Should I see a Primary Care Doctor or a Specialist?

Many patients wonder when they have a problem whether they should go straight to a specialist or a primary care physician. For example, if you have high blood pressure or high cholesterol, should you seek out a cardiologist? What about type 2 diabetes—do you need to see an endocrinologist? 

If you already have a specialist who is treating you for a problem related to their specialty, start with your specialist. But if you don’t currently have a specialist, your first stop should be with your primary care physician, who has been trained to diagnose complex conditions. He can either treat the condition himself or refer you to a specialist. 

What is the Difference Between an Internist and a Specialist

One main difference between these two medical practices comes down to training. A primary care physician, typically an internist, graduates from medical school and completes a three-year residency. Residency training includes a variety of specialties, such as cardiology, endocrinology and oncology. 

Internists treat common problems, such as a sinus infection, broken bone or diabetes, but they are also skilled at diagnosing and treating more complex conditions such as cancer, infections and diseases affecting internal organs. This could include the heart, kidneys and joints and the digestive, respiratory and vascular systems, according to the American Medical Association (AMA). Internists provide both outpatient and inpatient hospital care. They are sometimes referred to as the “doctor’s doctor” — think Dr. House without the eccentricities. They’re the ones other physicians call upon to help solve perplexing diagnostic problems. 

After completing their residency, some internists choose to go further and subspecialize in one particular area of internal medicine. This training, also called a fellowship, requires an additional one to three years of in-depth training and board certification. 

What Types Kinds of Doctors are Considered Specialists? 

Internists who focus on a specific condition or disease are specialists. Their patients tend to be limited to those requiring treatment for that medical condition. Some of the most common specialists, and the conditions they treat, include: 

• Allergists: immune system disorders such as asthma, anaphylaxis, rhinitis
• Cardiologists: disorders of the heart and blood vessels; cardiac conditions such as heart attacks and abnormal heart rhythms 
• Endocrinologists: disorders of the endocrine glands, including the thyroid and adrenal glands. Includes diabetes (type 1 and type 2), obesity and metabolic disorders. 
• Gastroenterologists: digestive system disorders involving the esophagus, stomach, pancreas, liver and gallbladder
• Hematologists: blood diseases and cancers such as leukemia, lymphoma and multiple myeloma. This specialty is often combined with oncology. 
• Oncologists: treat all forms of cancer. 
• Pulmonologists: respiratory tract disorders, including chronic obstructive lung disease (COPD), lung cancer and tuberculosis. Pulmonologists often oversee hospital ICUs, given their expertise in complex procedures such as hooking up mechanical ventilators to patients who are struggling to breathe. 

Other specialists are those who, after graduating from medical school, begin specialty training during their residency. These include:

Dermatologists: treat disorders of the skin, hair, nails and mucous membranes
Obstetrics/gynecologists: treat and manage women’s health before, during and after their childbearing years
Ophthalmologists: not to be confused with optometrists, who provide routine eye exams and provide eyeglass prescriptions, ophthalmologists are medical doctors who diagnose and manage eye diseases. 
Urologists: treat disorders of the urinary tracts of men and women, adrenal glands and men’s reproductive organs

When to See a Specialist  Vs. Your Primary Care Doctor

1. When you’re already seeing one for a related condition. Generally, if you’re already seeing a dermatologist and you have a new skin issue, you should probably reach out to your dermatologist. 

2. You’re not feeling better. You’ve seen your primary care doctor, but the treatment hasn’t helped. Talk to your physician about seeing a specialist. He can give you feedback about the right type of specialist and help you find one. Perhaps you’ve done some research and come across a new treatment. Your doctor can advise you about whether it pertains to your condition and if it could be an avenue worth pursuing. 

3. You’re diagnosed with a chronic, complicated illness. Fibromyalgia, for example, is a condition with a wide range of symptoms that affect both physical and mental health. The onset of fatigue, widespread pain and “brain fog” could point to fibromyalgia, but it often requires some detective work to know for sure. This would be a prime instance when your doctor may have you consult with a specialist such as a rheumatologist, who treats diseases of the joints, muscles and tendons. The rheumatologist would review any tests you’ve already had—meaning less duplication—and order new ones if needed. Throughout the course of treatment, you may need to see other specialists, such as a physical therapist, and take medications. Your primary care doctor would work with your team of healthcare professionals to coordinate your care. 
 
4. You have a rare disease. According to the National Human Genome Research Institute, there are over 6,800 rare diseases affecting an estimated 25 million to 30 million Americans. Should you have a condition that is not commonly treated by your primary care physician, you may require the expertise and resources of a specialist. For instance, Grave’s Eye Disease is a type of hyperthyroidism that causes swelling and inflammation of the eye tissue, resulting in increased pressure on the optic nerves. The eyes may become red, inflamed, bulging, sensitive and retracting. If left untreated, Grave’s Eye Disease could lead to double vision and partial blindness. Your primary care physician may refer you to an endocrinologist, who concentrates on thyroid disorders, and an ophthalmologist.

Before you look for a specialist on an issue you’re not familiar with or for which you’re not already seeing a specialist, see your primary care doctor. Your primary care doctor knows you and understands your health history. 

MDVIP-affiliated physicians see patients for many common, chronic conditions, including type 2 diabetes, heart disease, sleep disorder and pulmonary issues. Many also have specialties in lipidology, pulmonology, women’s health and more. You may not need to see a specialist for some conditions depending on your physician. And if you do need to, your MDVIP-affiliated physician can also help you find one.