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For Primary Care, More Patients Are Seeing Specialists
Date:3/10/2009

r cancer, I'd be just as guilty. It should be an easy two-way street between family doctors and specialists."

Dr. Marc Siegel, an internist at New York University Langone Medical Center in New York City, said that he "would argue that if a specialist sees you for primary prevention, you're more likely to end up having a procedure."

"Although the nation is going in the direction of specialization, it's clearly not cost-effective," Siegel said.

Valderas said that "all care that does not need the specific involvement of a specialist could potentially and should be done by primary care physicians." Looking at health-care systems worldwide, he said, "health systems oriented towards primary care have consistently demonstrated better or comparable outcomes at lower costs."

Pregnant women appear to be among those seeing specialists more often for routine care.

In the same issue of the journal, another study found that family physicians are less likely to offer prenatal care to their expectant patients today than they were a decade ago.

It found that prenatal visits to family physicians declined from nearly 12 percent to just over 6 percent in a 10-year period. In non-urban areas, the drop was even more striking: from about 39 percent to 13 percent, the study found.

Expectant mothers who did visit their family physician for prenatal care were more likely to live in a non-metropolitan area, to be on Medicaid, and to be either younger (under 24) or older (over 30).

In rural areas, a lack of family physicians who don't offer prenatal care "could be a disaster," said Awada. Many family physician residency programs no longer focus on prenatal obstetrical care, he added.

A third study in the journal suggests that the consequences could be more far-reaching than just prenatal care. It found that, along with getting prenatal care, nearly one in five prenatal visits with a family physician
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