Who Is the Primary Physician?

Published in: The New England Journal of Medicine, v. 308, no. 20, May 19, 1983, p. 1208-1212

Posted on RAND.org on December 31, 1982

by Jane S. Spiegel, Lisa V. Rubenstein, Bonnie Scott, Robert H. Brook

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Several studies have concluded that specialists form a hidden system for primary-care delivery. However, these studies assume that a specialist who provides the majority of care is the primary-care physician. Using data for a one-year period from 2752 people enrolled in the RAND Health Insurance Experiment, we examined the validity of this conclusion. The authors compared the effects of three different definitions of a primary-care physician on identification of the primary-care provider: the physician who delivered the majority of care (34 percent were specialists), the physician designated by the patient to receive the results of a multiphasic-screening examination (12 percent were specialists), and the physician who treated common problems (9 percent were specialists. Use of the majority-of-care criterion to define primary care overestimated by threefold the contribution specialists make to this activity. Definitions of a primary-care physician must be more specific and should include the tasks frequently associated with primary care, as well as patients' perceptions of the physician who provides their primary care.

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