The Diminishing Role of FPs in Caring for Children
One Pagers | May 01, 2006
Andrew Bazemore, MD, MPH; Robert Phillips, MD, MSPH; Martey Dodoo, PhD; Jessica McCann, MD; Lawrence Klein, PhD; Larry Green, MD
Nationwide, family physicians (FPs) deliver a smaller proportion of the outpatient care of children than they did 10 years ago. Millions of children depend on FPs for care. Family medicine should reevaluate how it will contribute to the care of the nation's children.
Table. Numbers of Generalist Pediatricians, FPs, and U.S. Children, 1981 to 2004
| Year | Generalist pediatricians | Children (0-17 years) | FPs |
|---|---|---|---|
| 1981 | 20,051 | 63,213,000 | 54,013 |
| 1986 | 24,128 | 62,865,000 | 60,311 |
| 1991 | 30,080 | 65,111,000 | 67,078 |
| 1996 | 35,202 | 70,226,000 | 77,185 |
| 2001 | 41,753 | 72,604,000 | 87,016 |
| 2004 | 45,994 | 73,277,000 | 93,833 |
| Increase | 129% | 16% | 74% |
| FPs = family physicians. Source: Information from reference 4. |
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The proportion of U.S. office visits for children performed by FPs declined between 1992 and 2002 (see accompanying figure1), as did the number of children cared for by FPs,2,3 while the number of children seen in outpatient settings remained stable. From 1981 to 2004, the U.S. pediatrician workforce more than doubled (see accompanying table4) and the U.S. birth rate declined from 15.8 to 14.1 live births per 1,000 persons.2 Growth in the workforce of physicians who care for children will continue to outpace the birth rate for five to 10 years or more. Children in rural and urban underserved areas, meanwhile, remain disproportionately dependent on FPs for their care.2
Figure. Percentage of child visits to physicians by specialty
Source: Information from reference 1.
According to the Future of Family Medicine report,5 most Americans can identify pediatricians as "the doctors who care for children," whereas the role of FPs is unclear. Facing a shrinking percentage of child visits and an increasingly competitive environment for child health care, family medicine has several choices about its future role in the health care of the nation's children. These include: (1) relinquishing such care and focusing on the increased demands of an aging population, (2) refocusing training of a part of its workforce to meet the continued needs of rural and underserved sites, (3) competing for a shrinking market through new model practice efforts to improve brand recognition and perceived value, and (4) engaging other providers of child health care in collaborative new models of practice that capture the unique features of each provider group and that can care for children in the context of family and community.
References
- National Ambulatory Medical Care Surveys. Analysis by the Robert Graham Center, 2005.
- Phillips RL Jr, Dodoo MS, McCann JL, et al. Report to the Task Force on the Care of Children by Family Physicians. Washington, D.C.: Robert Graham Center, AAP Center for Child Health Research, 2005.
- Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2003. Natl Vital Stat Rep 2005;54:1-116.
- AMA Masterfiles, U.S. Census Bureau. Analysis by the Robert Graham Center, 2005.
- Martin JC, Avant RF, Bowman MA, et al. The future of family medicine. Ann Fam Med 2004;2(suppl 1):S3-32.
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, May 1, 2006. Am Fam Physician. 2006;73(9):1518. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.