What is the difference between a primary care provider (PCP) and a specialist?

The Institute of Medicine states that primary care is “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing within the context of family and community.”^1,2

Primary care providers (PCP) include physicians who have completed one or more of the following types of training:

• Family Practice
• Internal Medicine
• Pediatrics
• Geriatrics

They can also be physician assistants (PA) or nurse practitioners (NP), who go through different training and can also be primary care providers.^3,4 They typically manage and coordinate most of the health care a patient receives. They are usually the first point-of-contact for questions, new problems, and injuries. They also perform wellness check-ups and critical screening and assessments, such as for cancer and risk factors for heart attack and stroke.⁵ Screening can result in early identification of cancers allowing for early and optimized treatments. PCPs provide lifestyle counseling for preventable conditions such as hypertension, hyperlipidemia, and type 2 diabetes.⁴ They are the first-line of treatment for all of these types of conditions with the goal to prevent disease progression and morbidity. Often, they are also the first to identify and diagnose other serious chronic conditions, such as rheumatoid arthritis or lupus. The responsibilities of a PCP include:

• Escalate urgent care to the appropriate setting when necessary
• Treat and manage patient’s multiple chronic conditions, such as asthma, hypertension, diabetes, and coordinating care with specialists when necessary

In a white paper by the North American Primary Care Research Group (NAPCRG),⁶ the authors have found that the primary care physicians decrease mortality rates (one primary care physician per 10,000 population reduces the mortality rate by 5.3% or 49 per 100,000 per year).⁷ PCP care improves quality of life, increase productivity (due to fewer absences from work due to medical illness), improve end of life quality, and help effectively with primary prevention of many chronic diseases.

Medical specialists are doctors who have completed advanced education and clinical training in a specific area of medicine, such as cardiology, pulmonary, or rheumatology.^2,8  For example, cardiologists focus on cardiac conditions and rheumatologists specialize in musculoskeletal and autoimmune disorders. Specialists are more knowledgeable about the management of conditions associated with their specialty. They usually have a deeper clinical understanding of the guidelines that delineate the management of conditions within their specialty.

 ^References

1. Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care? Ann Intern Med 2003; 138 (3): 256-261.
2. Institute of Medicine (US) Committee on the Future of Primary Care. Donaldson MS, Yordy KD, Lohr KN, et al., eds. Primary Care: America's Health in a New Era. Washington (DC): National Academies Press (US); 1996.
3. U.S. National Library of Medicine. Choosing a primary care provider. 2017; https://medlineplus.gov/ency/article/001939.htm. Accessed June 7, 2019.
4. Shi L. The impact of primary care: a focused review. Scientifica (Cairo) 2012; 2012: 432892.
5. Curry SJ, Krist AH, Owens DK. Eighth Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services. U.S. Preventive Services Task Force; Nov 2018.
6. Mold JW. How primary care produces better outcomes - a logic model. Ann Fam Med 2014; 12 (5): 483-484.
7. Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv 2007; 37 (1): 111-126.
8. Donohoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med 1998; 158 (15): 1596-1608.