Your Primary Care Provider is your Primary Care Physician (PCP). Your PCP is responsible for most of your medical problems.
Depending on the type of health insurance you have, your insurer may require you to have a PCP. But even if you don't need a PCP, it is best for you to have a PCP; They can help you navigate difficult medical situations if they arise and will already know and understand your medical history when you need it. more extensive care.
In the past, these doctors were known as family doctors or general practitioners. Today, they are often referred to as primary health care physicians or primary health care providers .
What do the treating doctors do?
In most cases, your PCP is a primary care physician and can meet most of your medical needs. If you have a problem that is more difficult than you can solve, your PCP will refer you to the appropriate specialist. It could be, for example, a surgeon, a psychiatrist or a cardiologist .
You will see your PCP for your annual checkup and preventive care . She will help you identify any medical problems you may have in the future. They will also advise you on how you can prevent these problems or reduce your risk.
You will also see your PCP for unforeseen problems that are not urgent. For example, your PCP will cure you when you have a bad chest cold that does not go away in a week. Did you turn your back on him when you bathed your dog? Your PCP's office should be your first stop.
Management of chronic conditions
In some cases, your PCP may work with a specialist to treat chronic conditions.
Take rheumatoid arthritis , for example. A rheumatologist can be involved in the initial diagnosis and treatment of the disease. He or she can transfer routine care to your PCP if the disease is well controlled with medications. Or, if you have had a kidney transplant , your PCP will contact your nephrologist to make sure you are getting the care you need to stay healthy.
Then your PCP will follow up on your regular blood tests and prescription refills. They may send you back to a rheumatologist if your condition worsens, symptoms worsen, or complications develop.
In these situations, your PCP is a key member of your health care team. Very often, she is your main point of contact and can help you along the way. You will also contact your health insurance company to make sure everyone is on the same page, especially if you have an HMO plan.
PCPs can coordinate care
Perhaps the most valuable role that primary care physicians play is also the least understood by the general public. PCPs are experts in coordinating health care.
Being healthy doesn't mean much to you. But if you have complex health problems, need several specialist doctors, or go to the hospital and are discharged, you will appreciate good treatment coordination .
As the Care Coordinator, your PCP is the captain of the team. He knows what each of the specialists does and makes sure they do not duplicate tests or procedures that have already been performed by another specialist. Your insurance company will also do this as part of its utilization review , but coordinating with your PCP will help avoid denied claims and unnecessary medical services.
Do you have 20 valid recipes from different specialists? Your PCP makes sure that they are all absolutely necessary and compatible with each other (your pharmacists can also help with this if you use the same pharmacy for all your medications).
Recently hospitalized for heart problems and now ready to start cardiac rehab? Your PCP will help you manage your arthritis and asthma so they do not interfere with your participation in the necessary cardiac rehabilitation program.
Types of Doctors Who Can Be a PCP
In the United States, primary care providers can be a physician, physician assistant (PA), or nurse practitioner (NP). PA and PN are generally performed under the guidance of a physician and are known as mid-level providers or physician assistants . Primary care physicians are typically family physicians, general practitioners, pediatricians, geriatricians, or obstetrician-gynecologists.
- Family Physician: A Family Physician (FP) is a physician who graduated from medical school and completed a three-year residency in family medicine. This residence provides training in caring for adults, children, the elderly and pregnant women. However, most family physicians choose not to offer maternity care as part of their practice.
- General practitioners: General practitioners (or therapists) are physicians who graduated from medical school and completed a three-year residency in internal medicine. This provides training in caring for adults and older adult patients, but generally does not include children. Internists undergo extensive training in the internal systems of the body, hence the name therapist.
- Pediatricians: Pediatricians are doctors who specialize in the care of children. They graduated from medical school and completed a three-year residency in pediatrics. The pediatrician may be your child's healthcare provider, but not the adult.
- Geriatrist: A geriatrician is a doctor who specializes in the care of the elderly. After graduating from medical school, they will complete a three-year residency in family medicine or internal medicine. They then undergo a one to three year internship in geriatric medicine.
- Obstetrician-Gynecologist: OB-GYN (OB- GYN or OB-GYN) are doctors who specialize in treating diseases of the female reproductive system. They graduated from medical school and residency in obstetrics and gynecology.
Although technically specialists, many healthy women of childbearing age visit a gynecologist more often than any other doctor. They see their gynecologist as their primary care physician, and the Affordable Care Act (ACA) protects this option.
Under the Affordable Care Act (ACA), women are not required to obtain a referral from another physician to see an OB / GYN. Referrals from an OB-GYN should be considered acceptable in terms of referrals required by managed care plans.) Basically, the ACA allows a woman to choose an OB-GYN as her primary care provider .
Why is it important to have a PCP?
If your health insurance is an HMO or POS plan , your insurer will ask you to have a PCP. If you do not choose a PCP from the plan's network PCP list, the plan will assign one to you.
In most HMO and POS plans, your PCP acts as a gatekeeper for other services covered by the health plan. For example, in an HMO, you cannot see a cardiologist or receive physical therapy unless your PCP refers you.
Traditionally, HMOs have always required a PCP referral to see a specialist, but some modern HMOs allow patients to see a specialist on their own in the plan's network. As a general rule, you should always carefully read the details and rules of your own plan; never assume that your coverage will work the same as your friend's or neighbor's coverage, even if they both have the same insurance company or the same type of managed insurance. safe. program of care (for example, PPO, HMO, etc.)
Even if your health insurance company does not require you to have a PCP, it is recommended that you choose one. Having a GP, even if you don't have a family, is an important part of staying healthy in the long run.
When you get sick, your doctor already knows you and your medical history, as well as how you look and behave when you are healthy. They also understand that you are not a hypochondriac or are just looking for medications, which can be very helpful.