Knowledge, patterns of care, and outcomes of care for generalists and specialists

OBJECTIVE:To critically evaluate the differences between generalist physici ans and specialists in terms of knowledge, patterns of care, and clinical o utcomes of care. METHODS: English-language articles (January 1981 to January 1998) were iden tified through a MEDLINE search and examination of bibliographies of identi fied articles. Systematic evaluation of articles relevant to adult medicine that had a direct comparison between generalist physicians and specialists in terms of knowledge relative to widely accepted standards of care, patte rns of care (including use of medications, ancillary services, procedures, and resource utilization), and outcomes of care was performed. MAIN RESULTS: In many survey studies, specialists were reported to be more knowledgeable about conditions encompassed within their specialty. In terms of overall practice patterns, specialists practicing in their area of expe rtise were more likely to use medications associated with improved survival and to comply with routine health maintenance screening guidelines; they u sed more resources including diagnostic tests, procedures, and longer hospi tal stays. In the:he limited number of studies examining the care of patien ts with acute myocardial infarction, acute nonhemorrhagic stroke, and asthm a, specialists had superior outcomes compared with generalists. CONCLUSIONS: There is evidence in the literature suggesting differences bet ween specialists and generalists in terms of knowledge, patterns of care, a nd clinical outcomes of care for a broad range of diseases. In published st udies, specialists were generally more knowledgeable about their area of ex pertise and quicker to adopt new and effective treatments than generalists. More research is needed to examine whether these patterns of care translat e into superior outcomes for patients. Further work is also needed to delin eate the components of care for which generalists and specialists should be responsible, in order to provide the highest quality of care to patients w hile most effectively utilizing existing physician manpower.