Primary Care

Relationship of a health practitioner to a patient which is first contact, continuous, and comprehensive.

Of all types of allopathic physicians, family practice comes closest to this definition as FP's treat all ages and all stages of both health and disease.

Specialists may have some continuity, but do not cover the full range of health problems. Internal medicine doctors often do not treat pediatric and women's health problems and many obstetric physicians do not address internal problems such as high blood pressure or other routine illnesses. Emergency physicians have first contact, but no follow up or continuity.

Primary care involves treatment of initial illnesses as well as prevention of illness as opposed to secondary or tertiary care which can  involves specialists, hospitals, and other providers.

Those providing primary care services to all ages

Family practitioner

Physician's assistant working with a family practitioner

Family nurse practitioner

Internal Medicine-Pediatrics physician

I have found the American Academy of Family Practice's (AAFP) video called "The Path Less Traveled" quite useful for med students early in their careers, to promote interest in rural generalist practice. It would be suitable for pre-med students who are debating about career choices. It is a bit propagandist for family medicine, but that is excusable. (17 mins long)  Joe Stenger http://www.aafp.org/rural/pathvideo/

Primary care services limited to children and adolescents

Pediatrician

Physician's assistant working with a pediatrician

Pediatric nurse practitioner

Primary care services limited to certain types of adults

Internal medicine physician

Physician's assistant working with an internist

Adult nurse practitioner

Primary care services limited to women's health/pregnancy

Obstetrician

Nurse midwife

Workforce Situations for Primary Care - COGME studies

Openings regardless of location

Geriatric physicians, mental health professionals, psychiatrists, psychologists, and social workers with mental health training

Openings for practitioners which seem to be unlimited for the next twenty years for those willing to accept all locations of practice:

Family practice, general internal medicine, general pediatric physicians, med-peds physicians, physician assistants, and nurse practitioners, especially those interested in serving rural and underserved populations such as inner city or disadvantaged peoples. 

Perspective of Primary Care

If you take 1000 adults over age 16

750 report one or more illnesses

250 visit a physician

9 visit a specialist or hospital

1 visits a university med ctr

This tiny university patient population (and usually male adults) is where most medical research is done. This is where most of the federal funding for research goes, 13 billion dollars in National Institutes of Health funding. Less than a half a billion dollars a year goes for primary care research.

The nation's physician population - 625,000      For rural comparisons see row 7 of table

67% specialists

33% primary care

22% women

22% foreign born

5% osteopathic physicians

Why the push for primary care? 

Continuity of care - costs less to have someone that can manage a broad range of conditions over time

The more specialists, the more of the nation's Gross National Product that goes into health care.

At current growth rates, the US GNP for health could reach 20% shortly into the next century. Also Medicaid is the fastest rising segment of the budget of each state, forcing states to either raise taxes or reduce education, roads, bridges, environmental programs, etc.