Primary Care

The Practice of Primary Care and Changes in the Workforce

The primary care physician—known in some parts of the world as a general practitioner—is a medical doctor (MD) or doctor of osteopathic medicine (DO) who, as a generalist, serves as the patient's first entry point into the health care system. This requires that the physician possess a comprehensive base of knowledge and skills to be able to effectively address prevention, diagnosis, treatment, and overall management of individual patient health throughout the life cycle. Thus, the primary care physician practices either family medicine, internal medicine, or pediatrics (though obstetrics and gynecology are sometimes, [Page 464]arguably, included because of the number of women who visit an obstetrician/gynecologist for routine medical care). And the specific tasks and responsibilities associated with these practice areas could be performed in any type of health care facility—an office, a hospital, a clinic, or an academic institution. Taken together, the primary care physician is oriented toward being accessible to patients with undifferen-tiated health issues and positioned to refer them to other, specialized professionals according to specific health care needs.

Although these points oversimplify many features of the practice and omit others, they are major factors that explain the function of primary care. And these factors have remained constant over time, despite the development of significant economic, political, and social changes that have affected delivery of care. Yet these external forces encouraged years-long, worldwide debates, such as whether there would be surpluses or shortages in the supply of primary care physicians.

It is becoming widely recognized that demand for all types of physicians is fast outpacing the supply. (Previously—that is, until the early 2000s—there had been a decades-long assumption that there would be an excess of physicians.) This prompted medical schools to quickly mobilize efforts to increase their enrollment, training and development, and construction and expansion plans severalfold. At the same time, the number of medical school graduates entering primary-care residencies decreased dramatically; in the United States, for example, it decreased by 50%. Instead, those going into the profession have increasingly elected to practice a specialty rather than primary care—a trend that has shown no signs of slowing down.

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