Trends in Well-Child Visits to Family Physicians by Children Younger Than 2 Years of Age

Donna Cohen; Andrew Coco

doi:10.1370/afm.1076

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Why the Differences of Family Physicians vs. Pediatricians in WCC?
Lee Radosh

Published on: 24 May 2010
Care of Children
Kimberly T. Krohn

Published on: 17 May 2010
Rural Perspective
Randall L Longenecker

Published on: 17 May 2010
NAMCS, warts and all
Richard C Wasserman

Published on: 12 May 2010
Well child visits are influenced by access to appointments for newborn well care
Richard Neill

Published on: 12 May 2010

Published on: (24 May 2010)
Page navigation anchor for Why the Differences of Family Physicians vs. Pediatricians in WCC?
Why the Differences of Family Physicians vs. Pediatricians in WCC?
Lee Radosh, Reading, PA, USA
The authors looked at a standardized data set and systematically analyzed this set using recommended techniques. They concisely proved a simple yet important research question: what are trends in proportions of well-child visits by children younger than 2 years of age to family physicians? They should be applauded for doing this.
What I find most interesting, however, are their results in Table 1 and the diff...
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The authors looked at a standardized data set and systematically analyzed this set using recommended techniques. They concisely proved a simple yet important research question: what are trends in proportions of well-child visits by children younger than 2 years of age to family physicians? They should be applauded for doing this.
What I find most interesting, however, are their results in Table 1 and the differences between family physicians and pediatricians. In particular, I think it very noteworthy that family physicians care for a larger percentage of patients with Medicaid than do pediatricians. How can this be explained? What if other factors, such as the geographic region and race/ethnicity, were controlled – would the insurance differences still hold?
It should be a source of pride that family physicians serve for the “underserved” (or underinsured), but we should also realize that we have a lot to offer patients. Why do pediatricians see a larger percentage of private insured children less than age 2 for well child care than family physicians? I believe we need to address these issues rather than worry about declining prenatal care as it relates to child-care. The message from the data seems to be: if you can’t afford care, we (family physicians) will be there for you, but once you have insurance (and you can choose where to go) you seem to choose pediatricians.
I would love to see a breakdown of rates of care with all of these other factors controlled, as well as seeing those proportions of visits as in Table 1 over time, not just as an aggregate 4,999 visits. Has there been a trend in the other characteristics in Table 1? This may be very telling.
Dr. Krohn makes a good point that perhaps we should examine overall pediatric visits, not just well-child care. Dr. Longenecker addresses care in rural communities, however despite his local experience at his 2 person practice, this data from this large database does in fact refute conventional wisdom.
In summary, this research leads to more questions, as good research should. I thank the authors for systematically addressing this question concisely, and head on. I would love to see more research regarding the findings of differences in well child care of pediatricians vs. family physicians.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (17 May 2010)
Page navigation anchor for Care of Children
Care of Children
Kimberly T. Krohn, Minot, ND, USA
The article is a thoughtful review of rates of well-child care based on specialty of the doctor. My observation in clinical practice is that few of my young patients are seen only for well-child care, particularly if they are under 2 years of age. There is usually a feeding problem, a cold, a concern about sleep, elimination, etc. that shifts the well-child appointment to an appointment which is considering a health pr...
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The article is a thoughtful review of rates of well-child care based on specialty of the doctor. My observation in clinical practice is that few of my young patients are seen only for well-child care, particularly if they are under 2 years of age. There is usually a feeding problem, a cold, a concern about sleep, elimination, etc. that shifts the well-child appointment to an appointment which is considering a health problem. So I would like to see the overall data on the care of children by pediatricians vs. family physicians, and I would also consider the contribution made by physician assistants and nurse practitioners.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (17 May 2010)
Page navigation anchor for Rural Perspective
Rural Perspective
Randall L Longenecker, Bellefontaine, Ohio, United States
Sad state, indeed! I agree with Dr. Neill that although the general findings of the study are somewhat reassuring, the devil is in the details. The largest decline in family physicians delivering prenatal care occurred in the decades prior to the current survey, and although it is reassuring to see that the proportionate numbers have stabilized, I'm not sure that the absolute numbers are as reassuring.
As I...
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Sad state, indeed! I agree with Dr. Neill that although the general findings of the study are somewhat reassuring, the devil is in the details. The largest decline in family physicians delivering prenatal care occurred in the decades prior to the current survey, and although it is reassuring to see that the proportionate numbers have stabilized, I'm not sure that the absolute numbers are as reassuring.
