Changes in the proportion and volume of care provided to children by generalists and subspecialists

Area of Science:

• Pediatric Healthcare
• Primary Care Medicine
• Healthcare Utilization

Background:

• Concerns exist regarding the shifting balance of pediatric care between primary care physicians and specialists.
• Understanding referral patterns and physician roles is crucial for healthcare resource allocation.

Purpose of the Study:

• To evaluate if primary care physicians (PCPs) are providing proportionally less care for common childhood diagnoses.
• To determine if this trend is increasing demand for specialist services.

Main Methods:

• Analysis of secondary data from a large US commercial healthcare organization (1993-2001).
• Examination of Evaluation and Management (E/M) visit codes and International Classification of Diseases (ICD) codes for asthma, constipation, headache, and heart murmurs.
• Assignment of visits to physician specialty and statistical testing using logistic regression.

Main Results:

• Both pediatrician generalists and specialists saw an increased proportion of E/M visits from children between 1993 and 2001.
• The absolute increase in visits to generalists was greater than to subspecialists.
• The relative increase in visits was significantly smaller for generalists compared to subspecialists, indicating a growing demand for specialists.

Conclusions:

• Increased visits to specialists were not associated with a decrease in visits to generalists.
• Primary care physicians continue to manage a significant and growing proportion of pediatric visits for common conditions.