ANN ARBOR, Mich.— Increasing numbers of parents brought their children to pediatricians rather than family physicians or internists over the last decade, a new study from the University of Michigan Health System finds. This is important as different types of doctors often make different decisions on diagnostic tests and therapies for children. The trend also has important implications for future planning for the medical workforce and the number of doctors needed in the United States.
Those are the findings of a new study now available online in the Journal of Pediatrics. Gary L. Freed, M.D., M.P.H., the study’s lead author, is director of the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan Health System.
For this study, researchers used data from 1980–2006 National Ambulatory Medical Care Surveys to examine trends in office visits by patients 17 and younger.
Overall, the proportion of visits to pediatricians rose from 56 percent in 1980 to 71 percent in 2006. During that same time period, the proportion of visits to family physicians and internists by children fell from 33 percent to 22 percent. The trends are consistent and appear to be accelerating over time. The greatest changes happened in the adolescent age group over the past six years, with the proportion of visits to pediatricians rising from 38 percent to 53 percent between 2000 and 2006.
The study found that across all pediatric age groups the majority of medical care is now provided by pediatricians. For some age groups, most notably the youngest children, almost 90 percent of visits are to pediatricians.
There are many reasons why this is happening, researchers say. Among the most likely is the impact of an aging population on the demographic make-up of family physician practices.
Also there is an increasing financial incentive for both family physicians and internists to decrease the proportion of care they provide to children and adolescents. Rates of reimbursement for children in the Medicaid program are on average about 30 percent lower than those for Medicare, which covers elderly patients.
Although both pediatricians and family physicians are trained to provide care to children, studies have shown these different specialties recommend different prevention and treatment strategies to their patients.
Because of their experience with adult patients, family physicians are more likely than pediatricians to assist patients under the age of 18 with smoking cessation. Family physicians also have been found to be more likely than pediatricians to discuss with families the impact of the potential cost of new asthma medications, to be aware of local domestic violence agencies and to recognize adult symptoms of domestic violence
On the other hand, likely due to having fewer pediatric patients, a previous study found that family physicians were less likely than pediatricians to believe they were competent to discuss with parents the conditions in the newborn screening panels. This includes screening tests for congenital hypothyroidism and phenylketonuria.
Different priorities for preventive services may also exist between the two specialties. For example, other studies havefound that family physicians are less likely than pediatricians to recommend the flu vaccine for pediatric patients with asthma.
Additional authors: Kelly M. Dunham, M.P.P., Achamyeleh Gebremariam, M.S., John R.C. Wheeler, Ph.D., and the Research Advisory Committee of the American Board of Pediatrics
Funding source: Funded by a grant from the American Board of Pediatrics Foundation
Journal reference: Journal of Pediatrics, 10.1016/j.jpeds.2010.01.003
Written by Margarita Bauza
Media contact: Margarita Bauza