Are there enough primary care physicians available to meet the demand? New research suggests not


Contact: Maureen Maxwell
(202) 232-9033 or (800) 274-2237, ext. 2560

WASHINGTON—A third of primary care medical services performed in Colorado was provided by non-primary-care specialists, according to a study of physicians in that state. But some of the details about the training and experience of those providing such care raise questions about the quality of the care.

"Nearly half of non-primary-care specialists surveyed provided primary care medical services," said George E. Fryer, Jr., lead author. "On average, specialists spent about a fourth of their time in direct patient care providing primary care services."

The research, "Specialist Physicians Providing Primary Care Services in Colorado," from the Robert Graham Center: Policy Studies in Family Medicine and Primary Care in Washington, D.C., was published in the March/April edition of the Journal of the American Board of Family Practice. For purposes of this study, "specialist" referred to physicians whose main specialty was not family medicine/general practice, general internal medicine or general pediatrics.

The research revealed:

Specialists spent, on average, 12.5 hours in primary care activity out of the average 47.9 hours per week spent on direct patient care.

Approximately one out of three -- 34 percent -- of specialists devoted at least one-fourth of their time with patients to providing primary care services, and one in four -- 26 percent -- spent half or more of their direct patient care time in primary care services.

The authors estimated that specialists provided 33.5 percent of the primary care services in the state.

"The significant amount of primary care services provided by non-primary-care specialists should be taken into consideration when researchers and policy-makers are looking at what doctors are needed where. Are there enough primary care physicians available to meet the demand? Our research suggests not," said Fryer.

The research also showed:

Female specialists were more likely to provide primary care services than their male counterparts.

Younger specialists (under 35 years of age) and older (over 64) provided a greater proportion of primary care services than did those between 35 and 64.

Osteopathic specialists (D.O.s) were significantly more likely to provide primary care services than allopathic specialists (M.D.s), and specialists who were not board-certified provided more primary care services than those who were certified.

Specialists with practices in rural areas and those spending less time seeing patients were more involved in primary care activity than other specialists.

Specialists who provided primary care services spent less time in direct patient care than did other specialists, even with primary care service time included in their total for patient care.

Physicians in emergency medicine and obstetrics/gynecology were the most numerous specialists providing primary care. 

 Nearly a fifth of all specialists reported a secondary specialty, three-fifths of which were primary care specialties. Most were board-certified in their secondary specialty.

The survey did not ask questions to determine if provision of primary care services reflected professional choice or a need to fill available clinical time for which there was no demand for specialized medical services.

"We concluded that further research is needed to determine if primary care services provided by non-primary-care specialists differ in quality or in the satisfaction of patients. Our study did not assess quality differences but raised some questions," said Fryer. "Recent research revealed that the care specialists provide outside their field of specialization is of lower quality than that provided by primary care physicians. We think it’s an area where analysis needs to be expanded."

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Note to journalists: To interview Dr. Fryer, or to obtain a copy of the article, please contact Maureen Maxwell at (202) 232-9033, (800) 274-2237 ext. 2560, or

The Journal of the American Board of Family Practice can be viewed at

The Robert Graham Center conducts research and analysis that brings a family medicine perspective to health policy deliberations in Washington. Founded in 1999, the Center is an independent research unit working under the personnel and financial policies of the American Academy of Family Physicians. For more information, please visit

The information and opinions contained in research from the Robert Graham Center do not necessarily reflect the views or policy of the AAFP.

April 01, 2004