Patients still turning to specialists for primary-care services: study

More than 40% of patient visits for primary-care services took place at a specialist physician's office, suggesting "current and continued inefficiency in the delivery of primary-care services," according to a research letter published in the Archives of Internal Medicine.

Researchers from the Mount Sinai School of Medicine, New York, and Yale University, New Haven, Conn., compared National Ambulatory Medical Care Survey records from 1999 with records from 2007 and saw virtually no change in the percentage of primary-care service visits conducted at specialists' offices: 41% in 1999 and 41.2% in 2007.

Visits were divided into two categories: "common symptoms and diseases," such as fever, nasal congestion, anemia and asthma, and preventive examinations. Physicians were classified as either primary-care doctors or specialists—the latter group including internal-medicine subspecialists, obstetricians/gynecologists and others.

The percentage of visits for common symptoms and diseases remained relatively unchanged, though visits to specialists for preventive exams fell from 33.8% in 1999 to 28.8% in 2007. The sharpest drop in this area was among obstetricians/gynecologists, who accounted for 16.1% of the preventive-exam visits in 1999 but only 10% in 2007.

The researchers offered two possible explanations for the high share of visits to specialists. First, they suggested, patients have come to believe that specialists provide better care for specific conditions, and this belief may be driving them to see specialists for general services as well. Also, the researchers suggested, the shortage of primary-care physicians has pushed patients toward specialists.

"A better coordinated system will likely involve realigning patient preferences along with increasing the primary-care workforce," the researchers concluded.

They also noted that their study was limited to care delivered outside of hospitals and did not count services from other providers such as nurses and physician assistants.