When should you see a specialist?
Regular doctor visits are an important part of healthy living. But when should you see your primary care physician or see a specialist?
Primary care doctors are trained to evaluate virtually any kind of problem, says Jay Geary, M.D., a board-certified family physician who works at Premier Family Care. This can include physical ailments, emotional problems, an infectious situation or an injury-related ailment for the young and old, male and female. “The vast majority of patients’ concerns can be addressed this way: through discussion, examination and a course of action prescribed by a primary care doctor,” Geary says.
Specialists, on the other hand, are trained to have a deep knowledge of a particular body system or topic, such as the cardiovascular system, the lungs, the kidneys, arthritis, cancer or complicated sports injuries. Specialists, Geary says, are skilled in medical procedures necessary to diagnose and treat problems related to those conditions.
Seeing a primary-care doctor initially is something you should almost always do, says Rebecca Thrun, D.O., a Warren Clinic internal medicine physician.
“You would almost always visit your PCP for an initial evaluation of a new complaint,” Thrun says. “Based on their evaluation, you may need preliminary testing and possibly referral to a specialist.”
She notes that many times insurance companies require a referral from a family physician before seeing a specialist.
Geary says that some health insurers allow patients to make specialty visits without a referral, most notably some Medicare plans. “However, a specialist also might not know if they are the best one to manage your condition, so the specialist themselves often prefer or require a referral from the primary care physician,” he says.
The primary care physician should make the initial evaluation since they know your medical history and health status, says Lance King, M.D., medical director at Warren Clinic and a Warren Clinic family medicine physician. “Then, if there are uncertainties, the PCP will offer a specialty referral and explain the rationale and talk through any questions with their patient,” he says.
Questions for patients to consider asking their PCP include:
Do you have confidence in the specialist I will see?
What further testing might be done before the visit?
What should I expect from the specialist visit?
What options might you prefer?
There are some differences when it comes to seeing particular specialists. Testing might be required before an appointment can be made available and it might take longer to make an appointment with a specialist versus a family care doctor.
To help make the process smoother, the best place to start is with the primary care physician. The patient can explain their symptoms and gather input from the PCP.
“Often that is all that is needed,” he says. “When tests such as MRI or other scans are necessary for a certain condition, the PCP guides that process. We try to remain ‘evidence-based’ in recommending a timeline for screening tests such as colonoscopy, performed by the gastroenterology specialist, and other preventative services.”
It’s also important to consider insurance when visiting a specialist. There might be differences when it comes to what tests or consultations are covered and the requirements for coverage and what copays to expect. It’s best not to be surprised, King says. Go ahead and ask questions.
Dentist vs. dental specialist
Specialty dentistry works much the same way as regular health care. Patients see a specialty dentist when there is a need for additional expertise in diagnosing and treating certain conditions, says Matt McShane, D.D.S., of Eastern Oklahoma Oral and Maxillofacial Surgery.
“There also are instances in which a fairly routine procedure or surgery can be made more complex by a patient’s health status, and these cases are sometimes referred to specialists to allow for a team approach to the patient’s overall care,” he adds.
Generally, a referral is often necessary and helpful to a dental specialist. There are often several treatment options, and a referral clarifies what the general dentist has in mind for the patient’s overall care. However, pediatric dentists usually do not require referrals, and accept new pediatric patients for dental screening, diagnosis, treatment, maintenance and management.
“There are also occasions in which oral and maxillofacial surgeons see patients who present with a severe dental infection, tumor or facial injury and require prompt care despite not having a referral,” McShane says. “Once a condition is treated and the patient is stable, I encourage these patients to seek routine dental care.”
One of the biggest roadblocks when it comes to specialty dentistry is that the specialist might not be in network, he says.
“It is always helpful to discuss this topic over the phone before your consultation to avoid any surprises,” he says. “In addition, some specialists limit their practice to certain conditions and treatments. For example, some oral surgeons may not treat malignant (cancerous) pathologies or perform cosmetic facial surgery despite having training in such areas.”
Specialty clinics have grown in numbers in recent years. Lance King, M.D., medical director at Warren Clinic and a Warren Clinic family medicine physician, says that as the population ages, they have a greater need for medical care. Many times in older patients, complexity of care increases and the need for procedures and specialty consultations increases.
Geary says he believes many doctors pursue a specialty because they find it rewarding to delve deeply into specific health topics. They also might enjoy performing surgeries or procedures related to a specific body system, or they like to stay ahead of the latest research pertaining to a certain field.
“I also think rapid advances in medical technology and the sheer volume of knowledge specific to the different aspects of human health allow a division of labor and different roles in order to ‘find our niche’ as physicians and ultimately help as many people as possible,” he says.