According to the 2008 National Ambulatory Medical Care Survey, there were over 960 million visits to office-based physicians. But outpatient care is not limited to primary care services. Once performed only in hospitals, most surgeries are performed on an outpatient basis, or day surgery. Non-hospital based outpatient services are expanding to include home health care, ambulatory clinics and several other specialty services.
A primary care provider (PCP) is a physician who is seen for checkups and general health problems, helping tomanage overall patient health. Primary care is seen as the entry pointto the health care system, with the use of primary care physicians as “gatekeepers” to the system.
The term “generalist” often refers to medical doctors (MDs) and doctors of osteopathic medicine (DOs) who specialize in internal medicine, family practice, pediatrics or obstetrics and gynecology.
Obstetrician/Gynecologists (OB/GYNs) are doctors who specialize in obstetrics and gynecology, including women’s health care, wellness, and prenatal care. Many women use an OB/GYN as their primary care provider.
Other health professionals involved in the primary care setting include nurse practitioners (NPs) whocan serve as a primary care provider in family medicine (FNP), pediatrics (PNP), adult care (ANP), or geriatrics (GNP). Others are trained to address women’s health care (common concerns and routine screenings) and family planning. NPs can prescribe medicines. A physician assistant (PA) can provide a wide range of services in collaboration with a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).Licensed practical nurses (LPNs) are state-licensed caregivers who have been trained to care for the sick, registered nurses (RNs) have graduated from a nursing program, havepassed a state board examination, and are licensed by the state. Advanced practice nurses have education and experience beyond the basic training and licensing required of all RNs. Advanced practice nurses include nurse practitioners (NPs): clinical nurse specialists (CNSs) have training in a field such as cardiac, psychiatric, or community health; certified nurse midwives (CNMs) are trained in women’s health care needs, including prenatal care, labor and delivery, and the care of a woman who has given birth. Licensed pharmacists have graduate training from a college of pharmacy. Pharmacists prepare and processes drug prescriptions written byprimary or specialty care providers.
Facilities where ambulatory or outpatient services are offered include medical procedures or tests that can be done without an overnight stay.The types of procedures and tests, offered usually withina few hours, include wellness and prevention services, such as counseling and weight-loss programs; diagnostic services, such as lab tests andimaging scans; treatment, such asday surgeriesor chemotherapy; and, rehabilitation, such as physical therapy or addiction treatment
Because no overnight stay is involved outpatient services usually cost less., Some centers specialize in one kind of treatment or procedure, although manycan be provided in one place.
Primary Care
Primary Care is the entry point into the health care system. Primary care clinics are the point of delivery of individual care, based on care over time and is not disease oriented, but rather preventive.Primary care is the type ofmedical facility where conditions seen at the clinic are not serious or life threatening. It is rather a “gateway” to healthcare services. The definition of primary care, adopted by the IOM Committee on the Future of Primary Care states: “primary care is the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.
Primary care medical specialities may include family medicine, general internal medicine, obstetrics and gynecology and general pediatrics.
Attributes of primary careencompass care that is accessible, comprehensive, coordinated and continuous. The perspectives of primary care are intended totarget the patient and family, the community and theecosystem,
Read article: A 2020 Vision of Patient-Centered Primary Care
General Internal Medicine
General Medicine, orInternal Medicine, is the practice of specialized adult patient care of a broad and comprehensive range of illnesses when undefined symptoms present to a primary care physician. Patients are referred to these specialists for diagnosis related to a variety of symptoms, such as shortness of breath, chest pain, abdominal pain and back pain. Collaboration in the treatment of chronic illness and in health promotion and disease prevention.involves amultidisciplinary team of specialized experts. Preventive care includes mammograms, Pap smears, routine colon cancer screening evaluations, cholesterol screening and blood pressure screening.Internistscommunicate with primary providers so care plans for ongoing care whena patientreturns home. Internists also provide comprehensive managementfor hospitalized patients, including risk assessment forpreoperative patients. Internist practice primary care as the follow adult patients over their lifetime.
