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To what extent is there a hidden system of primary care provided by subspecialists?


Park J, Lipner RS. — American Board of Internal Medicine

Presented: AcademyHealth Annual Research Meeting, June 2010

Objective: To examine the quantity and quality of primary care delivered by subspecialists in internal medicine.

Data Sources: The American Board of Internal Medicine (ABIM) databases from 11,681 general internists and 9,488 subspecialists who enrolled in the Maintenance of Certification program between 2006 and 2009 were linked to the area resource files.

Study Design: Using a two-part model, the probability of subspecialists providing any primary care and extent of time spent in primary care were separately estimated. The performance scores of general internists were compared to those of subspecialists derived from the ABIM Diabetes and Hypertension Performance Improvement Modules.

Principal Findings: About 36% of subspecialists devoted some practice time to primary care and their average percent of time spent in primary care was 27%. Market factors such as whether one practices in a primary care physician shortage area or a rural area were associated with subspecialists spending more of their time in primary care. Subspecialists (endocrinologists) performed better on diabetes care than general internists, while general internists received higher scores on hypertension care than their subspecialty (nephrology, cardiology) counterparts.

Conclusions: A substantial proportion of primary care is provided by subspecialists possibly due to the shortage of primary care physicians.

For more information about this presentation, please contact Research@abim.org.