As I interpret the data, only half of well-child visits after 6 months of age occur with either a family physician or pediatrician. This suggests to me an increasing role of the public health sector and well-child clinics in health departments and other public facilities. This is not necessarily a bad thing, but it does tend to support Dr. Neill's assertion that we may be dealing with a capacity issue as much as anything.
And although rural communities, as very roughly measured by MSA/nonMSA designation, likely represent a small portion of the total, the proportion of visits there by family physicians is dramatically different than for any other regional variation. In rural communities there are more likely to be no pediatricians and with physicians limiting the number of Medicaid and uninsured, family physicians and the public health sector must assume a greater role.
Finally, I believe that global data is obscuring a local truth, and I do not believe this article refutes conventional wisdom. Family physicians in our community who do not deliver prenatal care clearly have a different practice profile from those of us who do. We are the equivalent of a 2 person practice as a rural training track residency, and we regularly care for hospitalized pediatric patients (in contrast to our urban residency counterparts). 11.7% of our 5150 annual office visits are for patients less than 2 years of age, as compared to 7.3% for residency practices nationally and certainly less than 5% for family physicians (who do not do OB) locally.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (12 May 2010)
Page navigation anchor for NAMCS, warts and all
NAMCS, warts and all
Richard C Wasserman, Burlington, Vermont, USA
Warts and all, the nice thing about NAMCS is that the warts are pretty constant from year to year.
I enjoyed this focused NAMCS analysis, which demonstrated that well- child visits to family physicians by children under two years of age were not declining, in spite of the overall decline of children's visits to family physicians documented in other NAMCS analyses.
I would be curious to see longitudinal...
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Warts and all, the nice thing about NAMCS is that the warts are pretty constant from year to year.
I enjoyed this focused NAMCS analysis, which demonstrated that well- child visits to family physicians by children under two years of age were not declining, in spite of the overall decline of children's visits to family physicians documented in other NAMCS analyses.
I would be curious to see longitudinal data, NAMCS or other, on the proportion of total visits to family physicians accounted for by children. With the overall aging of the population, are children comprising less of the family physicians' overall daily workload?
Competing interests: None declared
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Competing Interests: None declared.
Published on: (12 May 2010)
Page navigation anchor for Well child visits are influenced by access to appointments for newborn well care
Well child visits are influenced by access to appointments for newborn well care
Richard Neill, USA
Drs. Cohen and Coco’s findings related to well care stand in contrast to prior work showing the overall proportion of pediatric visits to family physicians to be declining during an overlapping period. By implication sick visits likely account for the increase in overall visits to pediatricians described by others.
Entry into well care for newborns is influenced by parental preference for provider and where...
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Drs. Cohen and Coco’s findings related to well care stand in contrast to prior work showing the overall proportion of pediatric visits to family physicians to be declining during an overlapping period. By implication sick visits likely account for the increase in overall visits to pediatricians described by others.
Entry into well care for newborns is influenced by parental preference for provider and where children are delivered as much as who the delivering provider is. Family physicians delivering babies capture newborns into their practice, and family physicians who don’t deliver babies may still accept referrals from newborn nurseries of local hospitals.
But the pattern of these referrals has changed as the landscape of obstetrics and pediatric inpatient care has evolved. In many settings there are fewer and fewer obstetric units, and therefore many fewer general hospitals that have robust general pediatric and family medicine physicians on staff to accept referrals from a busy nursery in the same hospital.
Here in Philadephia referrals from newborn nurseries for unattached children go to all willing pediatric and family medicine offices. Despite this there remains a shortage of capacity for well child care that increases the likelihood of falling between the cracks, regardless of the specialty of the well care provider. That proportions of well visits to family physicians have remained constant while overall visits increasingly go to pediatricians (generalists and specialists) is not surprising in this context. There is little room to move this proportion without excess capacity at entry in either field.
Sadly I fear this finding is more a reflection of the sad state of primary care access than reassurance that family medicine is holding it's own in a market where supply of well child appointments is rampant.
Competing interests: None declared
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Competing Interests: None declared.