A Jacobian Future: Can Everyone Have a Medical Home?

Abstract

Abraham Jacobi and the other founders of pediatrics in the United States established pediatrics as a primary care specialty by providing well-child visits with health screenings and immunizations. This course differed from that taken in Europe where children received their primary care from general practitioners, and pediatricians were consultants. Thus, there has been an uneasy relationship between pediatrics and family medicine in which both are competitors and partners in the care of children and adolescents. Phillips et al1 now bring a challenge to the pediatric community regarding the future of health care for children and adolescents. The growth in the number of general pediatricians will greatly exceed the growth of the pediatric population by 2020.2 This growth is likely to exceed published measures of sufficiency,3 and there are signs of decreasing demand for general pediatricians.4 In addition, pediatrics has recognized the importance of caring for families to improve child health,5 potentially leading to a collision course with family medicine. The increasing number of general pediatricians has led to a decrease in the percentage of pediatric visits performed by family physicians since 1980.6 Family physicians, however, still provide approximately one fifth of pediatric-age office visits, with one third of rural visits and one quarter of adolescent visits. More than 5 million children and adolescents currently live in a county without a pediatrician, and many rural areas cannot support a pediatric practice. In addition, family physicians provide care for many uninsured or publicly insured children and disproportionately staff safety-net facilities such as community health centers. Thus, family physicians play a critical role in the care of children and adolescents in the United States. From the perspective of family medicine, Phillips et al present 4 responses to the growing number of general pediatricians and family physicians relative … Address correspondence to Richard J. Pan, MD, MPH, Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd, Sacramento, CA 95817. E-mail: richard.pan{at}ucdmc.ucdavis.edu