Although discussions about the need for physician workforce reform to ameliorate the growing shortage of primary care physicians have focused largely on care for the adult population, many children also face difficulties in accessing primary health care services. Now, research published in the September/October Annals of Family Medicine suggests the latter problem could be exacerbated in the coming years.
According to a study by researchers(annfammed.org) at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, the number of family physicians who provide care for children in their practices has dropped in the past decade, declining from 78 percent in 2000 to 68 percent in 2009.
By the Numbers
Using data collected from family physicians who took the Maintenance of Certification for Family Physicians exam between 2006 and 2009, the researchers found that family physicians overall spend about 10 percent of their time on care for children and are considered the usual source of care for one-third of this patient population. In all, FPs account for between 16 percent and 21 percent of child care visits.
The 10-point drop seen between 2000 and 2009 can be attributed to a range of factors, said one researcher involved with the study, including physician age and the availability of pediatricians in the practice area. In fact, said Scott Shipman, M.D., M.P.H., director of primary care initiatives and workforce analysis for the Association of American Medical Colleges and one of the study co-authors, the decline is not especially significant, primarily emphasizing the need for children to get care when needed.
- During the past decade, the number of family physicians who provide care for children has dropped, according to new research findings.
- Increasingly, pediatricians are filling this role in metropolitan areas, with family physicians continuing to care for a higher percentage of children in rural areas.
- Factors that predict a lower likelihood that family physicians will care for children include increasing physician age, belonging to a group practice and a higher concentration of pediatricians in the area.
"What really matters is that children are getting the care they need and it is readily available," Shipman told AAFP News. "It matters less whether it is provided by a pediatrician, a family physician or another physician as long as it is accessible and of high quality."
Shipman said that one of strongest influencers of the amount of time family physicians devote to caring for children is the density of pediatricians practicing in the same region. "Family physicians who practice in an area that is more saturated with pediatricians are less likely to care for children," he noted.
Other Contributing Factors
The aging population and a decline in the number of general internists who are providing primary care are also causing changes in FPs' patient panels. As many family physicians are, of necessity, shifting their practices to accommodate a growing number of older patients, they are able to devote less time to children.
Similarly, a physician's own age is another factor that affects the demographics of his or her patient panel. "As physicians age, it is common to have their patient population age with them and leave the younger patients for their younger partners," Shipman explained.
It's particularly noteworthy that family physicians in rural areas or locales with a higher percentage of children are more likely to provide care for this population, begging the question of whether declining numbers of FPs treating children overall could be leading to a gap in access.
"In urban and suburban areas, much of the gap is being filled by pediatricians," Shipman said. "I worry about rural areas, because pediatricians are not distributed as evenly in relation to population. In a rural area, if a family physician stops seeing children, there are significant implications for access for kids because the local availability of pediatricians is lower and there are fewer openings for appointments with pediatricians."
The research revealed several other notable findings, including that physicians in a partnership are more likely to provide care for children than those in a group practice.
There also is wide geographic variation in the amount of care for children provided by family physicians, with FPs in the Northeast being more likely to provide this type of care than those in the South and West. And in a state-by-state breakdown, family physicians in Nebraska provide the yeoman's share of care for children at 84 percent compared with a low of 45 percent in the District of Columbia.
Implications for Training
Shipman said the data reinforce the importance of family medicine residents receiving training in caring for children. Also, he noted, given that the lack of general internists and the relatively high number of pediatricians have not changed substantially during the past five years, it's important for family physicians to maintain their versatility in patient care regardless of where they practice so they are able to meet the needs of their local community.
"Being able to treat all patients regardless of age or gender has always been one of the strongest assets of family physicians," Shipman said. "If a physician's patient population narrows, that makes him or her less flexible to adapt to local needs."