Who Is the Primary Physician?

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Abstract
Several studies have concluded that specialists form a hidden system for primary-care delivery. However, these studies assume that a specialist who provides the majority of care is the primary-care physician. Using data for a one-year period from 2752 people enrolled in the Rand Health Insurance Experiment, we examined the validity of this conclusion. We compared the effects of three different definitions of a primary-care physician on identification of the primary-care provider: the physician who delivered the "majority of care" (34 per cent were specialists), the physician designated by the patient to receive the results of a multiphasic-screening examination (12 per cent were specialists), and the physician who treated common problems (9 per cent were specialists). Use of the "majority-of-care" criterion to define primary care overestimated by threefold the contribution specialists make to this activity. Definitions of a primary-care physician must be more specific and should include the tasks frequently associated with primary care, as well as patients' perceptions of the physician who provides their primary care. (N Engl J Med 1983; 308: 1208–12.)