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Research ArticleOriginal Research

A Cross-Sectional Study of Factors Associated With Pediatric Scope of Care in Family Medicine

Anuradha Jetty, Max J. Romano, Yalda Jabbarpour, Stephen Petterson and Andrew Bazemore
The Journal of the American Board of Family Medicine January 2021, 34 (1) 196-207; DOI: https://doi.org/10.3122/jabfm.2021.01.200300
Anuradha Jetty
From the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC (AJ, MJR, YJ, SP, AB); Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, Baltimore, MD (MJR); American Board of Family Medicine, Lexington, KY (AB).
MPH
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Max J. Romano
From the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC (AJ, MJR, YJ, SP, AB); Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, Baltimore, MD (MJR); American Board of Family Medicine, Lexington, KY (AB).
MD, MPH
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Yalda Jabbarpour
From the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC (AJ, MJR, YJ, SP, AB); Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, Baltimore, MD (MJR); American Board of Family Medicine, Lexington, KY (AB).
MD
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Stephen Petterson
From the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC (AJ, MJR, YJ, SP, AB); Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, Baltimore, MD (MJR); American Board of Family Medicine, Lexington, KY (AB).
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Andrew Bazemore
From the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, Washington, DC (AJ, MJR, YJ, SP, AB); Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, Baltimore, MD (MJR); American Board of Family Medicine, Lexington, KY (AB).
MD, MPH
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    Study flow diagram showing the analysis sample: American Board of Family Medicine (ABFM) Certification examination practice demographic questionnaire data (2017 to 2018). Lack of exact match between the National Provider Identifier (NPI) and physician’s identification number from the American Medical Association (AMA) because some physicians do not have an NPI or may have changed last name (n = 1477).

  • Figure 2.
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    Figure 2.

    A, Factors associated with family physicians’ provision of care to children (≤ 18 years): ABFM certification examination demographic questionnaire data (2017 to 2018) (n = 11,674). B, Factors associated with family physicians’ provision of care to children (< 5 years and 5 to 18 years): ABFM certification examination demographic questionnaire data (2017 to 2018) (n = 11,674). Adjusted odds ratios from multivariate logistic regression examining association between demographic and practice characteristics of family physicians and likelihood of providing care to children under 18 years of age (A), under 5 years of age and 5 to 18 years of age (B). ABFM, American Board of Family Medicine; HMO, health maintenance organization; IMG, international medical graduate; USMG, United States medical graduate; MD, doctor of medicine; NH, non-Hispanic; ER/OP, emergency room or outpatient facility; FPL, federal poverty level.

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    Figure 3.

    Percentage of family physicians registering for the ABFM certification examination who report caring for children under the age of 18 years, 2017 to 2018.

Tables

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    Table 1.

    Demographic Characteristics of Family Physicians Providing Care to Children (n = 11,674): American Board of Family Medicine Certification Examination Practice Demographic Questionnaire Data (2017 to 2018)

    CharacteristicsDemographicsCare of Children
    ≤ 18 YearsP-Value< 5 YearsP-Value5 to 18 YearsP-Value
    n%n%n%n%
    Gender
     Female509443.6418382.1< .001334165.6< .001417481.9< .001
     Male658056.4556184.5452768.8555384.4
    Age in years
     < 39141912.1123386.9< .001105674.4< .001123286.8< .001
     40 to 49431437.0363284.2293968.1362484.0
     50 to 59393633.7326082.8260666.2325582.7
     60+200517.2161980.7126763.2161680.6
    Location of medical school
     International medical graduate120010.393678.0< .00169459.0< .00193477.8< .001
     United States medical graduate10,47489.7880884.1717469.2879384.0
    Type of medical degree
     Osteopath11469.899787.0< .00181370.9.00699686.9< .001
     MD10,52890.2874783.1705567.0873182.9
    Race/ethnicity
     Non-Hispanic, White829671.1710285.6< .001594471.6< .001709385.5< .001
     Non-Hispanic, Black5474.743980.331056.743779.9
     Asian160513.7125077.988154.9124677.6
     Non-Hispanic, Other5324.643181.033262.443080.8
     Hispanic6945.952275.240157.852175.1
    • View popup
    Table 2.

