FROM INFANTS TO TEENS: GENERAL PEDIATRICIANS PROVIDED PRIMARY CARE FOR MORE CHILDREN FROM 1991 TO 2000 Suk-fong Tang, Lynn Olson, William Cull, Beth Yudkowsky. Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL.

BACKGROUND: Historically, most office visits to general pediatricians have been made by infants and young children, while non-pediatrician primary care physicians provided the bulk of care to adolescents. However, with the expansion of the pediatric workforce and increased emphasis on preventive care , general pediatricians may have a larger role in providing care to older children and adolescents.

OBJECTIVE: To examine trends (1991-2000) in general pediatricians? share of child visits by (1) nature of visit (sick vs well care) and (2) patient age.

DESIGN/METHODS: Analysis of the National Ambulatory Medical Care Surveys, 1991-2000. 33,570 records were weighted to represent office visits to primary care physicians by US children through age 18.

RESULTS: Increases were found in general pediatricians? share of both sick and well child visits, with some variation in magnitude across age groups. From 1991 to 2000, well-child visits to general pediatricians increased from 14.6% to 20.5% of total child visits to primary care physicians (p <.01). This increase was attributed to visits by children through age 11 (p <.01 for ages 0 through 5; p = .05 for ages 6 through 11). Also, general pediatricians? share of total child visits (sick and well care) to primary care physicians increased from an estimated 61.7% in 1991 to 68.0% in 2000 (p <.01), with gains observed across all age groups. From 1991 to 2000, general pediatricians? share of total visits to primary care physicians by children through age 5 increased from 72.1% to 80.2% (p <.01). Their share of visits from children ages 6 through 11 increased from 63.3% to 70.4% (p <.05). General pediatricians? share of visits from adolescents (ages 12 through 18) also increased, from 32.3% to 38.5% (p <.05) during the 10-year study period.

CONCLUSIONS: Pediatricians are providing primary care for a growing proportion of US Children. This shift includes more preventive care and more adolescent patients which may increase the demand for some services, for example for more counseling and treatment of psychosocial and behavioral conditions. These trends have both clinical and financial implications and should inform (1) payors and providers of pediatric services, and (2) the development of educational and research initiatives for pediatricians.