Journal of General Internal Medicine

, Volume 29, Issue 6, pp 947–955

Trends and Quality of Care in Outpatient Visits to Generalist and Specialist Physicians Delivering Primary Care in the United States, 1997–2010

  • Samuel T. Edwards
  • John N. Mafi
  • Bruce E. Landon
Original Research

DOI: 10.1007/s11606-014-2808-y

Cite this article as:
Edwards, S.T., Mafi, J.N. & Landon, B.E. J GEN INTERN MED (2014) 29: 947. doi:10.1007/s11606-014-2808-y



Although many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain.


To describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs.


Cross-sectional study and time trend analysis.


Nationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997–2010.


Proportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality.


Among 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p = 0.04). The proportion of medical specialist visits in which the physician self-identified as the patient’s PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p < 0.01). Medical specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p < 0.01), primarily for preventive care (54.0 %, p < 0.01). Quality of care for cardiovascular disease was better in visits to cardiologists than in visits to generalists, but was similar or better in visits to generalists compared to visits to other medical specialists.


Medical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/gynecologist PCPs serve different primary care roles for different populations. Delivery redesign efforts must account for the evolving role of generalist and specialist PCPs in the delivery of primary care.


primary health care primary care physicians specialization health manpower patient-centered care 

Supplementary material

11606_2014_2808_MOESM1_ESM.docx (53 kb)
Appendix Table 1(DOCX 52 kb)
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Appendix Table 2(DOCX 54 kb)
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Appendix Table 3(DOCX 51 kb)
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Appendix Table 4(DOCX 49 kb)

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Samuel T. Edwards
    • 1
    • 2
    • 3
  • John N. Mafi
    • 3
    • 4
  • Bruce E. Landon
    • 4
    • 5
  1. 1.Section of General Internal MedicineVeterans Affairs (VA) Boston Healthcare SystemBostonUSA
  2. 2.Massachusetts Veteran’s Epidemiology Research and Information CenterVA Boston Healthcare SystemBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Division of General Medicine and Primary CareBeth Israel Deaconess Medical CenterBostonUSA
  5. 5.Department of Health Care PolicyHarvard Medical SchoolBostonUSA

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