    Characteristics of Practice and Geographic Areas Served by Family Physicians Providing Care to Children (n=11,674): American Board of Family Medicine Certification Examination Practice Demographic Questionnaire Data (2017-2018)

    CharacteristicsPractice & Geographic CharacteristicsCare of Children
    ≤ 18 YearsUnder 5 Years5 to 18 years
    n%n%P-Valuen%P-Valuen%P-Value
    Census region
     South379932.5305280.3< .001220258.0< .001304780.2< .001
     Northeast169914.6140082.4114067.1140082.4
     West308926.5254782.5203265.8254082.2
     Midwest308726.5274588.9249480.8274088.8
    Practice size
     Solo142112.2115481.2< .00179055.6< .001115281.1< .001
     Small396233.9337485.2270868.3337085.1
     Medium364731.2313185.9269173.8312585.7
     Large264422.7208578.9167963.5208078.7
    Practice organization*
     Independently owned391033.5347388.8< .001271069.3< .001347188.8< .001
     Safety-net117510.199985.087974.899784.9
     Health Maintenance Organization6785.848471.432848.448371.2
     Academic7016.060786.653676.560486.2
     Hospital-owned413735.4369889.4309774.9369189.2
     Other10739.248345.031829.648144.8
    Rurality of location
     Rural196316.8177990.6< .001161282.1< .001177790.5< .001
     Urban971183.2796582.0625664.4795081.9
    Language of care delivery
     English801268.6667683.3.534544968.0.038666883.2.672
     Other Language366231.4306883.8241966.1305983.5
    Poverty status
     Percent population earning < 200% of federal poverty Level (top quintile)225219.3188683.7.690152367.6.795188183.5.773
    Percent census tract population < 18 years
     Tertile I (0.01-22.3)387119.480.8< .00162.5< .00180.6< .001
     Tertile II (22.3-25.1)389023.784.570.284.4
     Tertile III (25.1-42.0)391327.885.069.784.9
    Pediatricians per 3000 children
     Quintile IA (0)129882.2< .00177.3< .00182.1< .001
     Quintile IB (0.09-0.73)146774.664.374.4
     Quintile II (0.73-1.38)276773.460.273.3
     Quintile III (1.38-2.07)276370.756.370.6
     Quintile IV (2.07-3.32)276770.654.170.4
     Quintile V (3.33 to 59.8)276365.548.165.3
    Year of recertification
     2017622053.3524353.8.010424954.024523753.8.007
     2018545446.7450146.2361946449046.2
    • ↵* Practice organizations were collapsed into 6 categories from 11 responses on the survey. The “independently owned” category included respondents selecting “independently owned medical practice.” The “safety-net” category included federally qualified health centers or look-alikes; rural health clinics (federally qualified); Indian Health Service; and governmental non-federal clinics such as the state, county, city, maternal and child health and public health centers. The “managed care/HMO, health maintenance organization” category included managed care or HMO-owned clinics. The “academic” category included academic medical centers and faculty practices. The “hospital ER/OP, emergency room or outpatient facility” included all hospital or health system-owned medical practices, which excludes managed care or HMOs. The “other” category included federal (military, Veterans Administration/Department of Defense), workplace clinics, and other practice types not listed.

  • Appendix Table 1: Factors Associated with Family Physicians Provision of Care to Children

