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Pediatricians are plentiful, but not in poorer states

America's children have many more pediatricians available to treat them today than they did 25 years ago, a study finds, but the doctors aren't always where the children are. The wealthier the state, the more pediatricians there are for that state's children—and the reverse is true for kids in poorer states.

With a majority of parents choosing a pediatrician rather than a family doctor for their children's general primary care, and more children seeing specially trained pediatric specialists for diseases such as asthma, diabetes and cancer, the new findings have major implications for access to care among children in poorer states.

In a paper published in the June issue of the Journal of Pediatrics, a team led by a
U-M Health System researcher reports that the number of pediatricians in the United States rose by 140 percent between 1978 and 2000, while the number of children ages 14 and younger rose more slowly. As a result, the number of pediatricians per 100,000 children ages 14 and younger more than doubled in that period, from 49.8 to 106.2 pediatricians.

"American children have greater access to pediatricians and pediatric sub-specialists than ever before," says Dr. Gary Freed, the U-M pediatrician who led the study for the research advisory committee of the American Board of Pediatrics (ABP). "The demand for care is there, as we've shown in previous research, and it appears that the growing number of physicians is better at meeting that demand."

But when the researchers mapped the number of pediatricians per 100,000 children in each state, they noticed a stark trend: as many as 165 pediatricians per 100,000 children in some states, and concentrations as low as 28 pediatricians per 100,000 children in others.

Then, they compared those concentrations with each state's personal per capita income, in constant dollars. In 1980, they found, there was some association between income and pediatrician supply, but the effect was much stronger in 2000.

In other words, in 20 years the supply of pediatricians may have doubled, but they became far more concentrated in wealthier states than in poorer ones.

"Better economic opportunities in some states may create a draw for physicians, but we need to make sure that society provides incentives for physicians to locate and practice in areas that may offer less economic opportunity," says Freed, who leads the Child Health Evaluation and Research group in the Department of Pediatrics and Communicable Diseases and C.S. Mott Children's Hospital.

For instance, he says, the study might be useful to policymakers who could provide incentives and opportunities for pediatricians and other health professionals to operate in shortage areas, or protect existing programs from funding changes.

The study found that Massachusetts has the highest concentration of pediatricians per 100,000 children, at 165. The plains and western states, except California, had the lowest concentrations, with Idaho (28) at the bottom.

In 2001, the U-M team won the contract to lead pediatrician workforce supply research for the ABP, which examines and certifies doctors who specialize in the care of children from birth to adolescence. This study is the latest in a series of papers stemming from that research.

Earlier this year, the team published a paper in the Archives of Pediatric and Adolescent Medicine showing that a growing majority of non-surgical doctor's office visits by American children are with pediatricians (64 percent) and that the percentage of visits to family physicians, who treat both adults and children, is declining. Other studies have found differences between pediatricians and family physicians in patterns of vaccination, infection care, asthma care, depression care and other practices.

In addition to Freed, the study's authors include Tammie Nahra and John Wheeler.

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