One Pagers | Aug 15, 2003
Donna Cohen, PhD; Janelle Guirguis-Blake, MD; David Jack, MD; V.K. Chetty, PhD; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH
Family physicians (FPs) provided 30 percent of inpatient newborn care in Maine in the year 2000. FPs cared for a large proportion of newborns, especially those insured by Medicaid and in smaller, rural hospitals where FPs also delivered babies. Family medicine’s commitment to serve vulnerable populations of newborns requires continued federal, state, and institutional support for training and development of future FPs.
We analyzed Healthcare Cost and Utilization Project data for Maine in 2000, identifying the provision of all newborn services by physician specialty. The 501 FPs and 174 pediatricians, including neonatologists and specialists, practicing in Maine provided the vast majority of inpatient care to newborns. FPs cared for 30 percent of all newborns and 35 percent of normal newborns. In all hospitals where FPs provided delivery services, they provided the same or greater proportion of newborn services.
Family physicians provided newborn services to more than one-third of newborns in Maine insured by Medicaid, and nearly one-half of those newborns with no insurance. FPs contributed to a higher proportion of newborn services in smaller, rural hospitals. In the most rural counties of the non-metropolitan statistical counties, FPs provided 43 percent of newborn services, and in metropolitan counties, FPs provided 27percent of newborn services. FPs accounted for nearly one-third of total newborn services provided in larger hospitals (more than 60 beds) and one-half of total newborn services in smaller hospitals (less than 60 beds).
| Type of Service | Pediatrician Contribution (% total) | FP contribution (% total) | Total |
|---|---|---|---|
| Total Newborn Care* | 9,149 (67%) | 4,142 (30%) | 13,746 |
Normal Newborn Care* |
5,470 (62%) | 3,040 (34%) | 8,822 |
Term Newborn w/ Problem* |
2,442 (70%) | 938 (27%) | 3,488 |
Premature Newborn* |
711 (86%) | 102 (12%) | 829 |
| Insurance (cases per specialty)*† | 8,943 | 4,112 | 13,688 |
Private |
5,975 (69%) | 2,345 (27%) | 8,649 |
Medicaid |
2,302 (59%) | 1,368 (35%) | 3,920 |
Self-pay |
414 (53%) | 329 (42%) | 784 |
| Distribution of deliveries by hospital size* | |||
Hospital >60 beds (n = 15) |
7,573 (73%) | 2,751 (27%) | 10,333 |
Hospital <60 beds (n = 16) |
1,395 (50%) | 1,391 (50%) | 2,787 |
| Location of Hospital *† | |||
Metropolitan statistical areas |
4,064 (73%) | 1,481 (27%) | 5,553 |
Nonmetropolitan statistical areas |
4,761 (64%) | 2,619 (35%) | 7,382 |
| FP=Family Physician *Pediatrician and FP contribution does not equal 100% because of contribution of others †Insurance Distribution, Hospital Size, and Hospital Location data does not equal Total Newborn Care because of missing data |
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A large proportion of Maine’s newborns relied on FPs for care in 2000. Factors that limit the training and role of FPs in newborn care may limit access to services available to newborns, especially those insured by Medicaid and in smaller, rural hospitals.
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, Aug 15, 2003. Am Fam Physician. 2003;68(4):593. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.