day of the year in the Gregorian calendar (244th in leap years), with 122 days remaining. ... For the Manfred Mann album, see 2006 (album). ... August 31 is the 243rd day of the year in the Gregorian calendar (244th in leap years), with 122 days remaining. ... 1999 (MCMXCIX) was a common year starting on Friday, and was designated the International Year of Older Persons by the United Nations. ... November 2 is the 306th day of the year (307th in leap years) in the Gregorian calendar, with 59 days remaining. ... For the Manfred Mann album, see 2006 (album). ... November 6 is the 310th day of the year (311th in leap years) in the Gregorian calendar, with 55 days remaining. ...

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