Fewer Family Physicians Treating Children

The percentage of family physicians providing care to children decreased from 78% in 2000 to 68% in 2009, according to study results published in the September/October edition of the Annals of Family Medicine.

The decline adds a layer to the debate about physician shortages, the authors say, noting that care for children often gets lost in discussions about the overall physician shortage. Physicians will be further stretched in caring for children as the Affordable Care Act extends insurance to more children and adults.

Laura Makaroff, DO, from the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC, and colleagues found that family physicians spend about 10% of their time on care for children and are the usual source of care for one third of all children. Family physicians are the providers for between 16% and 21% of child care visits.

The authors note, "Children with a usual source of care have better health outcomes, including more preventive health counseling and fewer avoidable hospitalizations, than children who do not. Furthermore, access to patient-centered, comprehensive primary care has been shown to improve delivery of preventive services and decrease unmet medical needs of children."

Predictors of Care

The researchers looked at the geographic and demographic factors tied to whether physicians care for children. They used survey data from 37,020 family physicians who took the American Board of Family Medicine Maintenance of Certification Examination between 2006 and 2009.

Those who treat children are more likely to be young, female, and live in a rural area. The odds ratios (ORs) are 0.97 (95% confidence interval [CI], 0.97 - 0.98), 1.19 (95% CI, 1.12 - 1.25), and 1.50 (95% CI, 1.39 - 1.62), respectively, for those demographics.

The researchers also found that International Medical Graduates are less likely than other graduates to provide care for children (OR, 0.88; 95% CI, 0.81 - 0.94), and those in health management organizations or government settings are less likely than those in group practice to provide care to children (OR, 0.39 [95% CI, 0.35 - 0.45] and 0.26 [95% CI, 0.24 - 0.29], respectively).

Given the decline in numbers of physicians treating children, the authors suggest policymakers look at ways to reduce medical student debt and better address work–life balance issues to build more interest in family medicine and pediatrics among students.

"Policy makers must consider how ongoing discussions of payment reforms, principally aimed at value-based purchasing and broader population management, influence access to care for children in areas with few providers," they conclude.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2014;12:427-431. Full text

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