Differences Between Primary, Secondary, Tertiary, and Quaternary Care

Levels of Care

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In medicine, levels of care refer to the complexity of the medical cases doctors treat and the skills and specialties of the providers. Levels are divided into the following categories:

  • Primary care
  • Secondary care
  • Tertiary care
  • Quaternary care

As a patient, you might sometimes hear these terms. So knowing their definitions can help you better understand what your doctor is talking about and help you recognize the level of care you're receiving.

This article explains the levels of care, what type of provider is involved in each level, and what situations may require different levels of care.

Male doctor speaking to male patient
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Primary Care: Essentials

Most people are very familiar with primary care. This office is your first stop for most of your symptoms and medical concerns. You might seek primary care for the following:

  • Illness: You may see your primary care doctor when you notice a new symptom or when you come down with a cold, the flu, or some other infection.
  • Injury: You may also seek primary care for a broken bone, a sore muscle, a skin rash, or any other acute medical problem.
  • Referral: Also, primary care is typically responsible for coordinating your care among specialists and other levels of care.

In addition, you'll probably see a primary care provider (PCP) for regular screenings, general checkups, and wellness visits.

Primary care providers may be:

There are some primary care specialties as well. For instance, OB-GYNs, geriatricians, and pediatricians are all primary care doctors. But they also happen to specialize in caring for a particular group of people.

Studies have shown that primary care providers benefit the healthcare system by:

  • Enhancing access to healthcare services
  • Providing better health outcomes
  • Decreasing hospitalization and use of emergency department visits

Most health insurance policies require you to designate a primary care provider. In most cases, you can choose a family practice physician, internist, OB-GYN, geriatrician, or pediatrician for this role.

Secondary Care: Specialists

Secondary care is when your primary care provider refers you to a specialist. Secondary care means your doctor has transferred your care to someone who has more specific expertise in whatever health issue you are experiencing.

Specialists focus either on a specific system of the body or a particular disease or condition. Examples of specialists include:

  • Cardiologists focus on the heart and blood vessels.
  • Endocrinologists focus on hormone systems, including diseases like diabetes and thyroid disease.
  • Oncologists specialize in treating cancers, and many focus on a specific type of cancer.

Your insurance company may require that you receive a referral from your PCP rather than going directly to a specialist.

Sometimes problems arise in secondary care. These may include:

  • Wrong specialist: Sometimes, doctors refer people to the wrong kind of specialist. That can happen because symptoms often overlap between a variety of health conditions. So, your symptoms may suggest one problem when, in reality, it is another condition that requires a different specialist.
  • Lack of coordination of care: You may also experience problems if you're seeing more than one specialist and each is treating a different condition. Sometimes in these cases, doctors might not fully coordinate your care. Ideally, specialists should work with your primary care health team to ensure everyone knows what the others are recommending.

Tertiary Care and Hospitalization

If you are hospitalized and require a higher level of specialty care, your doctor may refer you to tertiary care. Tertiary care requires highly specialized equipment and expertise.

At this level, you will find procedures such as:

A small, local hospital may not be able to provide these services. So, if you require more advanced care, they may need to transfer you to a medical center that provides highly specialized tertiary level services. 

Studies have shown that when you are in tertiary care for certain chronic conditions such as diabetes and chronic kidney disease, your PCP must remain involved. That's because your PCP can help you establish and maintain a management plan for the long term.

Quaternary Care

Quaternary care is considered an extension of tertiary care. However, it is even more specialized and highly unusual.

Because it is so specific, not every hospital or medical center offers quaternary care. Some may only provide quaternary care for particular medical conditions or systems of the body.

The types of quaternary care include:

  • Experimental medicine and procedures
  • Uncommon and specialized surgeries

Summary

Levels of care refer to the complexity of medical cases, the types of conditions a physician treats, and their specialties.

Primary care involves your primary healthcare provider. You see them for things like acute illnesses, injuries, screenings, or to coordinate care among specialists.

Secondary care is the care of a specialist. These specialists may include oncologists, cardiologists, and endocrinologists.

Tertiary care is a higher level of specialized care within a hospital. Similarly, quaternary care is an extension of tertiary care, but it is more specialized and unusual.

A Word From Verywell

The majority of the time, you'll only receive primary or secondary care. However, when you have a severe injury, condition, or disease, your doctor will move you to higher levels.

Understanding the levels of care will help you navigate the medical system and receive the care you need.

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  2. Lo C, Ilic D, Teede H, et al. Primary and tertiary health professionals' views on the health-care of patients with co-morbid diabetes and chronic kidney disease - a qualitative studyBMC Nephrol. 2016;17(1):50. doi:10.1186/s12882-016-0262-2