Table of ContentsView AllTable of ContentsWhat PCPs DoManaging Chronic ConditionsCoordinating CareTypes of PCPsWhy Having a PCP Matters
Table of ContentsView All
View All
Table of Contents
What PCPs Do
Managing Chronic Conditions
Coordinating Care
Types of PCPs
Why Having a PCP Matters
A primary care provider (PCP) is considered your mainmedical provider. Your PCP is responsible for dealing with the majority of your routine healthcare issues, and for coordinating care with specialists you may need to see. Depending on thetype of health insuranceyou have, your health plan may require you to have a PCP.
It’s important to understand what PCPs do, the type of medical provider who can serve as a PCP, and why your health plan might assign you a PCP if you don’t select one yourself.
Several types of medical providers can serve as your PCP, depending on your needs. And even if you’re not required to have a PCP, it’s still in your best interest to have one. Your PCP can help you navigate complex health situations if they arise, and will already know you and understand your medical history if and when you need more extensive care.
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In most cases, your PCP is a generalist and can address most of your healthcare needs. In the event that you have a problem that’s more complex than they can manage, your PCP will refer you to an appropriate specialist. This may include a surgeon, a psychiatrist, or acardiologist, for example.
You’ll also go to your PCP for non-emergency problems that arise unexpectedly. For example, your PCP will fix you up when you have a miserable cold that settles in your chest and just won’t go away after a week. Did you tweak your back while giving your dog a bath? Your PCP’s office should be your first stop.
But as described below, some women choose to use an OB/GYN as their PCP, in which case some non-emergency medical problems might be better treated at an urgent care clinic or a different doctor’s office. You can check with your OB/GYN to see if they recommend that you see a different medical provider for the situation you’re experiencing.
Yourprimary careprovider is also good at managing most chronic medical problems. For example, if you havehigh blood pressure,diabetes,acid reflux disease, orosteoporosis, your PCP will help you keep these under control.
In some cases, your PCP may work together with a specialist to manage chronic medical problems.
Your PCP will then follow up on routine blood tests and prescription refills. They may send you back to the rheumatologist if you have a flare-up, your symptoms get worse, or you develop complications.
In these situations, your PCP is the key member of your healthcare team. Quite often, they are your primary contact who can help guide you along the way. They will also communicate with your health insurance plan to ensure everyone is on the same page—particularly if you have anHMOplan.
If you have an established long-term relationship with your PCP, they might notice health changes or medical issues that a doctor who sees you less frequently might miss.
PCPs Can Coordinate Care
If you’re healthy, this won’t mean much to you. But if you develop complicated medical problems, need multiple specialist physicians, or are in and out of the hospital, you’ll appreciate good care coordination.
Do you have 20 active prescriptions from different specialists? Your PCP makes sure they’re all necessary and compatible with each other. (Your pharmacists can also help with this, especially if you usethe same pharmacyfor all your medications.)
Recently hospitalized for heart problems and now ready to start cardiac rehab? Your PCP will help keep your arthritis and asthma under control so they don’t prevent you from participating in the cardiac rehab program you need.
The Types of Providers That Can Be PCPs
In the United States, primary care providers can be a physician,physician assistant(PA), or nurse practitioner (NP). PAs and NPs usually practice under the supervision of a physician and are known as mid-level providers orphysician extenders.
Primary care physicians are usually family practitioners, internal medicine doctors, pediatricians, geriatricians, or obstetrician/gynecologists (OB/GYNs).
If your health insurance is anHMO or a POS plan, your insurer will likely require you to have a PCP. If you don’t choose a PCP from the plan’s list of in-network PCPs, the plan will assign you one.
If your health plan assigns you a PCP, you still have the option to pick a different PCP. You can always change your PCP, even if it’s someone you picked yourself. You just need to select a new PCP who is in-network with your health plan and accepting new patients. You’ll be able to request that your medical records be transferred to the new doctor, so they’ll know the details of your medical history.
In most HMOs and POS plans, your PCP acts as a gatekeeper to the other services included in the health plan. For example, in an HMO, you may not be able to see a cardiologist or get physical therapy unless your PCP refers you.
Traditionally, HMOs always required a PCP referral in order to see a specialist, but some modern HMOs allow patients to self-refer to specialists within the plan’s network.
As a general rule, carefully read your own plan’s details and rules. Never assume that your coverage will work the same as your friend’s or neighbor’s coverage, even if you both have the same insurer or the same type of managed care program (e.g., PPO, HMO, etc.).
Even if your health insurer doesn’t require you to have a PCP, it’s a good idea to choose one. Having a primary care provider is an important part of keeping yourself healthy in the long run.
When you do get sick, your doctor already knows you and your medical history as well as how you look and behave when you’re healthy. They also understand you’re not a hypochondriac or just looking for narcotics, which can be very helpful.
Summary
A primary care provider can offer a range of general/routine medical care. They can also refer a patient to a specialist or other provider when necessary and will coordinate care that a patient receives from multiple providers. Some health plans require members to have a PCP and will assign one if the member doesn’t pick one. These same health plans often require a referral from a PCP in order to see a specialist.
A primary care provider can be a doctor (family practitioner, pediatrician, OB/GYN, geriatrician, or internist), nurse practitioner, or physician’s assistant.
Establishing a relationship with a PCP can go a long way toward keeping you healthy. They can provide a variety of routine medical needs and will come to know you over time. This can be helpful if you develop a new medical condition, as your PCP will be familiar with your usual health status, and better able to identify what might have changed. And if you do end up needing more extensive care, your PCP will be able to help you coordinate care across multiple specialists.
2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Medline Plus.Choosing a primary care provider.Department of Health and Human Services,Text of the Affordable Care Act. ‘‘SEC. 2719A [42 U.S.C. 300gg–19a]. PATIENT PROTECTIONS. (d) PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Medline Plus.Choosing a primary care provider.Department of Health and Human Services,Text of the Affordable Care Act. ‘‘SEC. 2719A [42 U.S.C. 300gg–19a]. PATIENT PROTECTIONS. (d) PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Medline Plus.Choosing a primary care provider.Department of Health and Human Services,Text of the Affordable Care Act. ‘‘SEC. 2719A [42 U.S.C. 300gg–19a]. PATIENT PROTECTIONS. (d) PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.
Medline Plus.Choosing a primary care provider.
Department of Health and Human Services,Text of the Affordable Care Act. ‘‘SEC. 2719A [42 U.S.C. 300gg–19a]. PATIENT PROTECTIONS. (d) PATIENT ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE.
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