ACA demands may deter family docs from treating children

The availability of primary care services for children is declining, as fewer family physicians are seeing children, according to a recent Annals of Family Medicine study.

The percentage of family physicians caring for children dropped from 78% in 2000 to 68% in 2009. That’s a significant decrease considering that family physicians see nearly one third of children and children make up about 10% of their practice.

The study’s authors say they are concerned that Affordable Care Act polices that are increasing coverage for adults are spreading the services of current family physicians too thin.

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“Policy discussions regarding looming physician shortages and the implementation of healthcare reform have focused predominantly on adults,” say the study’s researchers from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. “The costs of adult-related healthcare can overwhelm those of children’s care, leaving children’s health services to be an afterthought in the minds of many policy makers.”

Male family physicians, those who are older and those in a group practice are less likely to provide care to children. Also, in years when family physicians are taking recertification exams, they see fewer child patients.

The survey was given to family physicians taking the American Board of Family Medicine maintenance of certification exam between 2006 and 2009. Because the survey was a mandatory part of the test, it has a 100% response rate of 37,020 physicians.

Family physicians in the South and the West see fewer child patients than do Northeastern physicians. The Washington D.C. area had the lowest percentage of family physicians treating children at 45%; while 84% of Nebraska’s family physicians treat children.

“Family physicians, especially in rural and underserved areas, may face impossible demands to care for a larger insured population, resulting in decreased capacity to provide care for children,” the study’s authors say. “Additionally, current geographic maldistribution of the child health care physician workforce is leading to difficulty with access to care for many children and families.” 

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When family physicians practice obstetrics, they also treat more children, according to the study. Incentives for medical students who want to go into family medicine and the pediatric programs in medical schools should be strengthened to make the profession more profitable and less stressful, the study says.

“Strengthening existing partnerships and forging new collaborative relationships among general pediatric, obstetric, and family medicine educators may also be important if we are to ensure a well-trained, geographically well-distributed child physician workforce,” the study’s authors say. “Policy makers must consider how ongoing discussions of payment reforms, principally aimed at value-based purchasing and broader population management, influence access to care for children in areas with few providers.”