Advantages of Having a Primary Care Physician

A primary care doctor, also referred to as PCP or family doctor, often serves as the leader of your healthcare team. While some asthma specialists function as a primary care physician for their patients, I sometimes get referrals for primary care from asthma specialists. Patients are sometimes confused as to why this was occurring and I have even had patients who thought they were being abandoned (not the case) by their beloved asthma doctor.

What a Primary Care Doctor Does

The first question I get from asthma patients or parents is about whether or not they need a primary care doctor or not? It goes something like this “Why do we need to see another doctor,” or “Are you and Dr. X going to agree on our care?” In full disclosure, I am a primary care doctor in my real job, so it should not surprise you that I am going to say yes– I think just about everyone needs a PCP. I know this may not be an easy task as many patients complain that they have a difficult time finding a PCP. Many parts of the US, especially rural areas are experiencing primary care shortages. Additionally, your insurance may also dictate to a certain extent who you are able to see.

Your primary care doctor organizes all of your healthcare and should function as the leader of your healthcare team. In many instances, it will be your primary care doctor who identifies the need for a specialty referral and will likely make suggestions based on your needs. If, for example, you need to see an allergist and a pulmonologist, your PCP would coordinate the care between these two specialists. Your PCP can also help you understand and make decisions if you get different recommendations from your specialty consultations.

Your specialty asthma doctor may not want to see you for a urinary tract infection, abdominal pain or other medical problems. Some asthma specialists may not feel comfortable managing contraceptive issues or even treating other medical problems such as diabetes or hypertension. Even if they are comfortable, their practice may be so busy that they do not have time to address the other day to days needs of your general health.

The other issue that I sometimes see is people staying with their pediatric specialists for too long. Sometimes the pediatric specialist is reluctant to let go, or the patient or parents simply don't want to. While the asthma pathophysiology may be the same, I generally think adult doctors should not take care of kids, and kids need to move on to an adult doctor when they are of an appropriate age. While the exact age is debatable, a 40-year-old asthmatic should not, in my opinion, still be seeing their pediatrician or their pediatric lung doctor.

Your PCP will likely be able (and should be able) to treat asthma up to a point including acute and chronic management. Your PCP also provides screening and treatment for other conditions. An asthma specialist may or may not provide these services. For example, a specialist may not provide well-woman care as your daughter gets older, may not provide your son services if he begins to perform poorly in school, or give you a comprehensive immunization evaluation. On the other hand, your primary care doctor may not have the PFT machine and other specialty equipment in their office that an asthma specialist does.

A primary care physician treats you with both your medical and family history in mind. Going to some form of quick care or urgent care may lead to a less comprehensive approach. A primary care doctor is more likely to understand specific things about you as a patient like why do you continue to smoke, why you make certain food or exercise choices. A primary care physician will make recommendations about your preventive health care and will monitor your asthma with your asthma action plan.

Research has shown that people who have relationships with PCPs over time have better health outcomes including lowers costs and lower death rates. Many people develop strong bonds over years with their primary care physicians.

The Difference Between an Asthma Specialist and Your Regular Doc

An asthma specialist is most likely a physician who has pursued additional training in either pulmonology (diagnosis and treatment of lung diseases) or allergy/ immunology (diagnosis and treatment of allergic diseases). Both of these specialties require completion of medical school and a residency program, most likely internal medicine or pediatrics.

This training is very similar to the training your primary care physician completed. An asthma specialist then spends an additional 2 to 3 years focusing on their chosen specialty. In specialty training, your doctor focuses on a narrow and specific group of diseases that includes asthma.

Does Your PCP Need to Be an MD?

Today there are several different options for having a PCP. Other types of providers such as a nurse practitioner and physician assistant that may be able to fill this role for you. Because these providers are often able to spend more time with patients, some patients prefer them.

Depending on their training, most states require either direct or indirect supervision and a practice agreement with a licensed physician in your state. Many times PAs and NPs are practicing within an office with several other doctors. If the PA or NP needs to, they can just run a question by a colleague or have you seen by an MD if needed.

No matter what kind of doctor will be leading your asthma team, you want to make sure you understand if it is difficult to get an appointment. The last thing you want is to get sick and then be told it will be 3 weeks before you can get an appointment. You may also want to ask your doctor what is new with asthma care. While albuterol has been around for a long time and is a tried and true asthma medicine, there are new treatments available and a 1970's medicine may not be the best choice for your asthma today. Another question you may want to consider asking is what medications might be able to be stopped or have a decrease in dose. Finally, you may want to take a look at your records. If your doctor balks at your request, know that HIPAA or the Health Insurance Portability and Accountability Act laws mandate that you receive a copy of your medical records when requested from both physicians and hospitals where you receive care.

Do I Need a Specialist?

We know that asthma is a very complicated chronic disease, so quality care is of great importance to you. Without good, quality care, you are more likely to experience some undesirable outcomes like:

• Be admitted to the hospital
• Visit the emergency department for an asthma attack
• Develop more severe asthma symptoms
• Be less satisfied with your asthma

The following are reasons that you should consider seeing an asthma specialist:

• Following a life-threatening asthma attack, intubation, or admission to an intensive care unit for asthma.
• Following an asthma attack requiring hospitalization.
• For poorly controlled asthma despite following your doctor’s instructions and taking medications appropriately after 3 to 6 months of treatment.
• If you want an evaluation for allergy shots to help control asthma triggers.
• If you use oral steroids to treat worsening asthma symptoms
• If your current asthma severity is moderate persistent or worse.
• If you or your child need additional asthma education.