Choosing a primary health care provider requires a good understanding of the various health care professions and their respective scopes of practice. It is important to have a "primary care provider" to collaborate with in identifying and addressing your comprehensive health care needs. "Primary care" is your entry to the health care system in most non-emergency situations. It encompasses preventive care, health maintenance, identification and management of common conditions, and coordination of consultations and 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, maintain continuity in personal health care, and move from crisis-oriented or acute health care towards preventive care and health promotion and maintenance activities. 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). Physicians who are OB/GYN (obstetrics and gynecology) specialists are frequently considered primary care providers for women. This is because many women see their gynecologists initially for whatever health care problems they encounter.

Many people typically think of doctors when considering health care providers. Throughout the twentieth century, doctors have been the "gold standard" in American health care, against which all other providers are compared. This is exemplified by terms (such as, "nonphysician provider" or "alternative provider") that are used to describe other sources of health care.

With advances in medical research, knowledge, and technology, the roles for most physicians have moved from generalist to specialist, however. Since a single person cannot absorb, synthesize, maintain, and use the vast amount of health information which is now available, many physicians choose a specific area of interest (specialty or subspecialty area) in which to master knowledge and practice.

During the mid-to-late 1960s (with the prediction of a shortage of primary care physicians), two new professions entered the ranks of primary health care providers: nurse practitioners (NPs) and physician assistants (PAs). Despite distinct differences in preparation, licensure, certification, and scopes of independent practice, NPs and PAs are frequently grouped together and referred to as "mid-level providers," "nonphysician providers," or "physician extenders." "Alternative" or "nontraditional providers" (chiropractors, naturopathic practitioners, acupuncturists, "medicine men" and others) can also be sources of primary care for some patients.

Nurse practitioners and physician assistants have documented exceptional abilities to provide competent, cost-effective primary care for 75 to 88% of patient visits in a primary care setting, plus 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.

A 1986 study conducted by the Congressional Office of Technology Assessment (OTA) concluded that care provided within their respective areas of expertise by nurse practitioners, physician assistants, and certified nurse midwives (whom some women see beyond childbirth as an alternative source of primary care to OB/GYN's) is just as good as that provided by physicians when used appropriately.

The OTA study also reported that NPs and CNMs were found to be "more adept than physicians" in the areas of preventive care and patient communication. The OTA study found evidence that PAs were "more adept than physicians" in the areas of supportive care and health promotion. NPs, PAs, and CNMs all consult with or refer to physicians as needed for problems encountered outside their scopes of practice.

Of course, choosing the optimal person or group from which to receive health care requires knowing more than just the qualifications of the providers. You may consider perceived traits such as philosophy of care (disease-oriented vs. wellness-oriented), therapeutic approaches (conservative vs. aggressive), competency, availability, "style" or communication patterns (informal, warm vs. formal, detached), and degree of inviting patient involvement attributed to a specific provider. To find out about these qualities amongst providers, ask your friends, neighbors, or relatives (particularly those linked to the health care system). You can also get referrals from previous provider(s); state level professional organizations (state medical associations, state nursing associations, state associations for physician assistants) and other health care professionals (for example, your dentist, pharmacist or optometrist). If you or your children have specialized health care needs for a specific chronic condition or disability, advocate groups can also be good sources of information regarding the best providers. Another option for the consumer is to request an appointment to "interview" potential providers. This technique allows the consumer to ask specific questions related to expectations of both parties for coordination and management of personal health care. Some providers offer this type of "interview" at no cost to potential clients.

If you do not currently have a primary health care provider and an acute health care concern 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.