PHYSICIANS & OTHER INDIVIDUAL PRACTITIONERS

Physicians are licensed healthcare providers that are legally entitled to deliver medical care. In most cases, physicians are required to be licensed in each state in which they practice. The term physician can be used to indicate a licensed Doctor of Medicine (MD), Doctor of Osteopathy (DO), Chiropractor, Doctor of Podiatric Medicine (DPM), Doctor of Dental Medicine (DDM) or Doctor of Dental Surgery (DDS); however, we'll be focusing mostly on MD's and DO's in our discussions of physicians. Other practitioners include Nurse Practitioners (NP's), Physician Assistants (PA's), Optometrists, and Clinical Psychologists to name a few.

In general, Physicians (MD's and DO's) are designated as Primary Care Physicians (PCP's) or Specialists depending on the extent of their education and training and their specific practice focus. Within these two designations are many types of providers. Let's look at a few practitioner types relevant to our discussions here.

• Primary Care Physicians (PCP's) are normally general practitioners, family medicine, internal medicine, or pediatric physicians. Most patients choose a PCP who provides them with ongoing care and acts as their initial contact when they have an undiagnosed medical condition.
• Specialists receive the education and training of a PCP but then choose to receive more training in a specific area of medicine, which then becomes the focus of their practice. There are many types of specialists but a few common examples include most surgeons, cardiologists (heart), dermatologists (skin), nephrologists (kidneys), oncologists (cancer), pulmonologists (lungs), rheumatologists (arthritis), and OB/GYN's (female reproduction).
• Emergency physicians, who work mostly in emergency rooms and urgent care centers, have a skill set that crosses over between a PCP and a specialist, often with extensive training in trauma related conditions.
• Nurse Practitioners and Physician Assistants are known as mid-level providers, which indicates that they have received less training than a physician but can practice a more limited scope of medicine when properly licensed and credentialed.

For our purposes, it won't be necessary to explain each kind of PCP and specialist in detail, but knowing the general difference between the two is important. In the past, many managed care health insurance plans required patients to visit their PCP before they would be allowed to visit a specialist. The PCP acted as a "gatekeeper" who would then refer the patient to a specialist if they felt it appropriate. As you can imagine, this became burdensome for patients with ongoing conditions that required them to see a specialist regularly. Luckily, many plans no longer require a referral from a PCP to see a specialist (insurers refer to this as allowing "specialty self-referral"), but a PCP visit is normally the preferable and less costly first step for patients who have an undiagnosed medical condition.

Both PCP's and specialists work in a variety of different healthcare practices and facilities from private and group practices to urgent care centers to colossal hospital systems, so patients have a wide range of choices when they choose to seek care, and each choice can affect quality, service, and cost among other things. In our Healthcare Providers and Patient Choices sections, we look into the most common practice settings, what types of care they provide, and how they compare on quality, service, and cost.

Essential QSA Knowledge

Our goal here is to define physicians and other practitioners for anybody that may not be familiar with them and to introduce readers to the concepts of primary care physicians and specialists. It's helpful to be aware of whether or not your health insurance plan allows you to see a specialist without a referral ("specialty self-referral"), but it's also important to make appropriate decisions in terms of visiting your PCP or going directly to a specialist. In general, if you haven't been diagnosed with a specific condition and/or you're not sure what type of specialist you need to see, a visit to your PCP is probably the right choice. The cost of care provided by a physician depends in large part on where the physician delivers those services (e.g. private practice, hospital, etc). Other topics within our Healthcare Provider section will build on this general knowledge.

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