Should Our Well-Child Care System Be Redesigned? A National Survey of Pediatricians

Tumaini Coker, MD, MBAa,b, Lawrence P. Casalino, MD, PhDa,c, G. Caleb Alexander, MD, MSa,d,e and John Lantos, MDa,b,d
OBJECTIVE. The goal was to examine pediatricians' views about whether and how well-child care for children 0 to 5 years of age should be changed.
METHODS. A mail survey of a national random sample of 1000 general pediatricians was performed with a survey instrument that examined pediatricians' attitudes and behaviors toward our current way and an ideal way of providing well-child care. Results were analyzed for the following 3 major domains of change in well-child care: provider type, visit format, and visit location.
RESULTS. Sixty percent (n = 502) of eligible subjects responded to the survey. Nearly all respondents (97%) rated the current US system as excellent or good in providing well-child care. Most pediatricians (85%–91%) reported that they are currently the main providers of anticipatory guidance, developmental screening, and psychosocial screening. However, a majority (54%–60%) reported that, in an ideal system that maximized the effectiveness and efficiency of care, nonphysicians would provide these services. Fewer pediatricians (24%) reported that ideally nonphysicians should provide the physical examination. The majority of respondents (79%–93%) reported that at least some anticipatory guidance, minor acute care, and chronic care services could be conducted through telephone or e-mail communication, and 55% stated that at least some well-child care services should be provided in alternative locations, such as day care centers. In multivariate analysis, support for these changes was distributed widely across pediatricians with varying personal and practice characteristics.
CONCLUSIONS. Although most pediatricians are generally satisfied with our current way of providing well-child care, a majority think that a system that is less reliant on physicians and face-to-face office visits would be a more effective and efficient way to provide care.