VANCOUVER, B.C. — Family physicians provide ambulatory care to a higher proportion of disadvantaged adults than do other specialists, including general internists, according to a study presented at the annual meeting of the North American Primary Care Research Group.
Dr. Robert Ferrer of the University of Texas Health Science Center, San Antonio, analyzed 2004 data from the Medical Expenditure Panel Survey of that year by comparing proportional access to physicians and midlevel practitioners by people disadvantaged by income, health insurance status, race or ethnicity, and rural or urban status. He presented his findings during a Distinguished Paper session at the meeting.
Adults with at least three markers of disadvantaged status received just under 46% of their ambulatory care from family physicians, said Dr. Ferrer, whereas adults with no markers of disadvantage received about 31% of their care from family physicians.
Family physicians provided a higher proportional level of care to poor, near-poor, low-income, and publicly insured patients than did general internists, surgical specialists, other medical specialists, nurse practitioners, or physician assistants.
Internists provided a higher proportion of care to blacks than did other specialists, which may be explained by the presence of major hospitals and residency programs in urban areas, noted Dr. Ferrer.
Midlevel providers, including physician assistants and nurse practitioners, followed by family physicians, provided the highest proportion of care to rural adults.
In addition, family physicians even provided a disproportionate share of care to poor, near-poor, and low- and medium-income children, compared with pediatricians or nurse practitioners.
Pediatricians saw many more children overall than did family physicians, but more than 30% of children with at least three markers of disadvantage saw a family physician for ambulatory care, compared with just under 17% of children with no markers of disadvantage.
“[FPs] are the only clinician group that does not demonstrate income disparities in access to care,” Dr. Ferrer concluded.