Some reports have in fact shown that pediatric primary medicine physicians are not in short supply. But these have gotten lost among the
vast number of reports indicating an overall shortage.
Studies should focus more deeply on workforce issues and not overall numbers, Freed argues. For example, while there currently seems to be an
adequate number of pediatricians, there is a problem of geographic distribution and many areas in the United States are underserved.
Freed feels that rather than increasing quantity of physicians, more attention should be paid to quality of care. Financial support is needed to improve training in the quality of care that all primary care physicians provide.
A more serious issue in pediatrics is that residency programs at free standing children's hospitals receive limited support from Medicare
compared to training programs based in adult hospitals. This support is tenuous and relies on an annual appropriation separate from the federal
funding of internal medicine and family medicine residency training.
Primary care reimbursement is at the top of the list of issues in pediatrics that warrant revision and policy changes, particularly among physicians who care for large numbers of poor children.
Medicaid covers the vast majority of poor children and its rates are established on a state-by-state basis, not by national policy decisions.
Policy makers can't assume they've fixed the problem of reimbursement, if their policies don't trickle down to the state level, Freed says.
"Oversimplifying the nuances of the primary care workforce may result in policies and priorities at odds with needs," says Freed. "For pediatrics, it appears that a close to appropriate proportion of trainees continues to enter the primary care arena. However, the supply of physicians in all fields should be monitored closely."
Reference: JAMA, May 13, 2009 - Vol. 301, No. 18.
Back to HCB News