Pediatrics as a Primary, Secondary, and Tertiary Care Specialty, Cost and Reimbursement Implications

PEDIATRICS ◽  
1979 ◽  
Vol 63 (4) ◽  
pp. 659-661
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Practice ◽  
Primary Care Physicians ◽  
Tertiary Care ◽  
The United States ◽  
National Commission ◽  
Training Costs ◽  
Family Practice Physicians ◽  
The Cost

The National Commission on the Cost of Medical Care states that there should be an accelenation in the supply of family practice physicians as a cost-saving measure. According to the Commission, such an acceleration could be expected to contribute to the moderation of rising medical costs in two ways: (1) through the substitution of physicians who are trained in the delivery of primary care for more specialized physicians who are likely to provide more sophisticated and more expensive primary medical services and (2) through lower training costs for a given supply of physician manpower or, conversely, a larger supply for the same level of costs. In recommending only family practice, the Commission acknowledges that primary care physicians include physicians in general/family practice, internal medicine, pediatrics, and obstetnics-gynecology. The Commission alleges, however, that a progressively larger proportion of physicians certified in pediatrics and internal medicine are entering subspecialty fields and are therefore trained to function as secondary and tertiary care rather than as primary care physicians The American Academy of Pediatrics submits that the statements, rationale, and recommendations ions are not substantiated by available data. A survey1 of all pediatricians in the United States conducted by the Harvard School of Public Health in 1969 reported that four out of five pediatric practitioners reported no subspecialization practice. Only 3% of the practitioners restricted their practice to a subspecialty, while 17% combined comprehensive (general) pediatric practice with a subspecialty interest. These proportions varied only slightly by region and size of community; there were somewhat more pediatrcians providing comprehensive (general) child health care in smaller communities and somewhat fewer in the Western region.

Information Technology in Primary Care Practice in the United States

2011 ◽  
pp. 131-163
Author(s):  
James G. Anderson ◽  
E. Andres Balas
Keyword(s):  
Primary Care ◽  
Information Technology ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Medical Specialty ◽  
The United States ◽  
Care Practice ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology used by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools and electronic communication with patients. This indicates a slow rate of adoption since 2000-2001. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members as to the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

scholarly journals Computerization of Primary Care in the United States

2011 ◽  
pp. 1301-1321
Author(s):  
James G. Anderson ◽  
E. Andrew Balas
Keyword(s):  
Primary Care ◽  
Technology Use ◽  
Primary Care Physicians ◽  
Medical Specialty ◽  
The United States ◽  
Web Based ◽  
Barriers To Implementation ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology use by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall, between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, pointof- care decision support tools, and electronic communication with patients. This indicates a slow rate of adoption since 2000. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members in the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products, and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

scholarly journals Computerization of Primary Care in the United States

2010 ◽  
pp. 385-409
Author(s):  
James G. Anderson ◽  
E. Andrew Balas
Keyword(s):  
Primary Care ◽  
Technology Use ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Medical Specialty ◽  
The United States ◽  
Web Based ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology use by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall, between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools, and electronic communication with patients. This indicates a slow rate of adoption since 2000. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members in the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products, and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

Training in Primary Care

1987 ◽  
Author(s):  
William G. Rothstein
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Patient Care ◽  
Family Practice ◽  
Primary Care Physicians ◽  
Family Physicians ◽  
Medical Schools ◽  
General Internal ◽  
General Internists ◽  
Medical Examinations

Training in primary care has received limited attention in medical schools despite state and federal funding to increase its emphasis. Departments of internal medicine, which have been responsible for most training in primary care, have shifted their interests to the medical subspecialties. Departments of family practice, which have been established by most medical schools in response to government pressure, have had a limited role in the undergraduate curriculum. Residency programs in family practice have become widespread and popular with medical students. Primary care has been defined as that type of medicine practiced by the first physician whom the patient contacts. Most primary care has involved well-patient care, the treatment of a wide variety of functional, acute, self-limited, chronic, and emotional disorders in ambulatory patients, and routine hospital care. Primary care physicians have provided continuing care and coordinated the treatment of their patients by specialists. The major specialties providing primary care have been family practice, general internal medicine, and pediatrics. General and family physicians in particular have been major providers of ambulatory care. This was shown in a study of diaries kept in 1977–1978 by office-based physicians in a number of specialties. General and family physicians treated 33 percent or more of the patients in every age group from childhood to old age. They delivered at least 50 percent of the care for 6 of the 15 most common diagnostic clusters and over 20 percent of the care for the remainder. The 15 clusters, which accounted for 50 percent of all outpatient visits to office-based physicians, included activities related to many specialties, including pre- and postnatal care, ischemic heart disease, depression/anxiety, dermatitis/eczema, and fractures and dislocations. According to the study, ambulatory primary care was also provided by many specialists who have not been considered providers of primary care. A substantial part of the total ambulatory workload of general surgeons involved general medical examinations, upper respiratory ailments, and hypertension. Obstetricians/ gynecologists performed many general medical examinations. The work activities of these and other specialists have demonstrated that training in primary care has been essential for every physician who provides patient care, not just those who plan to become family physicians, general internists, or pediatricians.

