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We introduce a new term to describe this phenomenon: scope inversion, defined as the provision of primary care by specialist physicians. We aimed to quantify the extent of scope inversion by conducting a systematic review. MEDLINE and five other databases were searched using the keywords \u2018specialist AND (routine OR primary) AND provi*\u2019 as well as other variations. The search was limited to human research without restrictions on language or date of publication. The inclusion criterion was studies on rates of the provision of routine primary care by specialist physicians. Thirteen observational studies met the inclusion criteria. A wide range of primary care involvement was observed among specialists, from 2.6% to 65%\u2009of clinic visits. Among children, 41.3% of visits with specialists were routine follow-ups for conditions such as allergic rhinitis and seborrhoeic dermatitis which could be managed in primary care. Data quality was moderate to low across the studies due to limitations of source data and varying definitions of primary care. Specialist physicians provide primary care to patients in a substantial proportion of clinic visits. Scope inversion is wasteful as it diverts patients to more expensive care without improving outcomes. A systems approach is needed to mitigate scope inversion and its harmful effects on healthcare service delivery.<\/jats:p>","DOI":"10.1136\/fmch-2019-000247","type":"journal-article","created":{"date-parts":[[2020,2,26]],"date-time":"2020-02-26T09:34:25Z","timestamp":1582709665000},"page":"e000247","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Provision of primary care by specialist physicians: a systematic review"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9280-9709","authenticated-orcid":false,"given":"Muhammad Jawad","family":"Hashim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,25]]},"reference":[{"key":"2020022601341852000_8.1.e000247.1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.307"},{"key":"2020022601341852000_8.1.e000247.2","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1071\/PY13043","article-title":"Audit of referral pathways in the diagnosis of lung cancer: a pilot study","volume":"21","author":"Largey","year":"2015","journal-title":"Aust J Prim Health"},{"key":"2020022601341852000_8.1.e000247.3","doi-asserted-by":"crossref","first-page":"648","DOI":"10.5694\/j.1326-5377.1995.tb126052.x","article-title":"Waiting times for non\u2010urgent specialist appointments","volume":"162","author":"Baume","year":"1995","journal-title":"Med J Aust"},{"key":"2020022601341852000_8.1.e000247.4","doi-asserted-by":"publisher","DOI":"10.2190\/HS.44.4.a"},{"key":"2020022601341852000_8.1.e000247.5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1071\/HC16006","article-title":"Principles of family medicine and general practice \u2013 defining the five core values of the specialty","volume":"8","author":"Hashim","year":"2016","journal-title":"J Prim Health Care"},{"key":"2020022601341852000_8.1.e000247.6","doi-asserted-by":"crossref","first-page":"52","DOI":"10.15212\/FMCH.2015.0135","article-title":"The innovations in China\u2019s primary health care reform: Development and characteristics of the community health services in Hangzhou","volume":"3","author":"Lin","year":"2015","journal-title":"Fam Med Community Health"},{"key":"2020022601341852000_8.1.e000247.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.17.1364"},{"key":"2020022601341852000_8.1.e000247.8","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.08168.x"},{"key":"2020022601341852000_8.1.e000247.9","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s11606-014-2808-y","article-title":"Trends and quality of care in outpatient visits to generalist and specialist physicians delivering primary care in the United States, 1997-2010","volume":"29","author":"Edwards","year":"2014","journal-title":"J Gen Intern Med"},{"key":"2020022601341852000_8.1.e000247.10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.29271\/jcpsp.2018.01.76","article-title":"A definition of family medicine and general practice","volume":"28","author":"Jawad Hashim","year":"2018","journal-title":"J Coll Physicians Surg Pak"},{"key":"2020022601341852000_8.1.e000247.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"2020022601341852000_8.1.e000247.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198305193082007"},{"key":"2020022601341852000_8.1.e000247.13","first-page":"1","article-title":"National ambulatory medical care survey: 2002 summary","volume":"346","author":"Woodwell","year":"2004","journal-title":"Adv Data"},{"key":"2020022601341852000_8.1.e000247.14","doi-asserted-by":"crossref","unstructured":"Valderas JM , Starfield B , Forrest CB , et al . 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