American healthcare system

[Redlorryyellowduck]

Just idly pondering, do people in the USA have a GP system? Watching films it seems everyone goes straight to a specialist, for example a gynecologist would do a smear, a paediatrician gives childhood imms etc.
Anyone have the answer to this riveting question please?

I lived in the US and yes I did. It was called your primary doctor and was basically the same as a GP. They could refer you to specialists, but essentially that was just them telling you the name of one and you rang them up and made an appointment.

My children didn’t go to same doctor as me as they had a pediatrician. Basically a GP for kids. I know some practices will see both children and adults. It just depends who you pick. I just chose one near where I lived that accepted our health insurance and that was that

Yes, generally, everyone has a GP (but they aren't called a GP). You would be required to get a referral from them for specialist care, same as here, in order for your health insurance to pay. You generally then book directly with the specialist (usually only certain ones allowed by your insurance, though you can sometimes pay more to use one that is not permitted by insurance). Insurance has to pre-approve the specialist care though, and it is sometimes refused, and then you get sent back to the GP.

But yes, oddly, children see a paediatrician, which is basically a 'GP that specialises in children' not a hospital special paed like we would normally see here. I went to a paeditrician practice as a child, so the whole surgery was child-focussed, and only children went there.

It's expensive though. I would regularly pay $50 per GP visit (that's on top of what you pay for insurance, which at one point was $600 a month), and often something more like $200 per specialist visit (plus extra for any sort of testing).

Primary Care Physician

Thanks for the replies, definitely satisfied my curiosity!
Would you always get an impartial suggestion from the GP though, or would they recommend their friend the gynaecologist or whatever to you?
I also wondered about nurses, in the UK they can prescribe medication, run clinics, run hospitals by night etc, but in America (at least on tv) they seem to be portrayed as Dr's helpers, is that the case, do they have the same status as here?

Like the others I have a primary care doctor. They are part of a family medicine office, which is essentially a GP surgery. They do children as well as adults, but I actually take my baby to a pediatrician for primary care. The office is just better geared to kids. It's also common to see an OBGYN at a Women's Health office for all gynacological and obstetrical care as it's easier to go direct rather than through primary care which then needs a referral for surgery, procedures etc.

To add some more detail on referrals, whether it's needed often depends on your insurance. I have a PPO insurance plan. They are slightly more expensive, but you can generally go straight to a specialist without a referral and you have access to a wider range of doctors. IN some cases you need a referral- e.g. fertility treatment, psychiatric care.

Some people have HMO plans. These are generally cheaper but you need to go to Primary Care first and get a referral, and often there are fewer doctors who take the insurance.

Re: recommendations, IME they've always recommended good doctors but I'm sure there are informal networks between doctors that mean they are more likely to recommend some over others. Recently my OBGYN asked me who I was seeing for another issue and whether I liked them as she wanted to have more options to suggest for other patients.

Re: nurses, my experience is that they are still very pivotal to the running of hospitals, although I feel like doctors have more authority. When I gave birth recently I mainly saw nurses except for when I was pushing (my OB delivered) and my OB and the pediatrician doing rounds. However, there were nurse practitioners from pediatrics and the NICU who would be called on. That's my only experience of US hospital care though.

When I lived in America I belonged to an HMO as described by @MouseholeCat. This was like a mini NHS. It was a collection of PCP and American style paediatric surgeries, most with nurse practioners and physician assistants for a number of routine tasks, as here. We lived near a major university medical centre that was the HMO hub and provided all higher level health care.

Referrals were to a department or sub specialty at the university (paediatric cardiology, neuromuscular clinic, etc) rather than to a practitioner. My employer paid 100% of costs. I think you could pay a top up and have the option of going out of network, and I think they would refer out the rare things they couldn’t treat.

It was excellent. It is what a properly funded NHS could and probably would be.