Comparing Generalist and Specialty Care

Abstract

Policymakers, managed care organizations, medical educators, and the general public are showing an increasing interest in the amount and quality of care provided by generalists and subspecialists. This article reviews studies comparing the knowledge base of and quality of care provided by these 2 groups of physicians. English-language articles were identified through MEDLINE (1966-present) using the following keywords: generalist, generalism, (sub)specialist, (sub)specialty, (sub)specialization, consultation, referral, and quality of care, and through the bibliographies of these citations. All studies were evaluated. With respect to quality of care, only American studies were chosen. Data quality was assessed by me. Evidence is strongest that the knowledge base and quality of care provided by specialists exceeds those of generalists for certain conditions such as myocardial infarction, depression, and acquired immunodeficiency syndrome. Differences in many other areas are multifactorial, and often a function of study design or patient selection. The differences, however, are not as striking or important to the health of the public at large as those deficiencies in disease management, preventive care, and health maintenance that are common to all physicians. Furthermore, overuse of diagnostic and therapeutic modalities by certain specialists leads to increased costs with either no benefit or added risks to patients. The quality and coordination of care provided by generalists and specialists may be improved through changes in education and training, via quality improvement methods of providing patient care, and by increasing visit length and optimizing use of referrals and strategies for generalist-specialist comanagement. Further study of these areas is warranted and should concentrate on outcomes.Arch Intern Med. 1998;158:1596-1608 This article evaluates the amount and quality of care provided by generalists and specialists, a subject of increasing interest to medical educators, managed care organizations, and the general public. Weaknesses in the knowledge base of practicing physicians are reviewed, and investigations attempting to compare generalist and specialty care for common conditions are described. While some of the differences in quality of care may be due to generalists' knowledge deficits, many are secondary to system factors and most are remediable. Furthermore, disparities between generalist and specialty care likely have less impact on the population's health than the deficiencies all physicians share. After discussing the nature of these deficiencies, I explain how they might be corrected and how generalists and specialists can work together, building on their respective strengths, to improve the quality of health care in this country.

Underuse of Prevention and Lifestyle Counseling in Patients With Peripheral Artery Disease

“…Since quality of care can be dependent by physician type,(19) we sought to investigate medication use and lifestyle counseling by practicing physician. Specialty data is not available in NHAMCS (hospital outpatient) and thus a separate sensitivity analysis was performed with NAMCS (physician office) data.…”

Antipsychotic Use in Nursing Homes Varies by Psychiatric Consultant

“…Prior studies have shown that specialty training can affect care delivery and outcomes in a variety of medical conditions. 9–11 To date, there are no studies of the relationship between psychiatric consultations and antipsychotic prescribing in NHs. The objective of this study is to assess variation in antipsychotic prescribing across psychiatric consultant groups.…”

A Model for a Regional System of Care to Promote the Health and Well-Being of People with Rare Chronic Genetic Disorders.

“…specialist teams that direct care and coordination, teach self management strategies, refer to support services, and help patients navigate the health care system have been associated with improved health outcomes for people with prevalent conditions 1,2 such as asthma [3][4][5] and AIDS. 6,7 Lasker outlined the value of these medical and public health partnerships.…”