Internal medicine subspecialists, other specialty care physicians provide many primary care services

Almost 40% of medical visits for primary care services were to non-primary care physicians, a new study found.

Researchers performed a cross-sectional analysis of data from the National Ambulatory Medical Care Survey (NAMCS), examining over 8,000 and 12,000 visits, respectively, in 1999 and 2007. Visits for primary care services were determined by using the Reason for Visit code, which represents the patient's complaint, symptom, or other reason for the visit in the patient's own words, and classified these visits into those related to common symptoms or diseases (such as fever, nasal congestion, or asthma), or for general preventive care. The surveyed physicians were categorized into four groups: primary care physicians, internal medicine subspecialists, obstetricians/gynecologists and all other specialists. The results were published as a research letter by Archives of Internal Medicine on Aug. 20.

Overall, the study found no significant change in the type of physician patients saw for these primary care visits between 1999 and 2007. In both 1999 and 2007, 59% of the common/preventive visits were made to primary care physicians. Internal medicine subspecialists saw about 9% of the visits, OB-GYNs about 4%, and other specialists about 28%. For the common symptom or disease visits specifically, the percentages were: 58% primary care, 9% medicine subspecialties, 3% OB-GYNs and 30% other specialists. Over the study period, there was a nonsignificant increase in preventive exams by primary care and internal medicine subspecialties, and a decrease in those by OB-GYNs or other specialists.

The study authors concluded that these findings raise concerns about inefficiencies between primary care physician supply and demand. They offered two possible explanations: patients' preference for specialty care and the shortage of primary care physicians in the U.S. They called for additional research to better determine the causes of these findings and for improvements to create a better coordinated health care system.