Specialists Top Primary Docs for Patient Visits

If we need more proof that the days of Marcus Welby, M.D. have passed, consider that 2013 was the year more patients chose specialists over primary care doctors.

According to a report from the IMS Institute for Healthcare Informatics on how healthcare spending has risen after years of “self-rationing, ” all physician offices saw a 2.7% increase in visit in 2013. Of those, 51% were to specialist offices, a slight increase from the 49% and 48% recorded in the two previous years.

“It’s the crossing of a threshold, but it’s not a dramatic one-year change, ” said Murray Aitken, the executive director of the Institute.

The 2.7% increase in physician office visits reflected a 4.9% increase in visits to specialists and 0.7% decrease in primary care visits. While primary care office visits among senior citizens increased by 2.6% last year, according to the Institute, they decreased by 2.1% among adults ages 26-64 and fell by 2.7% among adults ages 19-25.

Andis Robeznieks of Modern Healthcare wrote on April 21, 2014 that Atul Grover, M.D., the chief public policy officer for the Association of American Medical Colleges said that the first two to four years of implementation of the Patient Protection and Affordable Care Act may temporarily alter this course as previously uninsured people gain coverage and enter the healthcare system via a local primary care office. “That’s the only thing that will interrupt the trend, ” he said.

A 2010 Centers for Disease Control (CDC) and Prevention’s National Ambulatory Medical Survey, according to Robeznieks, found that 55% of the more than 1 billion office visits to U.S. physician offices between December 28, 2009, and December 26, 2010, were to primary care offices. Twenty-four percent of the visits were to other medical specialists and 21% were to surgical specialists.

According to a report in the January-February issue of the Journal of the American Board of Family Medicine, the majority of patients sought treatment from a primary care physician for 10 of 14 highest-cost chronic conditions tracked by the CDC. Those included 86% of office visits for asthma treatment, 84% of visits for chronic obstructive pulmonary disease and 78% of visits for hyperlipidemia. The only conditions for which the majority of visits were not at a primary-care office were ischemic heart disease (34%), arthritis (36%); atrial fibrillation (37%) and diabetes (50%).