Medical professionals frequently talk about levels of care.

They're divided into

the categories of primary care, secondary care, tertiary care, and quaternary
care. Each level is related to the complexity of the medical cases being treated
as well as the skills and specialties of the providers.

Primary Care: Essentials

Most people are very familiar with primary care. This is your first and most
generalized stop for symptoms and medical concerns.

For instance, you may see your primary care doctor when you notice a new
symptom or are concerned that you contracted a cold, the flu, or some other
bacterial or viral disease. You may also seek out primary care for a broken
bone, a sore muscle, a skin rash, or any other acute medical problem.

Also, primary care is typically responsible for coordinating your care among
specialists and other levels of care. There are, however, times when that doesn't
always happen the way it should.

Primary care providers (PCP) may be doctors, nurse practitioners, or physician

assistants. There are some primary care specialties as well. For instance, OB-
GYNs, geriatricians, and pediatricians are all primary care doctors; they just
happen to specialize in caring for a particular group of people.

Studies have shown that primary care providers benefit the healthcare system as
a whole by offering enhanced access to healthcare services, better health
outcomes, and a decrease in hospitalization and use of emergency department
visits.1

Most health insurance policies require you to designate a primary care provider.
In most cases, you can choose an OB-GYN, geriatrician, or pediatrician for this
role.
Secondary Care: Specialists

When your primary care provider refers you to a specialist, you are then in
secondary care. Secondary care simply means you will be taken care of by
someone who has more specific expertise in what is ailing you.

Specialists focus either on a specific system of the body or a specific disease or

condition. For example, cardiologists focus on the heart and its pumping
system. Endocrinologists focus on hormone systems and some specialize in
diseases like diabetes or thyroid disease. Oncologists have a specialty in treating
cancers and many focus on a specific type of cancer.

Secondary care is where most people end up when they have a medical
condition to deal with that can't be handled at the primary care level. Your
insurance company may require that you receive a referral from your PCP rather
than going directly to a specialist.

There are times when problems with specialty care develop. One reason may be
that you have been referred to the wrong kind of specialist. For example, your
initial symptoms may indicate one thing when in reality it is another condition
that requires a different specialist.

You may also experience problems while seeing more than one specialist if
each is treating a different condition. In these cases, your care may not be fully
coordinated. The specialists should work with your primary care health team to
ensure everyone knows what the other is recommending.

Tertiary Care and Hospitalization

Once a patient is hospitalized and needs a higher level of specialty care within
the hospital, he may be referred to tertiary care. Tertiary care requires highly
specialized equipment and expertise.

At this level, you will find procedures such as coronary artery bypass surgery,
renal or hemodialysis, and some plastic surgeries or neurosurgeries. It also
includes severe burn treatments and any other very complex treatments or
procedures.
A small, local hospital may not be able to provide these services, so you may
need to be transferred to a medical center that provides highly specialized
tertiary level services. 

Studies have shown that in the management of certain chronic conditions such
as diabetes and chronic kidney disease, it is still important for the primary care
provider to be involved when a patient enters tertiary care. Having the PCP
involved may enhance long-term self-management by the patient.2

Quaternary Care

Quaternary care is considered to be an extension of tertiary care. It is even more

specialized and highly unusual.

Because it is so specific, not every hospital or medical center offers quaternary

care. Some may only offer quaternary care for particular medical conditions or
systems of the body.

The types of care that might be considered to be quaternary would be

experimental medicine and procedures as well as highly uncommon and
specialized surgeries.