Patterns of care are changing

For some age groups, the pediatrician market share has become quite striking; almost 90% of visits for children less than 1 year of age are with pediatricians. The biggest change in the past decade, however, was among adolescents. As of 2000, there were roughly equal proportions of adolescent visits to pediatricians and nonpediatric primary care physicians. However, from 2000 to 2006, the proportion of visits to pediatricians increased from 38% to 53%.

This continued shift in the proportion of visits to pediatricians is likely the result of a series of continuing demographic trends, most notably the continued aging of America and the shortage of primary care providers for adults. These trends are likely to continue for the foreseeable future. For the shift in adolescent visits, it may be that pediatricians are more comfortable today caring for adolescents than they were a decade ago. Although a significant proportion of adolescent care is not provided by adolescent specialists, the increase of this subspecialty has had a marked effect recently on pediatric training.

Conversely, there are areas where pediatricians can follow the lead of family physicians. Likely because of their experience with adult patients, family physicians are more likely than pediatricians to assist patients under the age of 18 with smoking cessation.⁴

What is the likely effect of these changes on pediatricians and children in the United States? Currently, as approximately 40% of those completing pediatric residency pursue primary care careers, there should not be an issue overall regarding access to care providers. However, some access problems may occur in rural or other health profession shortage areas where pediatricians may not be available. The most pressing shortages in pediatric care are in many of our subspecialties.

The most important issue for pediatric care is to strive to ensure that we continue to fill pediatric residencies and to encourage young physicians to choose pediatrics as a specialty. This is essential to ensure an adequate supply of primary care pediatricians and to help with the shortage of subspecialists in our field.

REFERENCES

1. Freed GL, Dunham KM, Gebremariam A, Wheeler JR. The Research Advisory Committee of the American Board of Pediatrics. Which physicians are providing care to America's children? An update on the trends and changes during the past 26 years. J Pediatr. 2010. Epub ahead of print.

2. Dombkowski KJ, Leung SW, Clark SJ. Physician perspectives regarding annual influenza vaccination among children with asthma. Ambul Pediatr. 2008;8:294-299.

3. Davis MM, Broder KR, Cowan AE, Mijalski C, Katrina K, Stokley S, et al. Physician attitudes and preferences about combined Tdap vaccines for adolescents. Am J Prev Med. 2006;31(2):176-180.

4. Kaplan CP, Perez-Stable EJ, Fuentes-Afflick E, Gildengorin V, Millstein S, Juarez-Reyes M. Smoking cessation counseling with young patients: the practices of family physicians and pediatricians. Arch Pediatr Adolesc Med. 2004;158(1):83-90.