1. COMMON INTEREST BREAKFAST DISCUSSION:
PEDIATRICS IN FAMILY MEDICINE: IS IT TIME TO RE-EXAMINE OUR ROLE?
Valerie F. Pietry, MD, MS
Assistant Professor of Family and Community Medicine
UMass Medical School Dept. of Family Medicine and Community Health
Worcester, MA
Family physicians and pediatricians provide primary care to children and adolescents,
sharing an emphasis on generalism and the medical home concept. What distinguishes the
family physician’s contribution to pediatric primary care from that of the pediatrician?
What are the attributes of Family Medicine, unique to our discipline, that allow us to offer
families with children a competitive “basket of services”? What should define the limits of
our expertise, and the nature of our collaboration with pediatricians? How does this impact
residency curriculum? And finally, are there directions in pediatric care, such as
Developmental/Behavioral Pediatrics, in which Family Medicine might expand its
expertise and credibility by means of fellowship training experiences, to enhance the
appropriateness of our specialty’s “fit” to the needs of families with children in today’s
health care environment? This breakfast discussion will provide a forum for sharing
perspectives in response to these questions. Participants of all disciplines are welcome.

2. COMMON INTEREST BREAKFAST DISCUSSION
PEDIATRICS IN FAMILY MEDICINE: IS IT TIME TO RE-EXAMINE OUR ROLE?
10/28/06
Valerie F. Pietry, MD, MS
Assistant Professor of Family and Community Medicine
UMass Medical School Dept. of Family Medicine and Community Health
Worcester, MA
Valerie.PietryFHCW@umassmed.edu
Background:
1) Trends:
a. Family physicians provide 16% - 26% of medical visits for children
b. Ambulatory visits by children to FPs have decreased by ~25% in the past 10
years, while visits to pediatricians have increase by 20%
c. Workforce of pediatricians has more than doubled in the past 25 years
d. Family physician workforce grew by 60% in the same time frame
e. Birth rate has declined by 11% in same 25 years
f. Market share of care to children by FPs 1992 – 2002:
Age 1992 2002
0–4 30% 13%
5 – 13 27% 15%
14 – 17 30% 21%
g. Prevalence of special health care needs ~13% of children under age 18
h. Medical home model in both Family Medicine and Pediatrics
2) Needs:
a. Underserved areas
b. Rural areas
c. Mental health
d. Chronic care of children, youth and adults with special health care
needs/disabilities
e. Transition care for same
3) Attributes of Family Medicine
a. Family systems
b. Continuous transition of care from adolescence to adulthood
c. Care for parents as well as their kids
d. Evidence-based care
4) Opportunities:
a. Developmental/behavioral pediatrics

3. i. Developmental screening
ii. ADHD and common behavioral problems
iii. Coordination of care
b. School-based health centers
c. Adolescent health
d. Sports medicine
e. Mental health
f. Individuals with disabilities, including transition care
g. Building a medical home
Discussion questions:
1) How accurately do the trends above reflect your practice setting? Are residency
training programs a case unto themselves, due to educational requirements?
2) Do you agree with any of the options as outlined in the article? Which? Are there
other options that come to mind?
3) What distinguishes the family physician’s contribution to pediatric primary care
from that of the pediatrician?
4) What are the attributes of Family Medicine, unique to our discipline, that allow us
to offer families with children a competitive “basket of services”?
5) What should define the limits of our expertise, and the nature of our collaboration
with pediatricians? How does this impact residency curriculum?
6) Are there directions in pediatric care, such as Developmental/Behavioral Pediatrics,
or children with special health care needs, in which Family Medicine might expand
its expertise and credibility by means of fellowship training experiences, to enhance
the appropriateness of our specialty’s “fit” to the needs of families with children in
today’s health care environment? How might these extend into the adult age range?

4. REFERENCES
Backer, LA. Caring for children: re-examining the family physician’s role. Family
Practice Management, July/August 2005.
Champlin, L. FPs bring needed skill to care of children with disabilities. AAFP News
Now, 2: 7, July 2006.
Council on Children with Disabilities. Identifying infants and young children with
developmental disorders in the medical home: an algorithm for developmental surveillance
and screening. Pediatrics 118: 1, July 2006.
Graham Center One-Pager. The diminishing role of FPs in caring for children. American
Family Physician 73: 9, May 1, 2006.
Phillips, RL et al. Family physicians in the child health care workforce: opportunities for
collaboration in improving the health of children. Pediatrics 118: 3, September 2006.
www.cdc.gov/healtyyouth/index.htm
www.cdc.gov/ncbddd/child/screen_provider.htm
www.dbpeds.org