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Am Fam Physician. 2003;67(1):17

Over the past 20 years, family physicians and general practitioners (FP/GPs) and pediatricians have upheld their commitment to preventive care for infants. Non-Metropolitan Statistical Areas (non-MSAs) depend on family physicians for almost one half of their well-infant care. FP/GPs have increased their overall provision of well-infant care despite a decline in delivery of prenatal services. This commitment to child health care demands continued excellence of family physician training in pediatric medicine, preventive care, and child advocacy.

We analyzed National Ambulatory Medical Care Survey (NAMCS) data spanning 1980 to 1999 identifying well-infant visits for children younger than one year. To create comparison periods consisting of an equal number of annual surveys, data were aggregated for seven surveys before 1993 (early period) and seven surveys after 1992 (later period).

While total prenatal visits by physicians declined over the two periods, the total number of well-infant visits by all specialties increased from 53 million visits to 67 million visits. FP/GPs delivered approximately 11.1 million visits in the early period and 12.6 million visits in the later period, while the percentage of total well-infant visits performed by FP/GPs slightly declined from 20.9 percent to 18.9 percent. When controlled for expansion of specialty workforce, the number of well-infant visits per FP/GP remained stable, while the number of well-infant visits per general pediatrician declined over the two periods.

In the later period, FP/GPs provided an increased number of well-infant visits in all regions of the country except the Midwest. Pediatricians provided more well-infant visits in all regions of the country. FP/GPs made their greatest percentage contribution to well-infant care in non-MSAs. In the early period, FP/GPs provided 43 percent of all well-infant care in non-MSAs; this contribution increased in the later period to 45.6 percent. Most notably, the number of well-infant visits performed by pediatricians and FP/GPs in MSAs substantially increased over the two periods.

In these two periods, FP/GPs decreased their provision of prenatal care while increasing their provision of well-infant care. Currently, FP/GPs provide nearly 2 million well-infant visits per year. Consistent educational and institutional support are imperative for family physicians to provide quality preventive health care for children.

RegionFP visits in early period*in millions (% of total visits in regions)FP visits in later periodin millionsPediatrician visits in early period* in millionsPediatrician visits in later periodin millions
MSA4.8 (14%)7.9 (14.1%)28.5 (82.8%)47.0 (83.6%)
Non-MSA§4.6 (43%)4.7 (45.6%)5.8 (54.2%)5.5 (53.4%)
Northeast1.2 (8.9%)1.4 (8.4%)11.6 (86.6%)14.7 (88%)
Midwest5.0 (34%)4.7 (29.3%)9.3 (63.4%)11.0 (68.8%)
South2.3 (17.1%)2.4 (15.3%)10.7 (79.9%)13.1 (83.4%)
West2.5 (21.6%)4.1 (22.7%)8.7 (75%)13.6 (75.1%)
Total visits11.1 (20.9%)12.6 (18.9%)40.4 (76.2%)52.5 (78.9%)

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

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Graham Center Policy One-Pagers published in AFP is available at One-Pagers are also available at

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