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Specialist Physicians Providing Primary Care Services in Colorado

Robert Graham Center for Policy Studies in Family Practice and Primary Care, American Academy of Family Physicians, Washington, DC (GEF, RC, SMD, RLP, LAG)
Colorado Area Health Education Center Program, University of Colorado Health Sciences Center at Fitzsimons, Aurora (TJM)

Correspondence: Address correspondence to: George E. Fryer, Jr., PhD, Robert Graham Center, American Academy of Family Physicians, 1350 Connecticut Avenue, N.W., Suite 950, Washington, D.C. 20036 (e-mail: efryer{at}aafp.org)

Background: There is general consensus that the size of the US physician workforce now exceeds the health care needs of the American public. There is a greater proportion of specialists than primary care physicians, a specialty mix different from that of most other developed countries.

Methods: The Colorado Board of Medical Examiners sent a one-page questionnaire to all physicians licensed to practice in the state. It contained the question: "How many hours in the last week did you provide primary care services, defined as either preventive care, routine physical exams, or treatment of common ailments?" The responses of physicians who reported non-primary-care medical specialties were analyzed with respect to their personal and practice characteristics.

Results: Just under half (46.5%) of the 2745 specialist respondents reported having provided primary care services. As a group, however, 27.9% of specialist physicians’ direct patient care time was devoted to primary care activities. The amount of primary care services being provided was greater among those not board-certified in their specialties, osteopathic physicians, and specialists spending less time in direct patient care.

Conclusion: Additional evaluation is needed with a more comprehensive definition of primary care than used in this article, which includes important but difficult-to-measure elements, such as the integration of services, a sustained partnership with patients, and practice in the context of family and community. To the extent possible, this definition should not rely on physician self-definition of which examinations are routine and which ailments are common. However, the contribution of specialists should be considered in future primary care needs assessments, and specialists who experience low demand for their particular specialties may be especially inclined to provide primary care services.

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