Smile as You Steal my Patient: Primary Care vs Specialists

Gail Garfinkel Weiss, MSW


August 09, 2010

In This Article


The line between primary care physicians (PCPs) and subspecialists, never a clear one, has blurred even more.

The percentage of PCPs continues to shrink, and patients either ask for or accept routine care from subspecialists. At the same time, internists, family practitioners, and other generalists, in an effort to boost income, are encroaching on subspecialists' territory by offering a variety of ancillary services.

Joseph R. Arulandu, MD, an internist in La Porte, Indiana, is a case in point. "There's nothing more irritating to primary care physicians than when they refer a patient to a subspecialist who, after doing what is asked, proceeds to treat the patient for routine issues that can be handled by the PCP," says Arulandu.

"This is the best way for a specialist to lose a referral source," he says. "On the other hand, I do a lot of ancillary work in my office that I used to send out to specialists, and therefore I need specialists less now than I did 10 years ago."

One reason that subspecialists are doing primary care procedures is that in some areas there aren't enough generalists to go around, says Fayetteville, Tennessee, internist J. Fred Ralston Jr., MD, president of the American College of Physicians. According to American College of Physicians figures, approximately 30% of US physicians are primary care doctors; in other parts of the world, that number is closer to 50%.

The extent to which subspecialists "co-opt" generalists' patients varies from location to location, often depending on the availability of generalists and the competitive atmosphere, Ralston notes. It's less common in underpopulated, poorly served areas, and more common in densely populated areas where physicians must compete for patients.


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