U.S. family practice lost its juvenile face over the past 20 years.
Starting in roughly 1990, U.S. family medicine physicians increasingly lost infants, children, and adolescents from their practices, giving the demographic up to general-practice pediatricians, Dr. Gary L. Freed reported last week at the Eastern Society for Pediatric Research. Dr. Freed is a pediatrician whose research centers on health management and policy, and the major spin he had on his findings, drawn from data collected annually by the National Ambulatory Medical Care Survey, centered on the implications for pediatricians: an increased share of the pediatric “market,” leading to increased demands on the pediatrician workforce.
image courtesy Flickr user Lance and Erin
But Dr. Freed also acknowledged the profound implications of this shift for family practice: “Family medicine is rapidly becoming a primary care specialty for adults,” he noted. “It’s a big issue for family medicine, for training and for care.” In other words, the whole concept of family practice as a cradle-to-grave discipline, geared to caring for every member of the extended family from neonate to great-grandparent, with pregnancy tossed in, seems headed for extinction in America. And this trajectory for a venerable form of medical practice is mostly beyond the control of family physicians themselves. The fate of their practice is being dictated by the general public as they decide who will deliver their medical care.
The numbers are striking. As recently as 1990, 55% of U.S. children aged 0-17 received their medical care from a primary-care pediatrician and 35% saw a family practice physician. By 2006 generalist pediatricians had 70% of America’s kids in their practices, with the family practice share cut to 20%. For infants younger than age 1, the family practice share dropped even lower, from 25% in 1990 to 15% in 2006; concurrently the pediatrician’s share rose from about 70% to 85%.
While the reasons for this shift aren’t known for certain, Dr. Freed offered his speculation: Expanded Medicaid and children’s health insurance programs, continued shift of the U.S. population to urban and suburban regions, aggressive contracting for care delivery by academic centers, the aging of America, an increased comfort level among Americans for adolescents to receive their medical care from pediatricians, and fewer FPs doing obstetrics.