How the 4 Levels of Medical Care Differ (2024)

In medicine, there are four levels of care: primary, secondary, tertiary, and quaternary. The levels of care refer to the complexity of the medical cases that healthcare providers treat and the skills and specialties of the providers.

• Primary care involves consulting with your primary care provider.
• Secondary care is when you see a specialist such as an oncologist (cancer expert) or endocrinologist (often for metabolic disorders like diabetes).
• Tertiary care refers to specialized care in a hospital setting such as renal dialysis or heart surgery.
• Quaternary care is an advanced level of specialized care.

This article explains these terms. Knowing their definitions can help you better understand what your provider is talking about and help you recognize the level of care you're receiving.

Primary Care: Essentials

Most people are very familiar with primary care. This office is your first stop for most of your symptoms and medical concerns. You might seek primary care for the following:

• Illness: You may see your primary care provider when you notice a new symptom or when you come down with a cold, the flu, or some other infection.
• Injury: You may also seek primary care for a broken bone, a sore muscle, a skin rash, or any other acute medical problem.
• Chronic health conditions: You may work with a primary care provider to manage chronic conditions such as high blood pressure, diabetes, heart disease, obesity, anxiety, and depression.
• Referral: Primary care is typically responsible for coordinating your care among specialists and other levels of care.

In addition, you'll probably see a primary care provider (PCP) for regular health screenings, general checkups, and wellness visits.

Primary care providers may be:

• Doctors
• Nurse practitioners
• Physician assistants

There are some primary care specialties as well. For instance, obstetrics and gynecology (OB-GYN) specialists, geriatricians who treat older people, and pediatricians are all primary care providers. But they also happen to specialize in caring for a particular group of people.

Studies have shown that primary care providers benefit the healthcare system by:

• Enhancing access to healthcare services
• Providing better health outcomes
• Decreasing hospitalization and use of emergency department visits

Secondary Care: Specialists

Secondary care occurs when your primary care provider refers you to a specialist. Secondary care means your healthcare provider has transferred your care to someone who has more specific expertise in whatever health issue you are experiencing. They remain in contact with the specialist.

Specialists focus either on a specific system of the body or a particular disease or condition. Examples of specialists include:

• Cardiologists, who focus on the heart and blood vessels
• Endocrinologists, who focus on hormone systems, including diseases like diabetes and thyroid disease
• Oncologists, who specialize in treating cancers, and many focus on a specific type of cancer

Sometimes problems arise in secondary care. These may include:

• Wrong specialist: Sometimes, doctors refer people to the wrong kind of specialist. That can happen because symptoms often overlap between a variety of health conditions. So, your symptoms may suggest one problem when, in reality, it is another condition that requires a different specialist.
  
• Lack of coordination of care: You may also experience problems if you're seeing more than one specialist and each is treating a different condition. Sometimes in these cases, doctors might not fully coordinate your care. Ideally, specialists should work with your primary care health team to ensure everyone knows what the others are recommending.

Tertiary Care and Hospitalization

If you are hospitalized and require a higher level of specialty care, your doctor may refer you to a tertiary care center. Tertiary care refers to highly specialized equipment and expertise to treat specific, complex health conditions.

Examples of medicine and procedures performed at tertiary care centers include:

• Plastic surgery
• Neurosurgery
• Organ transplants
  
• Head and neck oncology
• Perinatology (high-risk pregnancies)
• Neonatology ICU (high-risk newborn care)
• Trauma surgery
• High-dose chemotherapy for cancer
• Dialysis
• Coronary artery bypass graft (CABG)
• Burn treatment

A small, local hospital may not be able to provide advanced care, so you may be transferred to a tertiary care center.

Quaternary Care

Quaternary care is considered an extension of tertiary care. However, 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 provide quaternary care for particular medical conditions or systems of the body.

Summary

Levels of care refer to the complexity of medical cases, the types of conditions a physician treats, and their specialties.

Primary care involves your primary healthcare provider. You see them for things like acute illnesses, injuries, screenings, or to coordinate care among specialists.

Secondary care is the care of a specialist. These specialists may include oncologists, cardiologists, and endocrinologists.

Tertiary care is a higher level of specialized care within a hospital. Similarly, quaternary care is an extension of tertiary care, but it is more specialized and unusual.

By Trisha Torrey
Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.