    CharacteristicsCare of Children
    < 5 Years, OR (95% CI)5 to 18 Years, OR (95% CI)≤ 18 Years, OR (95% CI)
    Gender
     Male
     Female0.92* (0.84-1.00)0.95 (0.85-1.06)0.95 (0.85-1.06)
    Age (years)
     < 39
     40 to 490.80‡ (0.69-0.92)0.84* (0.70-1.02)0.85 (0.71-1.03)
     50 to 590.66‡ (0.57-0.77)0.73‡ (0.60-0.88)0.73‡ (0.60-0.89)
     60 or over0.52‡ (0.44-0.62)0.56‡ (0.45-0.70)0.58‡ (0.46-0.70)
    Location of medical school
     USMG
     IMG0.73‡ (0.63-0.83)0.74‡ (0.63- 0.88)0.74‡ (0.63-0.87)
    Type of medical degree
     MD
     Osteopath0.97 (0.83-1.12)1.16 (0.95-1.41)1.16 (0.95-1.41)
    Race/ethnicity
     Non-Hispanic, White
     Non-Hispanic, Black0.74‡ (0.61-0.90)0.97 (0.76-1.24)0.99 (0.77-1.26)
     Asian0.53‡ (0.47-0.61)0.64‡ (0.55-0.75)0.65‡ (0.55-0.76)
     Non-Hispanic, other0.69‡ (0.569-0.849)0.75† (0.58-0.96)0.75† (0.58-0.96)
     Hispanic0.60‡ (0.50-0.73)0.51‡ (0.41-0.63)0.50‡ (0.40-0.62)
    Census region
     South
     Northeast1.57‡ (1.37-1.80)1.09 (0.92-1.29)1.08 (0.91-1.28)
     West1.65‡ (1.47-1.85)1.37‡ (1.18-1.58)1.38‡ (1.19-1.60)
     Midwest2.52‡ (2.23-2.85)1.52‡ (1.31-1.78)1.54‡ (1.32-1.80)
    Practice size
     Solo
     Small (2 to 5 providers)1.67‡ (1.45-1.93)1.48‡ (1.23-1.77)1.47‡ (1.22-1.77)
     Medium (6 to 20 providers)2.36‡ (2.02-2.75)1.81‡ (1.49-2.20)1.81‡ (1.49-2.20)
     Large (> 20 providers)1.72‡ (1.46-2.02)1.28† (1.04-1.56)1.27† (1.04-1.56)
     Rural
     Urban1.60‡ (1.38-1.85)1.39‡ (1.15-1.67)1.38‡ (1.15-1.67)
    Speaks second language
     No, speaks English
     Yes, Spanish/other1.33‡ (1.20-1.48)1.43‡ (1.25-1.63)1.45‡ (1.27-1.65)
    Practice organization
     Independently owned
     Safety-net0.80‡ (0.68-0.95)0.47‡ (0.38-0.58)0.48‡ (0.39-0.59)
     HMO0.38‡ (0.31-0.46)0.30‡ (0.24-0.38)0.30‡ (0.24-0.38)
     Academic1.320‡ (1.07-1.62)0.81 (0.62-1.04)0.83 (0.64-1.08)
     Hospital owned0.91 (0.82-1.02)0.82† (0.70-0.96)0.83† (0.71-0.97)
     Other0.16‡ (0.14-0.19)0.096‡ (0.08-0.11)0.096‡ (0.081-0.11)
    Poverty status of the PCSA of practice location
     Percent population < 200% FPL (top quintile)0.96 (0.86-1.08)0.94 (0.82-1.09)0.95 (0.83-1.10)
    Percent population < 18 years
     Tertile I
     Tertile II1.31‡ (1.18-1.4)1.087 (0.951-1.241)1.082 (0.947-1.237)
     Tertile III1.36‡ (1.21-1.52)1.14* (0.99-1.32)1.14* (0.99-1.31)
    Pediatrician density per 3000 children
     Quintile IA
     Quintile IB0.53‡ (0.42-0.68)0.57‡ (0.41-0.79)0.57‡ (0.41-0.79)
     Quintile II0.42‡ (0.34-0.53)0.51‡ (0.38-0.69)0.512‡ (0.38-0.69)
     Quintile III0.36‡ (0.29-0.45)0.45‡ (0.34-0.605)0.44‡ (0.33-0.60)
     Quintile IV0.34‡ (0.27-0.42)0.42‡ (0.31-0.57)0.42‡ (0.31-0.56)
     Quintile V0.26‡ (0.21-0.32)0.29‡ (0.21-0.39)0.29‡ (0.21-0.39)
     2017
     20180.92* (0.85-1.01)0.88† (0.79-0.98)0.89† (0.80-0.99)
     Constant3.62‡ (2.70-4.84)15.80‡ (10.78-23.15)15.73‡ (10.72-23.11)
     Observations11,67411,67411,674
    • OR, Odds Ratio; CI, Confidence Interval; MD; Doctor of Medicine; IMG, International Medical Graduate; USMG, United States Medical Graduate; HMO, Health Maintenance Organization; PCSA, Primary Care Service Area; FPL, Federal Poverty Level.

    • Source: 2017 and 2018 American Board of Family Physician Recertification Examination Application Survey.

    • ↵* P < .1.

    • ↵† P < .05.

    • ↵‡ P < .01.

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The Journal of the American Board of Family     Medicine: 34 (1)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 1
January/February 2021
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A Cross-Sectional Study of Factors Associated With Pediatric Scope of Care in Family Medicine
Anuradha Jetty, Max J. Romano, Yalda Jabbarpour, Stephen Petterson, Andrew Bazemore
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 196-207; DOI: 10.3122/jabfm.2021.01.200300

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A Cross-Sectional Study of Factors Associated With Pediatric Scope of Care in Family Medicine
Anuradha Jetty, Max J. Romano, Yalda Jabbarpour, Stephen Petterson, Andrew Bazemore
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 196-207; DOI: 10.3122/jabfm.2021.01.200300
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