Graham Center One-Pager

The Diminishing Role of FPs in Caring for Children



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Am Fam Physician. 2006 May 1;73(9):1518.

Nationwide, family physicians (FPs) deliver a smaller proportion of the outpatient care of children than they did 10 years ago. Millions of children depend on FPs for care. Family medicine should reevaluate how it will contribute to the care of the nation's children.

The proportion of U.S. office visits for children performed by FPs declined between 1992 and 2002 (see accompanying figure 1), as did the number of children cared for by FPs,2,3  while the number of children seen in outpatient settings remained stable. From 1981 to 2004, the U.S. pediatrician workforce more than doubled (see accompanying table 4) and the U.S. birth rate declined from 15.8 to 14.1 live births per 1,000 persons.2 Growth in the work-force of physicians who care for children will continue to outpace the birth rate for five to 10 years or more. Children in rural and urban underserved areas, meanwhile, remain disproportionately dependent on FPs for their care.2

Figure.

Percentage of child visits to physicians by specialty.

Information from reference 1.

View Large


Figure.

Percentage of child visits to physicians by specialty.

Information from reference 1.


Figure.

Percentage of child visits to physicians by specialty.

Information from reference 1.

Numbers of Generalist Pediatricians, FPs, and U.S. Children, 1981 to 2004

Year Generalist pediatricians Children (0–17 years) FPs

1981

20,051

63,213,000

54,013

1986

24,128

62,865,000

60,311

1991

30,080

65,111,000

67,078

1996

35,202

70,226,000

77,185

2001

41,753

72,604,000

87,016

2004

45,994

73,277,000

93,833

Increase

129%

16%

74%


FPs = family physicians.

Information from reference 4.

Numbers of Generalist Pediatricians, FPs, and U.S. Children, 1981 to 2004

View Table

Numbers of Generalist Pediatricians, FPs, and U.S. Children, 1981 to 2004

Year Generalist pediatricians Children (0–17 years) FPs

1981

20,051

63,213,000

54,013

1986

24,128

62,865,000

60,311

1991

30,080

65,111,000

67,078

1996

35,202

70,226,000

77,185

2001

41,753

72,604,000

87,016

2004

45,994

73,277,000

93,833

Increase

129%

16%

74%


FPs = family physicians.

Information from reference 4.

According to the Future of Family Medicine report,5 most Americans can identify pediatricians as “the doctors who care for children,” whereas the role of FPs is unclear. Facing a shrinking percentage of child visits and an increasingly competitive environment for child health care, family medicine has several choices about its future role in the health care of the nation's children. These include: (1) relinquishing such care and focusing on the increased demands of an aging population, (2) refocusing training of a part of its workforce to meet the continued needs of rural and underserved sites, (3) competing for a shrinking market through new model practice efforts to improve brand recognition and perceived value, and (4) engaging other providers of child health care in collaborative new models of practice that capture the unique features of each provider group and that can care for children in the context of family and community.

REFERENCES

1. National Ambulatory Medical Care Surveys. Analysis by the Robert Graham Center, 2005.

2. Phillips RL Jr, Dodoo MS, McCann JL, et al. Report to the Task Force on the Care of Children by Family Physicians. Washington, D.C.: Robert Graham Center, AAP Center for Child Health Research, 2005.

3. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2003 Natl Vital Stat Rep. 2005;54:1–116.

4. AMA Masterfiles, U.S. Census Bureau. Analysis by the Robert Graham Center, 2005.

5. Martin JC, Avant RF, Bowman MA, et al. The future of family medicine. Ann Fam Med. 2004;2(suppl 1):S3–32.

note: The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Adapted from the Graham Center One-Pager #45.Bazemore A, Phillips RL, Dodoo MS, McCann JL, Klein LS, Green LA, et al. The diminishing role of family physicians in caring for children. May 2006. Available online at http://www.graham-center.org.From the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, 1350 Connecticut Ave., NW, Suite 201, Washington, DC 20036 (telephone: 202–331–3360; fax: 202–331–3374; e-mail: policy@aafp.org).

 


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