Family Physicians Increase Provision of Well-Infant Care Despite Decline in Prenatal Services

One Pagers | Jan 01, 2003 Janelle Guirguis-Blake, MD; Ed Fryer, PhD; Mark Deutchman, MD, MPH; Larry Green, PhD; Susan Dovey, MD, MPH; and Robert Phillips, MD, MSPH

Over the past 20 years, both 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 half of their well-infant care. In fact, 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 FP training in pediatric medicine, preventive care, and child advocacy.

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

While total prenatal visits by physicians declined over the two time 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% to 18.9%. When controlled for expansion of specialty workforce, the number of well-infant visits per FP/GP remained stable while number of well-infant visits per general pediatrician declined over the two time 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 43.0% of all well-infant care in non-MSAs; this contribution increased in the later period to 45.6%. Most notably, the number of both pediatric and FP/GP-performed well-infant visits in MSAs substantially increased over the two time periods.

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

Well-Infant Visits Provided by FP/GPs in Two Seven-Year Periods

RegionVisits in early period in millions (% of total visits in regions)Visits in later period in millions
Region: MSAVisits in early period in millions (% of total visits in regions): 4.8 (14.0%)Visits in later period in millions: 7.9 (14.1%)
Region: non-MSAVisits in early period in millions (% of total visits in regions): 4.6 (43.0%)Visits in later period in millions: 4.7 (45.6%)
Region: NortheastVisits in early period in millions (% of total visits in regions): 1.2 (8.9%)Visits in later period in millions: 1.4 (8.4%)
Region: MidwestVisits in early period in millions (% of total visits in regions): 5.0 (34.0%)Visits in later period in millions: 4.7 (29.3%)
Region: SouthVisits in early period in millions (% of total visits in regions): 2.3 (17.1%)Visits in later period in millions: 2.4 (15.3%)
Region: WestVisits in early period in millions (% of total visits in regions): 2.5 (21.6%)Visits in later period in millions: 4.1 (22.7%)
Region: Total VisitsVisits in early period in millions (% of total visits in regions): 11.1 (20.9%)Visits in later period in millions: 12.6 (18.9%)

Table. Well-Infant Visits Provided by Pediatricians in Two Seven-Year Periods

RegionVisits in early period in millions (% of total visits in regions)Visits in later period in millions
Region: MSAVisits in early period in millions (% of total visits in regions): 28.5 (82.8%)Visits in later period in millions: 47.0 (83.6%)
Region: non-MSAVisits in early period in millions (% of total visits in regions): 5.8 (54.2%)Visits in later period in millions: 5.5 (53.4%)
Region: NortheastVisits in early period in millions (% of total visits in regions): 11.6 (86.6%)Visits in later period in millions: 14.7 (88.0%)
Region: MidwestVisits in early period in millions (% of total visits in regions): 9.3 (63.4%)Visits in later period in millions: 11.0 (68.8%)
Region: SouthVisits in early period in millions (% of total visits in regions): 10.7 (79.9%)Visits in later period in millions: 13.1 (83.4%)
Region: WestVisits in early period in millions (% of total visits in regions): 8.7 (75.0%)Visits in later period in millions: 13.6 (75.1%)
Region: Total VisitsVisits in early period in millions (% of total visits in regions): 40.4 (76.2%)Visits in later period in millions: 52.5 (78.9%)
Region: Definitions
Early period= seven annual surveys between 1980-1992 (1980, 1981, 1985, 1989-1992)
Later period= seven annual surveys between 1993-1999
MSA=Metropolitan Statistical Area=county or group of contiguous counties that contains at least one city with a population of >50,000 or a Census Bureau-defined urbanized area of at least 50,000 with a metropolitan population of >100,000.
Non-MSA=non-Metropolitan Statistical Area=county that does not meet above criteria.
MSA plus non-MSA not equal to 100% due to missing NAMCS data.

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

Published in American Family Physician, Jan 1 20083 Am Fam Physician. 2003;67:17. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.