Primary care pediatricians' satisfaction with subspecialty care, perceived supply, and barriers to care.
OBJECTIVE
To compare satisfaction with specialty care by primary care pediatricians (PCPs), perceived barriers to care, and adequacy of specialist supply.


METHODS
A survey of U.S. pediatricians was conducted in 2007. PCPs were asked about satisfaction with specialty care for their patients, as well as supply of specific pediatric subspecialists. Responses of rural and nonrural PCPs were compared regarding 10 potential barriers to care.


RESULTS
Most PCPs are satisfied with the quality of subspecialty care. However, they were not satisfied with wait times for appointments, and the availability of many pediatric medical subspecialties and several pediatric surgical specialties. Rural PCPs were significantly more likely to report these shortages compared with nonrural pediatricians; these included 9 of the 18 medical and 5 of the 7 surgical specialties. In addition to wait times for appointments, PCPs reported that subspecialists' nonparticipation in health insurance plans and lack of acceptance of uninsured patients were also barriers to obtaining subspecialty care for their patients.


CONCLUSIONS
PCPs provide valuable insight into access to the pediatric subspecialty workforce. This survey of PCPs raises significant concerns about the adequacy of children's access to pediatric subspecialists, especially in rural communities.
Department of Pediatrics, UMDNJ - New Jersey Medical School, Newark, NJ. Electronic address: pletchba@umdnj.edu.
Beth A
BA
Pletcher
Department of Pediatrics, University of Arizona, Tucson, AZ.
Mary Ellen
ME
Rimsza
Department of Research, American Academy of Pediatrics, Elk Grove Village, IL.
William L
WL
Cull
Department of Pediatrics, Dartmouth Medical School, Lebanon, NH.
Scott A
SA
Shipman
Department of Pediatrics, University of Washington, Seattle, WA.
Richard P
RP
Shugerman
Department of Research, American Academy of Pediatrics, Elk Grove Village, IL.
Karen G
KG
O'Connor
D001291:Attitude of Health Personnel; D002648:Child; D003625:Data Collection; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000592:standards / Q000706:statistics & numerical data*; D010820:Physicians / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000600:supply & distribution; D013038:Specialization / Q000706:statistics & numerical data*; D014481:United States; D014850:Waiting Lists