Boundaries and overlap: Community medicine or public health doctors and primary care physicians

To explore the boundaries and overlap of practice profiles of primary care physicians (PCPs), including FPs and GPs, and community medicine specialists (CMs), particularly in the area of community-oriented clinical care.

Analysis of data from the 2004 National Physician Survey. Analyses included frequencies, cross-tabulations, and chi(2) statistics.

Canada.

Primary care physicians and CMs who responded to the 2004 National Physician Survey.

For PCPs and CMs, we compared main work and patient care settings, areas of professional activity, and credentials to practise public health or family medicine. Among CMs, we examined the most commonly treated conditions and services provided for evidence of community-oriented clinical care.

Data were available for 154 CMs and 11 041 PCPs. The most common work setting for CMs was government or public health agencies, while for PCPs it was offices, clinics, or community care settings, including community hospitals. Among CMs, 59.7% indicated that community medicine or public health practice was an area of professional activity and 13.0% indicated that they participated in primary care. The corresponding proportions for PCPs were 15.3% and 78.2%, respectively. Generally, CMs engaged in a mixture of individual-level and population-level practice activities, although the former was not distinguished by increased clinical prevention, health promotion, or disease prevention services. Of CMs who indicated that primary care was an area of professional activity, 55.0% had the relevant credentials, compared with only 1.9% of PCPs who conversely indicated that community medicine or public health was an area of professional activity.

In Canada CMs and PCPs have distinct practice profiles, despite some overlaps. Further role and practice profile refinement for both physician groups has implications for training, credentialing, and deployment within the health care system.