Why is a referral required for specialty care with health maintenance organizations (HMO’s)? HMO’s require us to make referrals before you see a specialist or have diagnostic testing. To avoid the possibility of your insurer denying benefits, talk to your primary care physician’s office before seeking care elsewhere. HMO’s prefer that we refer our patients within the provider network for our South Shore community. It is also our belief that our patients are better served by the specialists within our community since we have established excellent working relationships and receive timely feedback regarding your specialty care. In many instances paperwork must be completed to authorize your referral and this may take up to five business days, so please allow ample time. What's the difference between a physician assistant and a physician? Physician assistants are dependant medical providers of medicine. PAs practice medicine with the supervision of a physician. By supervision, this does not mean over-the-shoulder examination of all the patients seen by the PA. The physician is generally not required to be on site when the physician assistant is treating a patient. What it does mean is an interdependent relationship has been established -- with the physician depending on the PA to treat the patient in the same manner as if the physician were providing the care, and the PA depending on the physician to provide consultation and supervision to ensure all patients receive appropriate care. Doctors are independent practitioners. Physicians are required to do an internship, and the majority also completes a residency in a specialty. A doctor has complete responsibility for the care of the patient. PAs share that responsibility with the doctors. What is a Primary Care Provider (PCP)? A primary care provider is a general medical practitioner who will see adults of all ages (or a pediatrician who will see children through adolescents) for uncomplicated and common medical problems. This provider can be a doctor, a physician assistant, or a nurse practitioner. A primary care provider will often follow patients over long periods of time and refer them to medical specialists when necessary. It is important to have your own "primary care provider" to work with you to address your personal health care needs. To choose a primary care provider, you must have a good understanding of the various health care professions and their scopes of practice. "Primary care" is your entry to the health care system in most non-emergency situations. It involves preventing disease, good health practices, identifying and treating common conditions, and making referrals. Primary care is usually provided in outpatient settings, but the scope of the primary care provider may also extend into the hospital setting. Having a primary care provider allows you to establish a trusting relationship with one medical professional over time and maintain continuity in personal health care. Understanding the various types of primary care providers is only a start in choosing a provider. Many insurance plans either limit the provider selection or provide financial incentives for clients to seek care from a select list of providers. Make sure you know what your insurance covers before starting to narrow down your options. Until the 1960s, Doctors of Medicine or Osteopathy (M.D.s or D.O.s) were the only primary care providers recognized within the orthodox health care system. These primary care doctors include general practitioners, family practice specialists, pediatricians (specialists in children, birth through adolescence), and internists (internal medicine specialists serving the adult population, especially those with multiple medical problems). To address the shortage of primary care physicians, two new professions entered the ranks of primary health care providers: nurse practitioners (NPs) and physician assistants (PAs). Despite differences in preparation, licensure, certification, and scopes of independent practice, NPs and PAs are frequently grouped together and referred to as "mid-level providers". Nurse practitioners and physician assistants have documented exceptional abilities to provide competent, cost-effective primary care for patients in a primary care setting, with a high degree of patient acceptance and satisfaction. In fact, many health care consumers choose a nurse practitioner or a physician assistant instead of a doctor as their primary care provider because they find such professionals more approachable and easier to contact. If you do not currently have a primary health care provider and a health care problem arises, it is usually best to seek non-emergency care from an "urgent care center" rather than a hospital emergency room. This will often save you both time and a significant amount of money. In recent years, many emergency rooms have expanded their services to include reasonably priced urgent care within the emergency room setting or an adjoining area -- to find out, call the hospital first.