Comparing generalist and specialty care: discrepancies, deficiencies, and excesses

Area of Science:

• Medical research
• Health services research

Background:

• Growing interest in the quality and quantity of care provided by generalists and specialists.
• Need to compare the knowledge base and care quality between these physician groups.

Purpose of the Study:

• To review and evaluate studies comparing the knowledge and quality of care between generalists and specialists.
• To identify areas where specialists outperform generalists and vice versa.
• To assess the overall impact of these differences on public health.

Main Methods:

• Systematic review of English-language articles from MEDLINE (1966-present) and bibliographies.
• Keywords included: generalist, specialist, quality of care, referral.
• Inclusion of only American studies for quality of care analysis; data quality assessed.

Main Results:

• Specialists demonstrate superior knowledge and quality of care for specific conditions like myocardial infarction, depression, and acquired immunodeficiency syndrome.
• Differences in other areas are multifactorial, influenced by study design and patient selection.
• Deficiencies in disease management, preventive care, and health maintenance common to all physicians are more critical to public health than generalist-specialist disparities.
• Overuse of diagnostic and therapeutic modalities by some specialists increases costs without proven benefit or adds patient risk.

Conclusions:

• While specialists excel in certain areas, overarching physician deficiencies in fundamental care aspects are more detrimental to public health.
• Improving care quality and coordination requires changes in education, quality improvement methods, visit length, referral optimization, and generalist-specialist comanagement.
• Further research focusing on patient outcomes is warranted to guide improvements.