scholarly journals Conditions Influencing Collaboration Among the Primary Care Disciplines as They Prepare the Future Primary Care Physician Workforce

2020 ◽  
Vol 52 (6) ◽  
pp. 398-407 ◽  
Author(s):  
Patricia A. Carney ◽  
Erin K. Thayer ◽  
Larry A. Green ◽  
Eric J. Warm ◽  
Eric S. Holmboe ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Interprofessional Education ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Collaborative Practice ◽  
Interprofessional Collaborative Practice ◽  
Resident Graduates

Background and Objectives: Much can be gained by the three primary care disciplines collaborating on efforts to transform residency training toward interprofessional collaborative practice. We describe findings from a study designed to align primary care disciplines toward implementing interprofessional education. Methods: In this mixed methods study, we included faculty, residents and other interprofessional learners in family medicine, internal medicine, and pediatrics from nine institutions across the United States. We administered a web-based survey in April/May of 2018 and used qualitative analyses of field notes to study resident exposure to team-based care during training, estimates of career choice in programs that are innovating, and supportive and challenging conditions that influence collaboration among the three disciplines. Complete data capture was attained for 96.3% of participants. Results: Among family medicine resident graduates, an estimated 87.1% chose to go into primary care compared to 12.4% of internal medicine, and 36.5% of pediatric resident graduates. Qualitative themes found to positively influence cross-disciplinary collaboration included relationship development, communication of shared goals, alignment with health system/other institutional initiatives, and professional identity as primary care physicians. Challenges included expressed concerns by participants that by working together, the disciplines would experience a loss of identity and would be indistinguishable from one another. Another qualitative finding was that overwhelming stressors plague primary care training programs in the current health care climate—a great concern. These include competing demands, disruptive transitions, and lack of resources. Conclusions: Uniting the primary care disciplines toward educational and clinical transformation toward interprofessional collaborative practice is challenging to accomplish.

What Happens at a Fibromyalgia Consultation?

2002 ◽  
Author(s):  
Daniel J. Wallace ◽  
Janice Brock Wallace
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Primary Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Test Results ◽  
Diagnostic Laboratory ◽  
Medical Visits ◽  
Diagnostic Laboratory Tests

Fibromyalgia is usually a diagnosis of exclusion. Often poorly understood by some primary care physicians, the diagnosis of fibromyalgia is often delayed. Even though in one survey up to 10 percent of general medical visits involve a complaint of generalized musculoskeletal pain, the diagnosis was made only after patients saw a mean of 3.5 doctors. This chapter will take you through the workup that establishes the definitive diagnosis and eliminates other possible explanations for the patient’s complaints. Doctors who diagnose and treat fibromyalgia often cross specialty lines. Although rheumatologists tend to regard fibromyalgia as residing within their bailiwick, there are too few of us to handle all the needs of the 6 million fibromyalgia sufferers. The 5,000 rheumatologists in the United States are internal medicine subspecialists. A total of 80,000 doctors practice primary care internal medicine in the United States, and an additional 80,000 general or family practitioners are the front-line doctors for most patients. These physicians may suspect fibromyalgia and consult a rheumatologist to confirm the diagnosis. In complicated cases, the rheumatologist can take over the management of the condition. Orthopedists, neurosurgeons, and neurologists frequently diagnose fibromyalgia but generally refer patients to rheumatologists or internists for treatment. Rheumatologists may refer patients to physical medicine specialists or pain management centers when their approaches do not bear fruit. Suppose that you are suspected of having fibromyalgia, and a primary care physician has referred you to a fibromyalgia consultant (usually a rheumatologist but sometimes an internist, physiatrist, neurologist, orthopedist, or osteopath) to confirm the diagnosis and make management suggestions. Is any sort of advanced preparation advisable? Yes. Bring copies of outside records and previous test results or workups to the consultant. If you have more than a few complaints or are taking more than a few medications, a summary list is useful. The evaluation will consist of a history, physical examination, diagnostic laboratory tests, and possibly imaging studies (X-rays, scans, etc.). Once all the observations and test results are in, the doctor will discuss the findings with you—perhaps at the time of the visit, by telephone after the initial meeting, or in a follow-up visit.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

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