martes, 20 de enero de 2015

En todas partes cuecen habas. También en Usa exist

En todas partes cuecen habas. También en Usa existe la dicotomia medico de familia /pediatra en la atencion a los niños de forma ambulatoria es el medico de familia.

Medscape Family Medicine
Are Family Physicians Caring for the Whole Family?
Laurie Scudder, DNP, NP, Scott A. Shipman, MD, MPHDisclosures
January 15, 2015
6 comments
PrintEmail
Introduction
Is Reimbursement a Factor?
Caring for the Elderly
References
EDITORS' RECOMMENDATIONS
Family Physicians Launch Initiative to Promote Primary Care
Fewer Family Physicians Treating Children
Care From Family Physicians Reported by Pregnant Women
Editor's Note: A recent family physician workforce analysis[1] of data collected by the American Board of Family Medicine confirmed a trend, first documented in the 1990s, of decreasing numbers of family physicians providing care for children. Family physicians overall reported spending about 10% of their time in caring for children. This decline in the proportion of family physicians caring for children was consistent across multiple demographic characteristics, although the percentage varied among physicians of different ages and by practice type and location. Medscape spoke with study coauthor Scott A. Shipman, MD, MPH, an assistant professor of pediatrics and community and family medicine at Dartmouth University and director of primary care initiatives and workforce analysis at the Association of American Medical Colleges, about the results and the implications for family medicine.

Medscape: Could you review this trend of decreasing pediatric care by family medicine physicians? When was this trend first noted? Is there any evidence that this trend is accelerating? Your data are through 2009; is there any evidence this trend is continuing?

Dr Shipman: The robust data collected by the American Board of Family Medicine in the recertification process provides really rich information about the self-reported practice patterns of family physicians. The first data point that studied this trend was the turn of the century, in 2000, and we have seen a steady trend since then demonstrating a decrease in family doctors' participation in caring for children.[2,3]


It is important to emphasize that for this study, the determination of whether an individual family physician provided care to children was binomial: Either they provided none, or they provided some. We didn't look at how much care they say they provide. There are a variety of reasons for that, some methodological and some tied to the fact that this is self-reported information. We felt that this was the most appropriate way to dichotomize the data we had.

You can look at it from a few different perspectives. For instance, there is a national survey, the National Ambulatory Medical Care Survey, which looks at and reports on visits by children and allows us to see the proportion of all children's visits to physicians that are performed by family physicians. That answers a slightly different question than the one we looked at, which was from the family physicians' perspective and asked: Are you still providing any care to children?

Medscape: Your study examined factors that correlated with a likelihood of a family physician delivering services to children. Can you discuss those factors?


Dr Shipman: Our study examined data first reported in 2012[2] to tease out factors associated with whether a family physician provides care to children or not.

It probably is easiest to think of these in two categories: as physician characteristics and area characteristics. The physician characteristics that we found to be predictive of being more likely to provide care to children were younger age, being female, and being a US medical graduate.

I suspect that the reason younger physicians are more likely than older physicians to care for children is, in some part at least, due to the natural aging of a patient population that occurs along with the aging of an individual provider as they go through their years of practice. It is very common for a physician, whether a family physician or anyone else, to have their patient population age as they age: That is, they stop taking on new, younger patients and allow their younger partners to take on those patients as their practice fills, and they have a stable population over time. So that is my suspicion about why the younger physicians are more likely to care for kids.

The issue of women being more likely to care for children is interesting. Again, I can only speculate as to why that is. We do see in the field of pediatrics, and general pediatrics particularly, that nearly three out of four residents today are women. It may be some of the same factors that draw women into pediatrics are also drawing female family physicians into caring for kids, independent of their age and other factors.

In terms of area characteristics that are predictive of family doctors being more or less likely to care for kids, some may be intuitive—but the associations are pretty strong, and we need to think about the implications of these.

Areas where children make up a higher percentage of the overall population had a somewhat higher likelihood of family doctors providing care to kids. If there are more kids around, family doctors are more likely to provide care for them.

Similarly, if there are fewer pediatricians in a healthcare market, family doctors were more likely to provide care for kids. This one was really strong. Compared with geographic areas that had the highest per capita supply of pediatricians, family physicians practicing in areas with no pediatricians were 80% more likely to provide care to kids. So a really strong predictor of whether a family doctor provides care to kids seems to be related to how many pediatricians are in that same geographic region.

Finally, independent of those factors, there are some interesting regional differences. In some areas of the country, such as the South, family physicians were much less likely to provide care to children. Why that is independent of the population, the supply of pediatricians, and all the other factors about individual physicians is unexplained so far. I don't know what the answer to that is, but it was significant.



Enviado desde mi iPad

No hay comentarios:

Publicar un comentario en la entrada

Danos tu opinion, enriquece el post.