A new article in Pediatrics written by staff members in the AAFP’s Robert Graham Center in Washington notes that family physicians provide a medical home to about one third of the country’s children “but face shrinking panels of children.” Authors Robert Phillips, MD, MSPH, director of the Graham Center; other Graham Center staff members; and pediatrician Scott Shipman, MD, MPH, assistant professor at the Center for the Evaluative Clinical Sciences at Dartmouth Medical School, Hanover, NH, suggest that now is the time for collaboration (not competition) between family medicine and pediatrics.
Family physicians and pediatricians share common ground as they tackle issues such as children’s unmet needs; health in the context of families and communities; and “millennial morbidities” such as violence, obesity, family distress and poverty says the abstract for “Family Physicians in the Child Health Care Workforce: Opportunities for Collaboration in Improving the Health of Children” in the September issue of Pediatrics.
Although children’s visits to family physicians decreased by nearly 25% from 1992 to 2002, “family medicine’s role in children’s health care is more stable in rural communities, for adolescents and for under-served populations,” say the authors. “The growth of the pediatric workforce has largely occurred in areas of affluence and in urban or suburban areas. … Rural and other underserved populations depend more on FPs.”
Both pediatrics and family medicine “play an important role” in safety-net programs such as community health centers, “and health centers probably represent one of the best models of clinical cooperation between pediatricians and FPs in caring for communities,” the authors say. “Health centers could be a laboratory for collaborative education.”
In addition to pursuing advocacy efforts on behalf of children, the 2 specialties share a commitment to the concept of “medical home,” which was formulated by the American Academy of Pediatrics (AAP) and was incorporated in the 2004 Future of Family Medicine report. Marking another common interest, the AAP Task Force on the Family in 2003 concluded that children’s outcomes were strongly influenced by how well their families functioned and that pediatricians could do much to help nurture and support families.
After reviewing commonalities among the 2 specialties, as well as threats to children’s health, the authors say family medicine’s options include
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relinquish clinical care of children to pediatricians and focus on working with internists to meet the increasing demands of aging adults;
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relinquish most clinical care of children and focus on preparing some FPs to care for children in rural and underserved areas;
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compete head-to-head with pediatricians, nurse-practitioners (NPs) and physician assistants (PAs) for a shrinking child health care market; or
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seriously engage pediatricians, NPs and PAs in building “new models of training and practice that benefit from all sets of skill and compassion to provide better care in a family- and community-focused environment. This collaboration could involve joint or combined training and aggressive joint advocacy for improved services, both clinical and in the community.”
The authors bid for the last option. “Stimulated by a shrinking market for providing care to individual children, FPs and pediatricians have an opportunity to join efforts in meeting the needs of children, for many of whom their most pressing morbidity risks are framed in the context of their families and communities,” the authors say.
At least one pediatrician welcomes the authors’ challenge. Richard Pan, MD, MPH, assistant professor of pediatrics and medicine at the University of California, Davis, in Sacramento wrote the commentary “A Jacobian Future: Can Everyone Have a Medical Home?” in the same issue of Pediatrics. An extract is available online without a subscription at: http://pediatrics.aappublications.org/cgi/content/extract/118/3/1254.
Pan notes the traditional “uneasy relationship” between FPs and pediatricians as competitors and partners in the care of children and adolescents. Also, he notes, “Pediatrics has recognized the importance of caring for families to improve child health, potentially leading to a collision course with family medicine.”
“Phillips et al now bring a challenge to the pediatric community regarding the future of health care for children and adolescents,” says Pan. He defends family physicians’ “critical role” in caring for children and adolescents. “Collaboration is an important option for the future,” he asserts.
Pan demands reform of health care to support medical homes for children. In addition, “millennial morbidities” (a phrase coined by FP David Satcher, MD, PhD, and coauthor of a 2005 Pediatrics article) such as violence, obesity, family distress and poverty require change in the social and physical environments in which children live, says Pan. “To achieve the optimal physical, mental, and social health and well-being for children, pediatricians and family physicians need to do more than just deliver traditional health care services. … Our children need both pediatricians and family physicians to provide every child a medical home and create a health system that will sustain it.”
- © 2006 Annals of Family Medicine, Inc.
