Primary Care Physicians (PCPs)

What’s a Primary Care Physician

A Primary Care Physician (PCP) is a health care practitioner (mostly Medical Doctors- but can also be a physician assistant or a nurse) with background training in the prevention, diagnosis, and treatment of a broad array of illnesses and injuries in the general populace.

PCPs provide comprehensive care, they are your main medical provider — they tend to be in a good position to attend to;

• Routine (common medical problems) and Preventive care
• Management of Chronic and lifelong conditions like diabetes mellitus
• Acute conditions like bronchitis, allergies, colds, and flu.
• Early detection of certain illnesses or conditions e.g. cancer
• Referral to medical Specialist

A good number of health insurance types offered by most insurers require a PCP to coordinate primary care.  PCPs will coordinate care and ensure referral with specialists that you may need access to.

Even if choosing a PCP is not a requirement for some covers, it’s highly recommended to choose one—they are of great help in navigating complex health situations as they arise, considering they already know you and understand your medical history and can easily tell if you need more extensive care.

PCP care is usually provided in outpatient settings. However, if a patient has been admitted to the hospital, the PCP may assist or direct the patient’s care.

Primary Care Physician types

Different kinds of PCPs are available to provide primary care. The choice of a PCP solely depends on your needs as a family.

Below, please find a short description of how what they attend to and how they differ from each other:

Family Physicians

These are Doctors (MDs) who have already completed a family practice residency. They are board-certified, or board-eligible, for this kind of specialty. They treat patients of all ages (infants, kids, teens, adults, and the elderly).

Their scope of practice ranges from adult medicine, pediatrics, obstetrics, minor surgery, geriatric medicine, and musculoskeletal care.

Pediatricians

Doctors (MD) who have already completed a pediatric residency. They are board-certified or board-eligible, for Pediatrics.

Pediatric care usually focuses on primary wellness, development, and treatment of conditions that mainly affect babies, kids, and teens (up to the age of 21). However, there are Pediatricians who have specialized in pediatric neurology or cardiology.

Internists

 They are Doctors (MDs) who have already completed a residency in internal medicine. They are board-certified or board-eligible, as an internist. The scope of their practice includes the care of adults but some attend to patients in their late teens for many different medical problems (acute and chronic conditions.)

Internists have exposure to many different fields including endocrinology, rheumatology, neurology, orthopedics, geriatrics, and rehabilitation.

Geriatricians

These are Medical Doctors (MD) with a complete residency in either family medicine or internal medicine and are board-certified in this specialty. They are PCPs who have experience in treating older adults (over 65 years old) with complex medical diseases related to aging (insomnia, dementia, and balance problems.)

Obstetrician/gynecologists (OB-GYN)

OB-GYNs are Medical Doctors (MDs) with a completed residency in either family medicine or internal medicine. OB-GYNs are board-certified in obstetrics and gynecology. Their area of concern is women’s health issues (Women of childbearing age including postpartum conditions.) and can sometimes act as PCPs for girls who have started menstruating. Some OB-GYNs may also practice general health services, the same as an internist or family doctor.

Nurse practitioners (NP) or physician assistants (PA)

They are mostly the main providers that see a child or teen at a Medical Doctor’s (MD) office. They are highly trained professionals who have gone through a different training and certification process than doctors.

PAs usually work under the supervision of a physician.

Can an OBGYN be a Primary Care Physician

Under the Affordable Care Act (ACA), Women of childbearing age can choose their OB-GYN physician as their PCP. Also, they do not need to be referred to another doctor to see an OB/GYN.

Many healthy women who fall under the child-bearing age tend to visit an OB-GYN physician more often than any other doctor.

However, the downside is that most of these specialists are not in the best position to address health concerns not specifically related to women’s health e.g. sinus infection or digestive problems.

Finding a Primary Care Physician| How to choose Primary Care Physician

This information is usually available on the provider’s directory of preferred PCPs.

When you set on finding a PCP, the first step is looking for what matters the most to you. These are the practical matter most people consider;

• The location of the PCPs office. Ideally, the closer home the better.
• How helpful and friendly are the caregiver’s staff are-are you able to disclose personal information easily to them?
• Do the caregivers speak a language you clearly understand?
• Ease of getting in touch with the PCP. Consider if their working hours work with your schedule.
• Whether your insurance offers access to both in-network or out of network

Before you start, ensure you get recommendations from your friends, colleagues, close relatives, state-level associations, advocacy groups, and doctors or nurses that you trust.

When you have compiled a list of possible candidates, get as much possible information relating to the PCP.

Feel free to set up an appointment to “interview” the PCP. Usually, it doesn’t attract any cost, or it may attract a small co-payment or some other small fee.

It’s possible also to attend open house events to get an opportunity and meet the providers in that particular group.

Try and gauge whether:

• The PCP is formal or open and friendly. Are they good at returning calls?
• They pursue cases aggressively or are the “wait and see” type
• Whether cases are mostly handled at the physician’s office or are referred mostly to specialists.
• Do they focus on treatment, or wellness and prevention?
• Do they order a lot of tests?

Lastly, make sure you enquire about the availability of extra services under one roof. These extra services usually include;

• Mental health care,
• Dietitians,
• lactation consultants, and
• Social workers on-site.

Primary Care Physician accepting Medicaid

Where can you find a Doctor that accepts Medicare and Medicaid?

To find out if a medical health provider accepts Medicare payments, you will need to visit the Centers for Medicare and Medicaid Services Physician Compare tool.

You can use the Physician’s last name or group practice name, their medical specialty, your medical conditions, etc. The tool will return a listing of all physicians or group practices in the specialty and geographic area you specified on your search, along with detailed profiles, maps, and driving directions.

The physician Compare tool only lists professionals that accept Medicare. It’s not exhaustive as it does not list physicians who may accept Medicaid.

Medicaid programs vary greatly across states. Every state Medicaid agency maintains its own list of professionals that accept Medicaid. Visit the Medicaid & CHIP page on Healthcare.gov to find this listing.

Directories on Medline Plus are also helpful in finding medical doctors, services, and facilities that accept Medicare or Medicaid payments.

Bottom line

Establishing a strong relationship with a PCP can go a long way toward keeping you healthy.

PCPs are critical in diagnosing new medical conditions, they can easily determine whether you are in need of more extensive care and can easily coordinate care across multiple specialists. This is usually helped by the fact that;

• They know your Medical history better

PCPs tend to know their patients personally and have their entire medical history. This helps in keeping you healthy, and easy to find the source of any emerging health problems.

• Can create a Health plan. 

It’s easier for a familiar PCP to come up with a long-term health plan that suits both of you.

• Create an opportunity to revise the previous Annual Check-ups.

Most health plans do not require a copayment for annual checkups. Having the same PCP conduct annual check-ups creates an opportunity to discuss previous checks discussed with them previously.

Many insurance plans have a limited directory of preferred PCPs or will try to incentivize their members to select from a specific list of providers. Ensure you are familiar with the insurance cover before narrowing down your options.

Ensure you and the chosen PCP are a good fit. In as much as it’s easy to stay with one care provider, should you feel you are not getting the right level of care, you are at liberty to choose another PCP.