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PCP — What Is a Primary Care Physician?

what is pcp insurance

By Elizabeth Davis, RN. Health Insurance Expert

As a Registered Nurse and freelance medical writer, Elizabeth has been helping people navigate the complexities of their health insurance and the healthcare system for more than 25 years.

Updated May 28, 2015.

A primary care physician, or PCP, is considered to be your main doctor and will be responsible for dealing with the vast majority of your health care issues. In the past, these physicians were known as family doctors or general practitioners, but now they’re called primary care physicians or primary care providers .

What Do PCPs Do?

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In the event that you have a problem more complex than he or she can manage, your PCP will refer you to an appropriate specialist like a surgeon, a psychiatrist, or a cardiologist.

You’ll go to your PCP for your yearly physical exam and preventive health care. He or she will help you determine what future health care problems you’re at risk for developing, and what you can do now to prevent those problems or decrease your risk.

You’ll also go to your PCP for non-emergency problems that arise unexpectedly.

For example, you’ve had a cold for a week, and the cold has settled in your chest. You’re coughing up green phlegm and feel lousy. Your PCP will fix you up. Did you tweak your back while giving your dog a bath? Your PCP’s office should be your first stop.

Your primary care provider is also good at managing most chronic medical problems. If you have high blood pressure. diabetes. acid reflux disease. or osteoporosis. your PCP will help you keep these chronic illnesses under control.

In some cases, your PCP may work together with a specialist to manage chronic medical problems.

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An example of this is rheumatoid arthritis where a rheumatologist may be involved in the initial diagnosis and treatment of the disease, but turn routine care over to your PCP once the disease is well controlled by medications. Your PCP will then follow up on routine blood tests and prescription refills, but may send you back to the rheumatologist if the rheumatoid arthritis flares up, your symptoms worsen, or you develop complications.

Perhaps the most valuable role primary care physicians fill is also least understood by the general public. PCP’s are experts at coordinating 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.

In the role of care coordinator, your PCP is the team captain. He or she knows what each of the specialists is doing and makes sure they’re not duplicating tests or procedures that have already been done by another specialist. Do you have 30 active prescriptions from all sorts of different doctors? Your PCP makes sure they’re all absolutely necessary and they’re all compatible with each other. Recently hospitalized for heart problems and now ready to start cardiac rehab? It’s your PCP that will help keep your arthritis and asthma

under control so they won’t prevent you from participating in the cardiac rehab program you need.

What Types of Doctors Can Be Primary Care Providers?

In the United States, primary care providers can be physicians, physician assistants. or nurse practitioners. PAs and NPs usually practice under a physician and are known as mid-level providers or physician extenders .

Primary care physicians are usually family practitioners, internal medicine doctors, pediatricians, geriatricians, or rarely, gynecologists and general practitioners.

Family practitioners are doctors who have gone through medical school and then completed a three-year residency in family medicine. This residency provides training in the care of adults, kids, the elderly, and even pregnant women, although most FPs choose not to offer pregnancy care as part of their practice.

Internal medicine doctors. otherwise known as internists, are physicians who have gone through medical school and then completed a three-year residency in internal medicine. This residency provides training in the care of adult and elderly adult patients, but doesn’t usually include training in the care of children. Internists receive lots of training in the body’s internal organ systems, hence, the name internist.

Pediatricians are doctors that specialize in care of children. They’ve completed medical school and a three-year residency in pediatrics. A pediatrician can be your child’s PCP, but won’t be a PCP for an adult.

Geriatricians are doctors that specialize in caring for the elderly. They’ve completed medical school and a three-year residency in either family practice or internal medicine. After their residency, they completed a one to three year fellowship in geriatric medicine.

General practitioners are physicians who’ve gone through medical school and a one-year internship, but haven’t specialized further. General practitioners are uncommon in the United States; most physicians choose to complete a residency program.

Gynecologists are physicians who specialize in treating diseases of the female reproductive system. They’ve gone through medical school and done a residency in obstetrics and gynecology. While they’re not usually official primary care physicians, many healthy females of child-bearing age see their gynecologist more often than any other physician and therefore consider their gynecologist to be their PCP.

Why Does Having a PCP Matter?

If your health insurance is an HMO or a POS plan. your insurer will require you to have a PCP. If you don’t choose a PCP from the plan’s list of in-network PCP’s, the plan will assign you one. 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 won’t be able to see a cardiologist or get physical therapy unless your PCP refers you.

Even if your health insurer doesn’t require you to have a PCP, wise patients will choose to have one. Having a family doctor, even if you don’t have a family, is an important part of keeping yourself healthy over the long run. When you do get sick, having a doctor that already knows you, knows how you look and behave when you’re healthy, and knows you’re not a hypochondriac or just looking for narcotics is very helpful.

Category: Insurance

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