Primary care, private physicians, and public health personnel: a conflict in expectations

The elimination of categorical grants and their replacement by block grants provides public health departments the opportunity to integrate their services and provide general primary care to the underserved. While some may consider this an opportunity long overdue such a change may generate considerable conflict with private physicians. Questionnaire data from private physicians and health department personnel collected in North Carolina during an experimental program of primary care delivery by health department shows that there is substantial conflict. Private physicians oppose health department involvement in general primary care and in acute ambulatory care for the medically underserved. Physicians expect health departments to focus on preventive services, especially environmental monitoring and communicable disease control. Health department personnel want to expand their efforts beyond these more traditional areas into primary care and are in apparent conflict with private physicians. The community attitudes of a group of physicians within a community as well as the attitudes of a group of public health workers were found to be a major determinant of each individual's attitude toward public health, followed by the individual's age, sex, and years of working in the community.