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

OBJECTIVE: To assess whether primary care physicians, via referrals or other mechanisms, are now providing proportionally less care for children with specific common diagnoses, thus driving greater demand for specialist services. STUDY DESIGN: Secondary data analysis (1993-2001) from one of the largest commercial healthcare organizations in the United States. Evaluation and management (E/M) common procedural terminology (CPT) visit codes and International Classification of Diseases (ICD) codes pertaining to asthma, constipation, headache, and heart murmurs were selected. Visits were then assigned to the specialty of physician providing care. Significant differences between and among categories of physicians were tested using logistic regression. RESULTS: Overall, pediatrician generalists and specialists provided a greater proportion of E/M visits to children in 2001 than in 1993, compared with nonpediatrician providers. However, although the absolute increase in the proportion of all E/M visits by children <18 years of age to pediatrician generalists was greater than that of pediatrician subspecialists (4.77% vs 0.69%; P <.0001), the relative increase was much smaller for the generalists (8.9% vs 19.7%; P <.0001). Findings were consistent for most of the specific diagnoses examined. CONCLUSIONS: The increases in both the proportion and number of visits made to specialists has not been accompanied by a decrease in visits to generalists.

Relation of per capita income and gross domestic product to the supply and distribution of pediatricians in the United States.

OBJECTIVE: To describe the number and distribution of pediatricians per child nationally and on a state-by-state basis relative to the economic conditions within each state. STUDY DESIGN: Real inflation-adjusted gross domestic product (GDP) per capita (1996 dollars) was plotted against the number of all active physicians and pediatricians in the United States for all years data were available. GDP was then compared with the active number of pediatric medical physicians per child 0 to 14 years of age. RESULTS: The number of pediatricians per 100000 children has more than doubled, from 49.8 to 106.2. Since 1929, the growth in the total number of physicians per capita in the United States has followed a linear relation (r(2)=0.977) with per capita national GDP. This relation is consistent with that specifically for all pediatricians as well (r(2)=0.980) for the years in which data are available (1963 to 2000). There is an extremely uneven distribution of pediatricians. Income differences only partially explain this maldistribution. CONCLUSIONS: There has been a marked increase in the number of pediatricians relative to the number of children in the United States, correlating strongly with the rise in per capita GDP. However, there has been a furthering of their uneven distribution across the United States.

Predicting the pediatric workforce: use of trend analysis.

OBJECTIVE: To develop a predictive model for projecting the pediatric workforce and retrospectively test its accuracy at different points in time over the past several decades. METHODS: We applied a modified version of the physician workforce trend model developed by Cooper et al. We first analyzed and tested the relationship between economic activity and the number of active pediatric medical physicians for several periods from 1963 to 2000. To project economic activity and population changes in the United States, we conducted linear trend analyses by using the available historical data through the year before the forecast period of interest. RESULTS: There has been significant growth of the absolute numbers of the pediatrician workforce over the past several decades. There was a strong correlation (R2=.98) of gross domestic product per capita (using 1996 dollars) with the number of active pediatricians (generalists and specialists) per 100,000 children in the United States by year over a 37-year period from 1963 to 2000. Predictions of pediatrician supply using historical census and economic data to inform the trend analysis were also very highly correlated with actual supply. CONCLUSIONS: The methods used in this study to predict the pediatric workforce were very accurate and consistent over a 37-year period.