Dermatologists meet the primary care standard for first contact management of skin disease

Background: It has been suggested that first contact for skin disease should be the domain of primary care providers because they provide comprehensive services beyond those offered by dermatologists, Objective: The purpose of this study was to test the hypothesis that dermatologists do not meet the standards for providing primary care to which generalists are held. Methods: National Ambulatory Medical Care Survey data from the year 1995 were used to determine the frequency at which counseling and preventive examinations were per formed at visits to primary care providers and dermatologists. Results: Counseling and preventive examinations were performed at a minority of visits for skin disease. No counseling was reported at 91% of the visits to primary care providers and at 94% of visits to dermatologists. Preventive examinations other than blood pressure were done at 4.7% of the visits to primary care providers and at 1.5% of visits to dermatologists. Conclusion: The standard of primary care for skin disease, as set by the generalist, is attention to the skin disease and not comprehensive medical care. Dermatologists are best able to meet this standard.