Starting in roughly 1990, U.S. family medicine physicians increasingly lost infants, children, and adolescents from their practices, giving the demographic up to general-practice pediatricians, Dr. Gary L. Freed reported last week at the Eastern Society for Pediatric Research. Dr. Freed is a pediatrician whose research centers on health management and policy, and the major spin he had on his findings, drawn from data collected annually by the National Ambulatory Medical Care Survey, centered on the implications for pediatricians: an increased share of the pediatric “market,” leading to increased demands on the pediatrician workforce.
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But Dr. Freed also acknowledged the profound implications of this shift for family practice: “Family medicine is rapidly becoming a primary care specialty for adults,” he noted. “It’s a big issue for family medicine, for training and for care.” In other words, the whole concept of family practice as a cradle-to-grave discipline, geared to caring for every member of the extended family from neonate to great-grandparent, with pregnancy tossed in, seems headed for extinction in America. And this trajectory for a venerable form of medical practice is mostly beyond the control of family physicians themselves. The fate of their practice is being dictated by the general public as they decide who will deliver their medical care.