Factors Influencing Family Physicians’ Contribution to the Child Health Care Workforce

In this new excellent analysis by Makaroff and colleagues we get a look at both the changing scope of care of family medicine and the implications for the nations health. Care of children is a central component of family medicine and a key ingredient in what separates the specialty from other primary care by (among other things): 1) providing a major opportunity to harness the therapeutic strength of continuity (here both across the life-course and across generations) to improve health, 2) creating opportunities for parents to receive additional "care touches" during pediatric care, 3) enhance the efficiency of the primary care workforce by allowing care sessions that cross the life course, and 4) providing a case mix for individual physicians that is highly personally rewarding and reduces physician burnout. The trend outlined in this paper showing a steady reduction in the number of family physicians providing care of children and the factors associated with this change are key tools for the specialty and for health policy makers in mapping out strategies for the future.

The authors use the excellent ABFM recertification survey system to gather a sample of practitioners and augment this through the use of geographic databases to create an expansive view of the current state of this issue. There are critical concerns for the specialty which are raised including how to enhance and re-energize the care of children as a part of family medicine practice that is central to the DNA of family physicians and should not be viewed as expendable for anyone at any stage (from medical students or international medical graduates to residents and practitioners).

Factors which reduce the probability of providing care for children such as working for HMOs and government health sites are not surprising to anyone who has seen the tendency (in at least some) of these settings to fall into the overly simplistic pattern of plugging health care providers into gender and age based pigeon holes that ignore the opportunities for efficiency that come from having providers who can see all family members at once. Efforts of our national and regional Family Medicine organizations to present the logic and benefits of using the full scope of practice available with Family Physicians to these organizations should be a priority to ensure that graduates can step into these positions when completing training.

There are a number of interesting patterns identified in this paper that deserve continuing monitoring and further investigation. The regional variation in care of children by family physicians is fascinating and in some cases counter intuitive. I look forward to some additional work potentially linking these patterns to other important measures such as cost, quality, and equity of distribution of care across patient income. I hope that organizations such as the ABFM and AAFP use the measures presented in this work as standard metrics with planned periodic follow up. Linked to this should be strategies for moderating this reduction in scope of practice of the specialty.

Competing interests: None declared