Pediatricians’ Growing Share of Pediatric Primary Care Office Visits, 1996‐2015

Tang, Suk‐fong S; Cull, William L; Olson, Lynn; Freed, Gary

Background: Previous research shows that pediatrician‐provided visits increased as a percent of all office visits for children from 1980‐2006. It is unknown if this trend has continued, or whether any changes vary by patient age.

Objective: Investigate potential changes in pediatrician share of primary care physician office visits made by children and young adults over the last 2 decades.

Design/Methods: Based on 20 years of nationally representative non‐hospital based primary care physician office visit data for patients through age 21 (N=88,358 unweighted visits) from the 1996‐2015 National Ambulatory Medical Care Survey, we compared the proportion of pediatrician‐provided visits by patient age over time using bivariate statistical analyses. A general linear model was used to test potential interaction effect between patient age and time trend.

Results: Pediatrician‐provided visits increased from 61.2% of all primary care office visits during 1996‐ 2000 to 73.8% during 2011‐15 (p < .01). Increases were found for all age groups (p < .01) and larger growth was observed for older patients (p < .01, based on general linear model), including increases from (a) 78.3% to 87.5% (relative change = +11.7%) for the age 0‐5 group, (b) 66.5% to 81.5% (+22.6%) for the age 6‐12 group, (c) 34.3% to 57.9% (+68.7%) for the age 13‐18 group, and (d) 4.2% to 11.4% for the age 19‐21 group (+169.1%). Mean age of visits to pediatricians rose from 4.9 to 5.9 years (p < .01) as a result. Average patient age of all primary care visits remained unchanged at 7.6 years (p > 0.1), suggesting that pediatricians’ higher average patient age was not explained by demographic shift in the pediatric patient population during the study period. Changes in pediatrician versus non‐pediatrician shares of visits are shown by patient age in Figure 1.

Conclusion(s): Overall, pediatricians’ share of primary care office visits continued to increase with larger relative growth for older patients. Changing patient demographics may create new demands on pediatricians, such as increasing workload associated with treating potentially more chronic and complex conditions of older patients over the recent 2 decades.