General, Specialized, and Preventative Care Part II

Last week, we delved into the concept of general/primary care, its relationship with insurance, and its overall role within the personal healthcare structure. This week, we’ll take a deeper dive into specialized medicine and its importance with regard to both proactive and preventative healthcare. For many people, especially those under 30, good health means they’ve never had to see a specialist. As such, for a fair percentage of people, they’ll only need to see a specialist if there’s an acute need. For individuals with chronic conditions, specialists are often used in a roughly similar, preventative fashion as PCPs.  For example, if you have Cystic Fibrosis, a genetic condition affecting multiple aspects of the body, you’ll probably see a Pulmonologist, (lungs and airways) an otolaryngologist, (eyes/nose/throat) and a Gastroenterologist (digestive) on a regular basis, even if you’re not symptomatic or otherwise, healthy. As a caveat to the above statements, regarding feminine health: Gynecologists are specialists in an academic/technical sense, but for most insurance (and conversational) purposes, they fall under the umbrella of general care, considering the near-universal nature of the services they provide.

 

Specialized doctors take a different academic and training-related path than PCPs. All medical doctors go through four years of medical school, but the number of years spent in their residency (postgraduate training) varies. General and primary care doctors, such as adult PCPs and Pediatricians, usually spend two to four years in residency. Specialists often spend a greater amount of time in their residency tract; Neurosurgeons, for example, tend to spend about seven years in residency. Following residency, some doctors may enter into a fellowship, though this is not the case for all. For some, there may be an integrated fellowship during residency. The point of all this is that there’s an extremely high investment in their training and education; although doctors are not infallible, and it’s often healthy (no pun intended) to get a second opinion, they’re well equipped for what it is that they do. There are other types of specialists as well; a Doctor of Physical Therapy, for example, goes through a clinical doctoral program; although this is generally a three-year program, and it’s different from medical school, though the comprehensiveness of education is comparable. Osteopaths (initialized as D.O.) make up about 25% of medical school graduates, and they perform a mix of traditional medical services, as well as manipulative therapies, somewhat similar to Chiropractors.

 

As we mentioned last week, some insurance plans, (usually HMOs- Health Maintenance Organizations) require a PCP’s referral to see a specialist. However, many PPOs (preferred provider plan) don’t require the patient to even have a PCP; patients can choose whichever specialist is relevant, as long as they’re in-network. Next week, we’ll go into further detail about in- vs. out-of-network coverage, and other common aspects of private insurance.