In the United States, Internal medicine is the largest medical specialty, with nearly 200,000 internists in practice. Internists may function as generalist physicians practicing primary care, hospital medicine, or both. They may also pursue further training to practice a subspecialty.The National Institutes of Health (NIH) is awards over two-thirds of it’s research grantsto internists.
Family Practice
Family Medicine provides healthcare for the individual and family, integrating all aspects of care and encompassing all ages, genders and types of diseases. Family physician visits account from 20% of medical office visits, almost half of all medical specialties combined.According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The types of medical training of family physicians are usuallythe Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree. Family practice physician visits account for 25% of all doctor visits in the United States, over 200 million office visits per year. Family practice physicians provide preventive care through routine checkups, health risk assessments, immunization and screening, and health behavior and lifestyle counseling. Family practitioners also diagnose and treat acute and chronic illnesses and coordinate with specialists to manage chronic illnesses.
Although the number of primary care providers in slowly increasing,many studiesindicatethe demand for family physicians will exceed their supply by 2020. Salaries for family practice physicians are lower than specialty providers and the increasing frustrations in billing, financing and record keeping has contributed to the shortage.Most family physicians have solo or small group practice, or practice as an employee of a hospital.
Pediatrics
Pediatrics is the branch of medicine that deals with the care of infants, children and adolescents. Pediatric health services include diagnosis and treatment of diseases. The specialty recognizes the anatomical, physiological and immunological differences between children and adults.The differences in body size are paired with developmental issues of greater concern than when treating an adult. Pediatricians are proficient in the differing diagnostics and prescription needs of the infant and child. Another consideration is that the patient is not responsible for their own care, so the pediatrician must consider issues of guardianship, privacy, legal responsibility and informed consent.Pediatricians often must take in to account the patient as part of a family in procedure.
Obstetrics and Gynecology
Gynecologyis the care of the female reproductive system. The specialities of gynecology and obstetrics are most often combined. In the United States, law and many health insurance plans allow gynecologists to provide primary care in addition to aspects of their own specialty.
Obstetricsis the care of women during pregnancy and immediately after childbirth.Prenatal care is important in screening for various complications of pregnancy. This includes routine office visits with physical exams and routine lab tests: ultrasound,complete blood count (CBC), blood type, general antibody screen,,amniocentesis,hematocrit andscreens for gestational diabetes. During labor, the obstetrician monitors the progress of labor, delivery and the postpartum phase.
A primary care physician (PCP), or primary care provider, is a health care professional who practices general medicine. PCPs are our first stop for medical care. Most PCPs are doctors, butnurse practitionersand even physician assistants can sometimes also be PCPs.
A PCP is the person your child should see for a routinecheckupor non-emergency medical care. If your child has a mildfever,cough, or rash, or is short of breath or nauseated, a PCP usually can find the cause and decide what to do about it.
Usually, PCPs can treat conditions in their own offices. If they can’t, they can refer you and your child to a trusted specialist. If your child needs ongoing treatment or is admitted to a hospital, the PCP may oversee the care, help you make decisions related to treatment, or refer you to other specialists if needed.
One of a PCP’s most important jobs is to help keep kids from getting sick in the first place. This is called preventive care.
The best preventive care means forming a relationship with a PCP you like and trust, taking your child for scheduled checkups andvaccines, and following the PCP’s advice for establishing a healthy lifestyle, managing weight, and getting the right amount of exercise.
Types of PCPs
Different types of PCPs treat kids and teens. Which is right for you depends on your family’s needs:
- Family practitioners, or family medicine doctors, care for patients of all ages, from infants, kids and teens, to adults and the elderly.
- Pediatricianscare for babies, kids, and teens.
- Internists, or internal medicine doctors, care for adults, but some see patients who are in their late teens.
- Adolescent medicine specialistsare pediatricians or internists who have additional training in caring for teens.
- Combined internal medicine and pediatric specialistshave training in both pediatrics and internal medicine, allowing them to bridge the gap between treating young patients and adults.
- Obstetriciansandgynecologistsspecialize in women’s health issues and are sometimes PCPs for girls who have started menstruating.
- Anurse practitionerorphysician assistantsometimes is the main provider a child sees at a doctor’s office.
