When to Skip the Specialist

by Carole Jackson Bottom Line Health

According to the latest statistics on the topic, there’s a good chance that you’ve been seeing a specialist for primary care problems.

For example, maybe you’ve been seeing your ear, nose and throat physician any time that you get a sore throat.

Or you might be the kind of person who goes to an orthopedist every time your back hurts.

But let me ask you this—is that what’s best for your health?

A new study reports that it probably isn’t.


Just how often are we Americans seeing specialists for primary care?

The study reports that over 40% of doctor visits for primary care in the US occur in the offices of specialists. These include both preventive exams and appointments that deal with common symptoms and diseases, such as fever, nasal congestion, anemia and asthma. The research found that all kinds of specialists were treating primary care problems, such as ob/gyns, cardiologists, gastroenterologists and nephrologists.

While the study didn’t delve into why patients were taking primary care concerns to specialists, lead researcher Minal S. Kale, MD, said that one reason may be the growing shortage of primary care doctors.

The number of medical students choosing to go into primary care started falling in the late 1990s. Based on a supply-and-demand analysis done by the Association of American Medical Colleges, in 2010, there were 9,000 fewer primary care doctors than were needed nationwide. And the association predicts that this shortage will grow to 65,800 by 2025—assuming that the Patient Protection and Affordable Care Act (aka “Obamacare”) is fully implemented so that formerly uninsured people can begin seeking medical care. The doctor shortage is worst in rural areas, said Dr. Kale.

Another reason patients go to specialists for routine care—patients may believe that specialists are better qualified to treat them. But past research shows that the opposite is actually true.


Dr. Kale acknowledged that there are certain situations in which it is appropriate to see a specialist. For example, a person in the midst of chemotherapy should certainly see his oncologist, rather than his primary care physician, if he develops a rash…and a person with chronic heart failure should see his cardiologist if he develops chest congestion. But these are symptoms that almost everyone else should discuss with a primary care physician.

“Primary care physicians usually have long-standing relationships with patients, so they tend to have a full understanding of the totality of their medical conditions,” Dr. Kale said. A specialist might look at a patient with a specialist’s eye—in other words, a gastroenterologist may be specifically on the lookout for stomach and intestinal problems if a patient comes in with abdominal pain. He or she might be alert to common causes such as indigestion, constipation, food poisoning, ulcers, gallstones or kidney stones. But a gastroenterologist might not notice that the problem is stemming from another part of the body entirely, such as from a migraine headache or psychological stress. Since primary care doctors deliver preventive health care and treat lots of different conditions on a routine basis, they have more expertise in treating the whole you.

And there’s science that supports Dr. Kale’s point. Other national research from the Primary Care Institute at University of Rochester School of Medicine and Dentistry in New York found that people who used primary care physicians, rather than specialists, as their regular source of health care were more likely to report fewer medical diagnoses and had a lower mortality rate, on average.


So if you’re scheduling your annual, preventive physical or if you’re planning to see a doctor about a common symptom, such as a nagging cough, the message is—call your primary care physician. If you don’t have one, take the time to find one—get suggestions from friends and family members and/or search your insurer’s Web site for in-network doctors. You can always see a specialist later if you need to—but you generally won’t!

Source: Minal Kale, MD, research associate, general internal medicine, The Mount Sinai Hospital, New York City. She is coauthor of a research letter published in Archives of Internal Medicine.