 Source: National Ambulatory Medical Care Survey |
BY TONI LAPP
If it seems like you've been seeing fewer children in your office in recent years, it might be because you have: Children's visits to FPs numbered 32.5 million in 2000, down from 41.5 million in 1990, according to data from the National Ambulatory Medical Care Survey.
Meanwhile, pediatricians have seen a jump in visits by patients younger than 18.
Disturbed by this trend, the AAFP Board of Directors in August approved the establishment of the Task Force on the Care of Children by Family Physicians. The panel will include members of the commissions on Education, Health Care Services, and Quality and Scope of Practice. The Robert Graham Center in Washington will conduct an evidence-based study and analysis for the task force to use in its work.
Mark Johnson, M.D., of Newark, N.J., president of the Association of Departments of Family Medicine, in 2003 became aware of the drop in children's visits and brought it to the AAFP's attention.
"We were looking at this in relation to the Future of Family Medicine project and how we want the new model of care to look," he said. "I believe we want children in that model."
He learned that in the mid-1990s, 22 percent of children's medical visits were handled by FPs, which seemed apt. But then he learned that the percentage was declining. By the year 2002, the most recent for which National Ambulatory Medical Care Survey data are available, FPs/GPs recorded 16.6 percent of office visits by patients younger than 18.
What disturbs Johnson most is that he suspects some FPs are voluntarily choosing not to treat children, particularly in geographical areas where the ratio of subspecialists to primary care doctors is very high. "We are giving up parts of our practice that are normally within our purview," he said.
From an educational standpoint, it is becoming more difficult to give students interested in family medicine a complete education when more and more practices are treating only adults, he said.
In addition, patients' choices are narrowing. Johnson recalls the experience of a friend who became guardian of two nieces, 16 and 10, and tried to schedule their health visits.
"She went to an FP because she wanted total family care, but the office manager said they could take care of one, the 16-year-old, but not the other, the 10-year-old," Johnson said.
Why should patients care? Because studies show that FPs provide more efficient care -- requiring fewer visits and charging less money -- than pediatricians, and FPs' patients have better outcomes, says Norman Kahn, M.D., AAFP vice president for science and education.
For instance, even though FPs recorded 16.6 percent of children's visits as cited in the NAMCS data, 31.7 percent of children saw an FP/GP in 2002, according to the National Health Interview Survey. In other words, FPs/GPs tended to see more than one child in a single visit.
Such numbers will be taken into consideration by the task force, which will craft recommendations for the Board of Directors to consider in March 2005.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
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Copyright © 2004 by
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