Role Reversal: When the Specialist Plays General Practitioner

Study of the generalist role of medical specialists and its impact on patients

From 1995 to 1998, researchers at the University of Washington School of Medicine, Seattle, studied the impact on patient care when specialist physicians assume the generalist role.

Researchers conducted a retrospective analysis of Medicare administrative data for the state of Washington during a three-year period.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Generalist Provider Research Initiative.

Key Findings

  • Despite their importance as care providers, specialists rarely provided primary care.

  • Generalists did a better job at providing continuity, comprehensiveness, and preventive care.

  • Many specialists missed many opportunities to provide effective preventive care for their patients.

  • The strength of the doctor-patient relationship was a key element in both quality care and cost-effective care regardless of whether the care provider was a specialist or a generalist.

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