Characteristics of medicine-pediatrics practices: results from the national ambulatory medical care survey.
BACKGROUND
Combined medicine-pediatrics (med-peds) training has existed for 40 years, yet little is known about national med-peds practices. A more comprehensive understanding of med-peds practices is important to inform medical students and guide evolving curricula and accreditation standards.


METHODS
The authors used data from the National Ambulatory Medical Care Survey from 2000 to 2006 to characterize the age distribution and types of visits seen by med-peds, internal medicine, pediatric, and family physicians.


RESULTS
Forty-three percent of visits to med-peds physicians were from children < or = 18 years of age. Compared with family physicians, med-peds physicians saw a higher proportion of infants and toddlers < or = 2 years of age (21.0% versus 3.7%; P = .002) and children < or = 18 years of age (42.9% versus 15.5%; P = .002), but they treated fewer adults age 65 or older (13.8% versus 21.3%; P = .013). Compared with internists, med-peds physicians saw a greater percentage of visits from adults 19 to 64 years of age (75.8% versus 61.2%) and fewer visits from patients age 65 or older (24.2% versus 38.8%; P = .006). Med-peds physicians, like family physicians and pediatricians, most commonly treated patients for acute problems and reported high levels of continuity of care for patients-pediatric (93.6%) and adult (94.6%).


CONCLUSIONS
Med-peds physicians care for a considerable proportion of pediatric patients while maintaining high levels of continuity of care for adult and pediatric patients. Within their practices, med-peds physicians treat a larger percentage of pediatric patients than do family physicians, but they see a smaller percentage of elderly patients.
Fortuna
Robert J
RJ
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA. rfortuna@post.harvard.edu
Ting
David Y
DY
Kaelber
David C
DC
Simon
Steven R
SR
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D002675:Child, Preschool; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007388:Internal Medicine / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010372:Pediatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011364:Professional Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult