The National Commission on the Cost of Medical Care states that there should be an accelenation in the supply of family practice physicians as a cost-saving measure. According to the Commission, such an acceleration could be expected to contribute to the moderation of rising medical costs in two ways: (1) through the substitution of physicians who are trained in the delivery of primary care for more specialized physicians who are likely to provide more sophisticated and more expensive primary medical services and (2) through lower training costs for a given supply of physician manpower or, conversely, a larger supply for the same level of costs.
In recommending only family practice, the Commission acknowledges that primary care physicians include physicians in general/family practice, internal medicine, pediatrics, and obstetnics-gynecology. The Commission alleges, however, that a progressively larger proportion of physicians certified in pediatrics and internal medicine are entering subspecialty fields and are therefore trained to function as secondary and tertiary care rather than as primary care physicians
The American Academy of Pediatrics submits that the statements, rationale, and recommendations ions are not substantiated by available data. A survey1 of all pediatricians in the United States conducted by the Harvard School of Public Health in 1969 reported that four out of five pediatric practitioners reported no subspecialization practice. Only 3% of the practitioners restricted their practice to a subspecialty, while 17% combined comprehensive (general) pediatric practice with a subspecialty interest. These proportions varied only slightly by region and size of community; there were somewhat more pediatrcians providing comprehensive (general) child health care in smaller communities and somewhat fewer in the Western region.
- Copyright © 1979 by the American Academy of Pediatrics