Although the total number of children's visits to family physicians has dwindled, demand for FPs remains high among children from rural or underserved areas and among teenagers, says FP Robert Phillips, M.D., M.S.P.H., director of AAFP's Robert Graham Center in Washington.
Rural, Underserved Kids and Teens Depend on FPs
Share Care to Improve It, Says FP
By Jane Stoever
6/9/2006
Kids play before receiving care at the practice of FPs Ron Mansolo, M.D., and Elizabeth Burnell-Mansolo, M.D., in Leander, Texas, which is close to Austin.
Phillips and others at the Graham Center worked with the American Academy of Pediatrics' Center for Child Health Research in preparing a report on children's care (PDF file: 79 pages / 411 KB. More about PDFs.) for AAFP last year.
Based on data from National Ambulatory Medical Care Surveys, the Graham Center found that the total number of visits by children to family physicians declined by one-third from 1993 to 2002, with only 21 percent of children's medical office visits being to family physicians or general practitioners in 2002. However, the federal Medical Expenditure Panel Survey, or MEPS, for 2002 found that one-third of children for whom a usual source of care could be named used an FP or GP as their source of care.
"Even though only one in five visits made by children is to us, there's a larger proportion of children for whom we're their place of care," says Phillips. "We can't get out of the business of taking care of children. The children couldn't sustain it."
Rural Communities
"Pediatricians can't get to a right-sized business model in rural areas" because there are often too few children there to support pediatric practices, says Phillips, noting that many children in rural areas may be uninsured or on Medicaid.
A 2001 article in Pediatrics reports that 14.6 percent of pediatric graduates chose rural practice in 1981. By 2003, only 1 percent of pediatrics graduates were choosing rural practice.
By contrast, 30 percent of new family medicine residency graduates chose rural practice in 1981, and about 23 percent did so in 2005, according to information from internal AAFP surveys. In addition, AAFP data show that about 23 percent of active AAFP members serve rural communities, a percentage that has stayed steady for about 10 years.
Other Underserved Areas
Phillips also notes the importance of having FPs in other medically underserved areas. "Many people in inner cities get their care in community health centers," which often are staffed by family physicians, or from family medicine practices that serve many families on Medicaid, Phillips says. "Medicaid pays so little that it's hard for pediatricians to locate in underserved areas," he adds.
In 2003, 3,048 full-time-equivalent FPs and GPs provided services in the nation's community health centers during 12,143,000 visits by adults and children. Those figures compare with 1,189 full-time-equivalent general pediatricians who offered care during 4,810,000 visits by adults and children during 2003.
"We (family physicians) do define the safety net," says Phillips. "For the rural and underserved, these populations -- including the children -- depend heavily on family physicians for care."
Adolescent Population
As for youth ages 13-17 across the country, the 2002 MEPS found that these youngsters made 26 percent of their medical office visits to family physicians and general practitioners, compared with 24 percent to general pediatricians.
"Family physicians are an important place for teens to land as they transition from childhood health care to adulthood health care," says Phillips. "What's concerning is that half of teenagers' visits are to general internists and subspecialists. These teens -- not yet adults -- may be at risk for receiving age-inappropriate care."
In other words, the country's teens might need more, not less, care from family physicians and pediatricians.
Shared Care?
Looking at the need for more physicians in rural and underserved areas, as well as the need to bring more teens into primary care medical homes, Phillips suggests family physicians and pediatricians experiment with "shared care." That would mean sharing responsibility for caring for children in the population and, in the course of caring for individual patients, talking about families and communities.
Phillips has experienced shared care. "I've seen it work best and most often in community health centers," he says. "Pediatricians and family physicians take care of populations together. What pediatricians get out of that is a better understanding of family dynamics that affect the health of children and how to manage family health. Pediatricians get a more sustainable business plan. And family physicians get more in-depth collaboration around the care of children. Pediatricians train more intensively in caring for children, particularly in inpatient settings, and that's what they bring" to the shared care FPs and pediatricians offer.
Although the AAP encourages pediatricians to focus on the health of families and communities, "Pediatricians are really struggling with this notion of how to provide care to families and communities," says Phillips. Neither concept is in their training nor have they been part of pediatricians' scope of practice, but "family physicians may be the answer" to pediatricians' dilemma, says Phillips.
