CDC: Primary care docs outnumbered by specialists, still see more patients yearly

Sept. 20, 2012, 2:05 p.m.

Primary care doctors, like Dr. David Noya (pictured above) who works at South Central Family Health Center, are more likely to provide at least 31 hours of direct care to patients every week than are specialists, says the federal government. (Mae Ryan/KPCC)

Even though there are far more specialist doctors than there are general physicians in the U.S., it's much harder to get an appointment with a specialist.

That's according to a new data brief released today by the Centers for Disease Control and Prevention (CDC), which looked at how many doctors there were in the U.S. between 2009 and 2010 – and how easy it was to get to them.

Nina Vaccaro, the executive director of the Southside Coalition of Community Health Clinics, explained the difference between general physicians (often called primary care physicians or doctors) and specialists thus:

A specialist is someone who has an expertise in a particular area: the heart (cardiologist), the brain (neurologist), the feet (podiatrist) – the list goes on. They spend additional time studying these body systems in medical school. General physicians have the same foundation in terms of an education, but haven't spent extra time studying a particular area of medicine.

True to their name, general physicians take care of the general health problems someone might have, said Vaccaro – a cold, a headache, pain, the flu, trouble sleeping at night. If they can't treat a patient with their knowledge and the resources available to them, general physicians will refer her or him to a specialist.

In that way, she said, the general physician is the "portal of access to the specialist."

Between 2009 and 2010, the CDC found that for every 1 million people, there are 472 general physicians and 636 specialists. Despite that:

– General physicians completed 30 percent more visits than did specialists
– More general physicians (70 percent of them) spent 31 hours or more per week providing direct care than did specialists (61 percent)
– More general physicians (40 percent) worked weekend and evening hours than did specialists (19 percent)
– More general physicians (82 percent) worked in practices that made time for same-day appointments than did specialists (49 percent)

Specialists accepted more new Medicaid patients (71 percent) than general physicians did (65 percent).

Vaccaro said specialist care is more attractive to folks who become doctors because it pays more.

"You spend additional time in school developing that additional expertise, and you can charge more," she said. "You're not going to have that in primary care."

But folks don't often need a specialist – they just need an effective primary care doctor. Right now, said Vaccaro, there "just aren't enough" of them.

"The patient load is probably more significant for primary care doctors than it is for specialists," she explained. A glance at the report reveals that it's 30 percent more significant.

Still, it was easier for a patient to gain access to a general physician than it was to get into a specialist's office. That can be at least partly explained, wrote the CDC, by the additional and extended hours primary care physicians put in.

That could spell out exhaustion for primary care providers, though, especially in the non-stop health care landscape that is South Los Angeles, or any densely-populated, low-income area. In fact, folks who work in southside clinics have begun to notice that community clinics in the area are losing employees.

South L.A. is no exception when it comes to the difficulty of connecting patients with specialty care. Clinics have turned to telemedicine as a way to remotely connect patients with specialists, and are making an attempt to move toward integrated systems.

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