Primary care physicians and specialists as personal physicians: Health care expenditures and mortality experience

Peter Franks, Kevin Fiscella

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


BACKGROUND. The advent of managed care has resulted in considerable debate regarding the relative effects of specialist and primary care on patient outcomes and costs. Studies on these subjects have been limited to a disease-focused orientation rather than a patient-focused orientation inherent in primary care management. We examined whether persons using a primary care physician have lower expenditures and mortality than those using a specialist as their personal physician. METHODS. Using data on a nationally representative sample of 13,270 adult respondents to the 1987 National Medical Expenditure Survey reporting as their personal physician either a primary care physician (general practitioner, family physician, internist, or obstetrician-gynecologist) or a specialist, we examined total annual health care expenditures and 5-year mortality experience. RESULTS. Respondents with a primary care physician, rather than a specialist, as a personal physician were more likely to be women, white, live in rural areas, report fewer medical diagnoses and higher health perceptions and have lower annual health care expenditures (mean: $2029 vs $3100) and lower mortality (hazard ratio = 0.76, 95% confidence interval [CI], 0.64 - 0.90). After adjustment for demographics, health insurance status, reported diagnoses, health perceptions; and smoking status, respondents reporting using a primary care physician compared with those using a specialist had 33% lower annual adjusted health care expenditures and lower adjusted mortality (hazard ratio = 0.81; 95% CI, 0.66 - 0.98). CONCLUSIONS. These findings provide evidence for the cost-effective role of primary care physicians in the health care system. More research is needed on how to optimally integrate primary and specialty care.

Original languageEnglish (US)
Pages (from-to)105-109
Number of pages5
JournalJournal of Family Practice
Issue number2
StatePublished - Aug 1998
Externally publishedYes


  • Costs
  • Mortality
  • Primary care physicians
  • Specialists

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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