Based on data from National Ambulatory Medical Care Surveys, the Graham Center found that the total number of visits by children to family physicians declined by one-third from 1993 to 2002, with only 21 percent of children's medical office visits being to family physicians or general practitioners in 2002. However, the federal Medical Expenditure Panel Survey, or MEPS, for 2002 found that one-third of children for whom a usual source of care could be named used an FP or GP as their source of care.
"Even though only one in five visits made by children is to us, there's a larger proportion of children for whom we're their place of care," says Phillips. "We can't get out of the business of taking care of children. The children couldn't sustain it."
Rural Communities
"Pediatricians can't get to a right-sized business model in rural areas" because there are often too few children there to support pediatric practices, says Phillips, noting that many children in rural areas may be uninsured or on Medicaid.
A 2001 article in Pediatrics reports that 14.6 percent of pediatric graduates chose rural practice in 1981. By 2003, only 1 percent of pediatrics graduates were choosing rural practice.
By contrast, 30 percent of new family medicine residency graduates chose rural practice in 1981, and about 23 percent did so in 2005, according to information from internal AAFP surveys. In addition, AAFP data show that about 23 percent of active AAFP members serve rural communities, a percentage that has stayed steady for about 10 years.
Other Underserved Areas
Phillips also notes the importance of having FPs in other medically underserved areas. "Many people in inner cities get their care in community health centers," which often are staffed by family physicians, or from family medicine practices that serve many families on Medicaid, Phillips says. "Medicaid pays so little that it's hard for pediatricians to locate in underserved areas," he adds.
In 2003, 3,048 full-time-equivalent FPs and GPs provided services in the nation's community health centers during 12,143,000 visits by adults and children. Those figures compare with 1,189 full-time-equivalent general pediatricians who offered care during 4,810,000 visits by adults and children during 2003.
"We (family physicians) do define the safety net," says Phillips. "For the rural and underserved, these populations -- including the children -- depend heavily on family physicians for care."
Adolescent Population
As for youth ages 13-17 across the country, the 2002 MEPS found that these youngsters made 26 percent of their medical office visits to family physicians and general practitioners, compared with 24 percent to general pediatricians.
"Family physicians are an important place for teens to land as they transition from childhood health care to adulthood health care," says Phillips. "What's concerning is that half of teenagers' visits are to general internists and subspecialists. These teens -- not yet adults -- may be at risk for receiving age-inappropriate care."
In other words, the country's teens might need more, not less, care from family physicians and pediatricians.
Shared Care?
Looking at the need for more physicians in rural and underserved areas, as well as the need to bring more teens into primary care medical homes, Phillips suggests family physicians and pediatricians experiment with "shared care." That would mean sharing responsibility for caring for children in the population and, in the course of caring for individual patients, talking about families and communities.
Phillips has experienced shared care. "I've seen it work best and most often in community health centers," he says. "Pediatricians and family physicians take care of populations together. What pediatricians get out of that is a better understanding of family dynamics that affect the health of children and how to manage family health. Pediatricians get a more sustainable business plan. And family physicians get more in-depth collaboration around the care of children. Pediatricians train more intensively in caring for children, particularly in inpatient settings, and that's what they bring" to the shared care FPs and pediatricians offer.
Although the AAP encourages pediatricians to focus on the health of families and communities, "Pediatricians are really struggling with this notion of how to provide care to families and communities," says Phillips. Neither concept is in their training nor have they been part of pediatricians' scope of practice, but "family physicians may be the answer" to pediatricians' dilemma, says Phillips.
Annual Clinical Focus
Related News Stories
Go Online for CME Videos, Family Resources on Kids
(7/3/2006)
Diabetes Continues to Rise in Young Patients
(6/14/2006)
FPs Bring Needed Skill to Care of Children With Disabilities
(6/9/2006)
Go Online for CME Videos, Family Resources on Kids
(7/3/2006)
Diabetes Continues to Rise in Young Patients
(6/14/2006)
FPs Bring Needed Skill to Care of Children With Disabilities
(6/9/2006)