More than a third of our primary care is delivered by specialty doctors

August 22, 2012

File this under reasons our health care system is expensive: 41 percent of our most basic health care needs, the fevers and colds we all get, are taken care of by higher-paid specialty doctors.

Mount Sinai's Minal Kale lead a team of researchers that combed through data on more than 20,000 doctor visits in 1999 and 2007. All of it had information on why the individual turned up at the doctor's office, whether it was a runny nose (not so serious) or a heart attack (decidedly more serious).

Their results, just published in the Archives of Internal Medicine: 59 percent of those with primary care needs, the people in the runny nose group, were seen by a primary care doctor. Forty-one percent sought out care at a specialist.

To be fair, some people went to specialty doctors who tend to handle a heavy primary care case load such as gynecologists and internal medicine physicians. Exclude those two groups and you still have 27 percent of primary care appointments happening in specialty offices.

"Patients have been shown to prefer specialist physician care and believe that specialists are better able to treat specific conditions," Kale and his colleagues write. "These preferences and beliefs may drive some patients to seek all of their care from specialists, including basic primary care services."

They may also drive up prices: Andrew Seaman points out a 2010 study finding that primary care doctors earn a $69 hourly rate, compared to the $92 per hour and $85 per hour that surgeons and ob-gyns earn, respectively.

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Dylan Matthews · August 22, 2012