Declining Number of Family Physicians Who Care for Children Threatens  Access to Care in Rural and Pediatrically-Underserved Areas

FOR IMMEDIATE RELEASE: Wednesday, Februay 10, 2021

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Declining Number of Family Physicians Who Care for Children Threatens Access to Care in Rural and Pediatrically-Underserved Areas

WASHINGTON, DC — Access to comprehensive primary care is especially important for children, however, recent years have seen a decline in the number of family physicians who provide care to children aged 18 years and younger. This current trend is unsettling, because family physicians provide the majority of pediatric care in rural and pediatrically-underserved areas of the United States.

Ideally, a patient-physician relationship begins in childhood, with a family physician who cares for the child’s whole family. New research by the Robert Graham Center identified demographic and practice characteristics associated with family physicians’ provision of care to children, as well as factors that may be driving this downward trend. The paper, entitled “A Cross-Sectional Study of Factors Associated With Pediatric Scope of Care in Family Medicine,” was published in the January 2021 Journal of the American Board of Family Medicine.

“While general pediatricians provide the majority of ambulatory care to children in the United States, family physicians are the usual source of care for about 20 percent of US children. Although family medicine training prepares physicians to care for patients from the ‘cradle to the grave,’ some family physicians do not care for children after completing training,” writes Anuradha Jetty and colleagues. “Anecdotally, many factors may influence a family physician’s decision to stop caring for children, including organizational, personal, social, and economic factors. Recent research has demonstrated that early-career family physicians with a broader scope of practice experience less burnout; however, many fail to attain the scope of practice that they intend on graduation from residency. Maintaining pediatric scope of practice is a key priority for family medicine educators and leaders.”

This study found that the percentage of family physicians who care for children aged 18 and younger declined from 84.3 percent in 2017 to 83 percent in 2018. This is consistent with previous Robert Graham Center research that reported a similar steady decline from 1992 to 2002. While that period also saw a simultaneous increase in pediatricians, the overall decline of family physicians caring for children poses a broader concern for a specialty that defines itself by its comprehensive scope of practice.

Key study findings:

• Older family physicians (aged 60+) and family physicians from racial/ethnic minorities were less likely to see pediatric patients than were non-Hispanic White family physicians. No difference was observed for non-Hispanic Black physicians.
• Family physicians who provided care in a language other than English were more likely to see pediatric patients than English-only speaking physicians.
• Family physicians in solo practice were less likely to see pediatric patients than physicians in group practice.
• Family physicians who worked in independently owned practices were more likely to see pediatric patients than those who worked in managed care/HMO practices or safety-net clinics.
• Family physicians in rural areas were more likely to see pediatric patients than family physicians in urban areas.
• There was no significant difference in the percentage of family physicians seeing children associated with physician gender, pediatric population percentage, allopathic versus osteopathic training, or geographic poverty rate.

The authors note, “Although some debate exists regarding whether there is an overall shortage of pediatric primary care physicians, there is undoubtedly significant variability in the regional supply of pediatric primary care physicians and thus areas where family physicians are needed to meet current pediatric workforce demand.”

While a majority of family physicians continue to care for children, more study is needed to determine how factors such as organizational policies, personal preference, social needs and the economy are driving this downward trend.

“The opportunity to enjoy a full scope of practice, caring for people of all ages and building long term relationships, are important contributing factors that influence medical students to specialize in family medicine,” Jetty said. “This is why it is so important for family physicians in early training and residency to be exposed and encouraged to pursue a broad scope of practice – not only for career satisfaction, but to ensure people of all ages have access to comprehensive primary care, regardless of location or the type of clinic they visit.”