How to Choose a Primary Care Physician, What’s a Primary Care Provider Team? (podcast)

Geriatric physicians are typically internal medicine physicians. They typically specialize in caring for folks 65 and up.

Internal medicine physicians handle just about anything that a primary care physician would see. You would see an internal medicine physician for preventative care. If someone has multiple chronic diseases, you would see the internal medicine physician. They would provide treatment for things such as diabetes, high blood pressure and coronary artery disease. Family medicine physicians will care for the same types of problems as well.

Because there is a shortage of mental health providers and specialists — such as psychiatrists — a lot of the initial mental health falls on the primary care physician. The first time a patient may see someone for mental health issues could be with their primary care physician.

Normally, pediatricians will see babies when they’re born, and then they will normally care for patients up to the age of 18. However, some patients get really attached to their pediatricians and sometimes stay with them into their early 20s. There are some pediatricians who will recommend transitioning their patients at an earlier age than 18. Others I’ve seen hang onto patients into their early 20s, until they kind of tell them maybe it’s time to transition to adult medicine.

A doctor of osteopathic medicine and a medical doctor basically have the same qualifications. They’re both board certified. They’re both highly qualified. They both go to medical school. The difference would be that osteopathic physicians have a bit more of a holistic approach — letting the body heal itself. They also have training in osteopathic manipulation, which is more hands-on [for orthopedic purposes]. When you see an osteopathic physician or a medical doctor physician, you will have basically the same trained level of practitioner.

Physician assistants and nurse practitioners at Scripps are used fairly interchangeably. They’re advanced practice clinicians and they’re highly trained folks. The difference is mostly in their training. A nurse practitioner will have training through the nursing model, whereas the physician assistant will have training through more of a medical model. They both have extensive clinical experience prior to getting their PA or nurse practitioner degrees.

They’re not doctors, but it’s a matter of degrees. They are highly trained and they’re a vital part of our [primary care provider] teams.

The role of the nurse practitioner is to provide access for our patients. In our primary care provider teams, the nurse practitioners will provide care; they can do physicals; they can treat acute care types of problems; they help the primary care provider teams with incoming patient messages and can address diagnostics. They assist the team in improving our access for our patients.

You could see your primary care physician; you could see your nurse practitioner; you could see your physician assistant and they would be all very qualified to help you with these conditions.

Physician assistants and nurse practitioners are able to treat some acute care cases that may be relatively straight-forward. This frees up the primary care physician to treat more complex types of issues.

Our primary care provider teams at Scripps have been designed to keep the patient’s best interest in mind, and to be able to maximize the quality of care the patient receives. A primary care provider team is basically a small group of health professionals working to the top of their qualification to be able to serve our patients in the best way possible.

Patients like to access us in different ways. They like to see us in the office, but sometimes they don’t. Sometimes they would rather call in or sometimes they’d rather email us and we have to be flexible and nimble enough to address access from any of the ways that they want to get a hold of us.

A lot of times when a patient calls in, the care team will decide what is the best care team member to address the patient’s question. If it’s a question about something clinical — for example, someone calling and saying: “I’m sick. Do I need to be seen?” — that may be addressed by the nurse practitioner or the physician assistant or the primary care physician. If they ask to make an appointment, that may be handled by another care team member. It just depends on what it is about.

The most important thing for a patient is finding a primary care physician that they feel really comfortable with, someone who no matter what I’m going in for understands me and that I have a good rapport with. I can tell this doctor anything that’s on my mind, regardless of how simple or complicated or embarrassing it is. It’s less about the type of primary care physician, as opposed to finding that primary care physician who you find that right balance with.

It’s important to find out if the primary care doctor is licensed and board certified. Some of that can be found on the internet. Fortunately, at Scripps, that’s all vetted ahead of time. It’s almost a given for us.

[The Scripps website, www.scripps.org features a site to find a doctor according to specialty.]

I have a number of families in my own [family medicine] practice who I’ve been fortunate enough to care for. It really depends on what the patient is looking for. Every patient is different. Some patients would prefer to have their own doctor and have their family members be treated by someone else. There are other patients who are just very enthusiastic about having one doctor to provide care for everyone. Maybe because it’s more convenient.

When you have a team of people focusing on your best interest, that means a lot. It helps with the efficiency of things. Maybe getting your messages answered quicker. Maybe you have better access to that primary care provider team because you can see the primary care physician, but if that primary care physician isn’t available, the care team nurse practitioner or physician assistant can see you. You become more familiar with the medical assistants and the nurses that work with that particular primary care provider team. It’s a confidence type of thing for the patient, but it’s also quality and being able to get the answers you need faster and more efficiently.