Primary care physicians often continue to be the experts in preventive health care for these patients. Either primary or principal physicians may refer complex medical problems outside of their expertise to other specialists. In the last several years there has been an emphasis on training an increasing number of primary care physicians. This trend has resulted in more residents in family practice, general internal medicine, and pediatrics. Conversely, subspecialty training in many fields has attracted fewer numbers.
Some rheumatologists are pure consultants in autoimmune disease or musculoskeletal disorders.
These roles are generally well accepted. The debate has been over whether rheumatologists should be allowed to pursue a diverse or dual function of providing primary as well as rheumatologic care to their patients. The central question is whether rheumatologists are capable of delivering primary care. Primary care has often been thought to be care delivered only by those who have received generalist training but play no specialist role. However, it has also been described more broadly as a physician-patient relationship that incorporates the notion of a principal care relationship that is validated by the patient.