Primary Care or Specialist? Where to Go for the Right Care

By Mary Purcell | September 8, 2017 | Rally Health


Long gone are the days of the country doctor who took care of all of your medical needs. Modern health care is often fragmented and complex. Today, many of us see cardiologists, dermatologists, endocrinologists, and numerous other specialists, along with our primary care provider.

As health care becomes more complex, and treatments more sophisticated, patients are increasingly referred to specialists. According to the Centers for Disease Control and Prevention, the rate of annual visits to a specialist increased 21 percent between 1999 and 2010. Nowadays, many people go directly to specialists, without a referral from another physician. It may not be unusual for someone to see a cardiologist if they are worried about a heart symptom, for example, or to go to the neurologist that helped a friend tackle migraines. But is it a good idea to go straight to specialty care first?

Generally not. Your primary care provider is usually the best person to see when there’s a new health issue.

Your Medical Home Base

A primary care doctor, or general practitioner, is the person you should see for most preventive care and health concerns as they arise. Think of them as the front-line providers for most medical issues. Your primary care doctor can take care of:

  • Checkups
  • Immunizations
  • Preventive screenings
  • Common medical complaints
  • Initial diagnosis
  • Chronic disease management
  • Referral to and coordination of care with specialists and other providers

If you don’t have a primary care provider, you should find one.

“Your primary care physician will be the one physician who knows you as a whole person, not simply as an organ system or a body part,” says Michael Munger, MD, a family physician in Leawood, KS, and president-elect of the American Academy of Family Physicians. “Your primary care physician can make sure that your overall treatment plan is right, and tailored for you.”

Primary caregivers may be specialists in a number of fields: internal medicine, family practice, pediatrics, geriatrics, or OB/GYN. In some cases a nurse practitioner may be your primary care provider. “The most important thing is to find someone you feel good about, whom you can have a good relationship with, and whom you can communicate well with,” advises Munger.

Over time, your primary doctor will get to know you, your medical issues and lifestyle, making it easier to interpret changes in your health. Studies show this “continuity of care” leads to better health outcomes and patient satisfaction. "Often, folks don't understand all the things family physicians can do," notes Ada Stewart, MD, a family physician in Columbia, SC. “We really know the patients and their families, and are able to take care of a lot issues ourselves.”

In fact, your primary doctor can address most of your health problems without the need for a specialist. “Your PCP will manage most of your chronic diseases,” says Munger. “For example, most diabetes is cared for in this country by primary care physicians.” But if you get to a point where you and your primary doctor aren’t able to control your diabetes, you may need to see a specialist.”

A primary doctor is usually in the best position to determine the likely source of your problem and steer you to the appropriate specialist, if needed. Choosing the wrong specialist not only wastes time and money, it can also expose you to unnecessary tests that carry health risks of their own. Your primary doctor should coordinate your care with the specialist to make sure you don’t undergo any treatments or medications that would be especially risky for you, based on your medical history, prescriptions, or other reasons.

When Do You Need a Specialist?

If you have a condition that your primary doctor isn’t equipped to treat, or if you’re dissatisfied with the results, it may be time for another point of view. For example, you may consult a specialist for:

  • Management of some complex chronic conditions
  • Diagnosis and treatment of rare diseases
  • Diagnosis and treatment of certain acute conditions, such as metabolic disorders, or cancer
  • Certain procedures and surgeries, such as orthopedic surgery
  • The latest treatments and expertise in a specialty
  • Reproductive health (such as OB-GYN)
  • A condition that is not improving
  • Cutting edge or experimental treatments

If you receive a life-changing diagnosis and need to hear multiple opinions to explore treatment options, a specialist might be able to help. Chronic and rare conditions may require specialty care. Or, if you’ve been struggling with a condition that is not getting better, it might be worth seeking out a specialist.

Specialists have advanced education and training in specific areas of medicine, and should have access to sophisticated diagnostic tests and treatments. There are over 120 medical specialties and subspecialties(opens in new window), and the doctors in these fields stay on top of the latest developments.

If you are concerned about a medical issue, you may be tempted to skip your primary doctor and go straight to a top-notch specialist, but experts don’t recommend it. “Primary care really is the best thing,” notes Matthew Burke, MD, a practicing family physician in in Washington, DC. “There is a huge amount of evidence in the medical literature about how wonderful primary care is in terms of treating people well, promoting quality, and reducing cost.”

Whether or not you need to see the specialist may depend on your medical history, says Munger. “For example, if you need a general skin cancer screening, your primary physician can usually do that, but if you have a history of skin cancer, your primary physician may want to involve a dermatologist for the screening.”

If you have a chronic condition, like diabetes or high blood pressure, a specialist may focus on that condition while your primary doctor looks at the big picture. “You’re seeing more and more sub-specialists saying, I’m here to manage the critical aspects of a chronic disease, but as soon as that is stabilized, we need to get back to the primary care physician for that ongoing care,” notes Munger.

Most HMOs require a referral from your primary physician before you can see a specialist. If you are a member of a PPO, you probably don’t need a referral, but may want to find a specialist in your network to save money.

That said, if you have a relationship with a specialist, say a dermatologist who removes your moles, don’t hesitate to book an appointment on your own if you know you need one. Just circle back to your primary care doctor with any new developments.

Selected References

Patrick J. Skerrett, "Doctor groups list top overused, misused tests, treatments, and procedures," Harvard Health Blog, April 5, 2012.

Orly Avitzur, MD, "When Do You Need a Specialist Doctor?," Consumer Reports, June 07, 2016.

Michael D. Cabana, MD, MPH, and Sandra H. Jee, MD, MPH, "Does continuity of care improve patient outcomes," The Journal of Family Practice, December 2004.

Copyright © 2017 Rally Health, Inc. All rights reserved.


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