Primary Care Physician

A primary care physician is a generalist physician who provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient's care. Primary care physicians devote most of their practice to providing primary care services to a defined population of patients. The style of primary care practice is such that the personal primary care physician serves as the entry point for substantially all the patient's medical and health care needs. Primary care physicians are advocates for the patient in coordinating the use of the entire health care system to benefit the patient (AAFP, 2009).

Patients want a physician who is attentive to their needs and skilled at addressing them, and with whom they can establish a lifelong relationship. They want a physician who can guide them through the evolving, complex U.S. health care system.

The ABFM and the American Board of Internal Medicine have agreed on a definition of the generalist physician, and they believe that "providing optimal generalist care requires broad and comprehensive training that cannot be gained in brief and uncoordinated educational experiences" (Kimball and Young, 1994, p. 316).

The Council on Graduate Medical Education (COGME) and the Association of American Medical Colleges (AAMC) define generalist physicians as those who have completed 3-year training programs in family medicine, internal medicine, or pediatrics and who do not subspecialize. COGME emphasizes that this definition should be "based on an objective analysis of training requirements in disciplines that provide graduates with broad capabilities for primary care practice."

Unfortunately, the number of students entering primary care continues to decline. "In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low levels" (Bodenheimer et al., 2009).

Physicians who provide primary care should be trained specifically to manage the problems encountered in a pri mary care practice. Rivo and associates (1994) identified the common conditions and diagnoses that generalist physicians should be competent to manage in a primary care practice and compared these with the training of the various "generalist" specialties. They recommended that the training of generalist physicians include at least 90% of the key diagnoses. By comparing the content of residency programs, they found that this goal was met by family practice (95%), internal medicine (91%), and pediatrics (91%), but that obstet-rics-gynecology (47%) and emergency medicine (42%) fell far short of this goal.

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