Scope of Practice: Reclaiming Young Patient Care
Caring for the whole family is a defining aspect of family medicine, yet many physicians have stopped seeing young patients. Here's why and how to welcome them back.
Fam Pract Manag. 2019 Sep-Oct;26(5):26-31.
Author disclosures: no relevant financial affiliations disclosed.
Related articles from American Family Physician: "Health Maintenance in School-Aged Children: Part I. History, Physical Examination, Screening, and Immunizations" and "Part II. Counseling Recommendations."
Caring for infants, children, and teens can be one of the major joys of being a family physician. It helps fulfill our mission to maintain our patients' health through every age and stage of their lives. But a recent study found that family physicians increasingly are no longer seeing children in their practices.1 The proportion of family physicians providing care to children fell from 78 percent in 2000 to 68 percent in 2009.2 Of course, this is not a uniform trend. The care of children by family physicians is more prevalent in rural areas and in communities with fewer pediatricians.2 The message is clear, however: Caring for children is no longer assumed to be an integral part of a family physician's scope of practice.
Several likely factors are fueling this narrowing of family physicians' scope. As more physicians work for hospitals or other large health care organizations, they may find employers attempting to streamline care into silos, leading family physicians to focus exclusively on adult patients. Emerging risk-sharing and pay-for-performance models that provide enhanced payments for complex care may lead some family physicians to undervalue caring for young patients. Some may also perceive the financial challenges and clinical demands of caring for young patients to be discouraging. For instance, a commonly mentioned barrier is the cost and administrative hassle of providing childhood vaccines. Lastly, in some regions with a high number of pediatricians, competition for young patients is stiff.
So should we accept the erosion of a defining aspect of family medicine and surrender all of our young patients to pediatricians? Not at all. We should actively embrace the whole family focus of our training and, where possible, reintroduce children to our offices. This article will explain why caring for children can be important to your practice and your community and how to expand this care.
Caring for children is a key part of family medicine, but the changing health care landscape has led many family physicians to either give up on pediatrics or reduce the number of young patients they see in their practices.
Family physicians should restore this aspect of their practices to maintain comprehensive family care, keep their practice panels mixed in age, and help young patients more smoothly transition into adult care.
Practices must be welcoming to young patients and their families in terms of the physical environment, the appointment types and clinical services offered, and the training maintained.
Young patients do not typically generate the same level of revenue as older patients, but pediatric care can still make financial sense for a practice.
WHY TREAT YOUNG PATIENTS?
The authors would like to acknowledge Daniel K. Von Forell, Spencer F. Guzman, Jennifer Dominguez, and Kavi Duvvoori for their analysis and review of this article.
Referencesshow all references
1. Wasserman RC, Varni SE, Hollander MC, Harder VS. Change in site of children's primary care: a longitudinal population-based analysis. Ann Fam Med. 2019;17(5):388–393....
2. Makaroff LA, Xierali IM, Petterson SM, Shipman SA, Puffer JC, Bazemore AW. Factors influencing family physicians' contribution to the child health care workforce. Ann Fam Med. 2014;12(5):427–431.
3. McManus M, White P, Barbour A, et al. Pediatric to adult transition: a quality improvement model for primary care. J Adolesc Health. 2015;56(1):73–78.
4. Szalda D, Pierce L, Hobbie W, et al. Engagement and experience with cancer-related follow-up care among young adult survivors of childhood cancer after transfer to adult care. J Cancer Surviv. 2016;10(2):342–350.
5. Reddy S, Reddy B. Encouraging children's literacy in your practice. Fam Pract Manag. 2016;23(3):20–22.
6. Klass P. Taking the pain out of children's shots. The New York Times. Jan. 14, 2019. https://www.nytimes.com/2019/01/14/well/family/taking-the-pain-out-of-childrens-shots.html. Accessed July 22, 2019.
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