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The term secondary care is a service provided by medical specialists who generally do not have first contact with patients, for example, psychiatrists, psychologists in hospital departments. A physician might voluntarily limit his or her practice to secondary care by refusing patients who have not seen a primary care provider first, or a physician may be required, usually by various payment agreements, to limit the practice this way.
In the United States, however, there is a trend toward self-referral by patients for these services, rather than referral by primary care providers. This is quite different from practice in the United Kingdom and Canada, for example, where all patients must first seek care from primary care providers who will in turn decide whether to refer the patient to secondary or tertiary care providers. In Canada, secondary care providers will not be paid by the publicly funded health care system unless the patient has been assessed by a primary care provider (a hospital emergency room doctor is considered a primary care provider, as is a general practitioner or family doctor).
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