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The complex relationship between family-practice physicians and pediatricians continues to evolve as today’s families weigh strategies for kids’ care.
The choice of route to take for a child’s primary-care provider is a matter of both convenience and necessity for parents. From physicians’ point of view, it often lies in the gray area of overlap between doctors who care for the entire family and those who focus exclusively on children.

“Our motto is ‘from the cradle to the grave,’ so we see kids of all ages,” said Rachel Jones, MD, of St. Dominic’s Family Practice Associates in Clinton, and a graduate of the University of Chicago-Pritzker School of Medicine.

“I definitely think that more kids are coming to family-practice physicians for primary-care services, although to a certain extent it’s always been that way,” she said. “Particularly in rural places, you don’t have access to a lot of specialties, so family practice tends to be a lot broader.”

Among the reasons why parents choose to bring their children to a general practitioner, are accessibility and convenience, Jones said. Mothers, who tend to make the healthcare decisions for their families, may also feel more comfortable taking their children to the same physician they also see.

“It’s just easier, when you have a mom sick and the kids sick, not to have to go to two separate places,” Jones said.

The notion of treating families as a collective rather than as individuals can be a benefit to the physician as well. The advantage may be as simple as, when a child is sick, knowing what ailment the mother might also have had recently.

“For us, sometimes we’re taking care of three or four generations of people — grandma, aunts, the whole family ends up coming,” Jones said.

“When that’s the case, it’s easier to get a health history and to understand the belief system. I have a huge advantage if I’m taking care of the whole family.”
For a family practitioner serving as a primary-care doctor for children, the focus is on treating ailments like colds or the flu while also screening for more-serious diseases or developmental problems.

“Preventive care and wellness overall are really our strengths when it comes to kids,” Jones said. “My role is in recognizing when there’s something abnormal, and at that point directing the patient to more-specialized areas.”

That referral relationship is a key point of intersection today between pediatricians and family-practice doctors, said pediatrician John Gaudet, MD, of the Children’s Medical Group on the campus of Wesley Medical Center in Hattiesburg.

“Although both are primary-care and have to take a systems approach to the family, in some areas pediatricians act almost like specialists that function in a referral mode,” he said.

“They have patients referred to them from family practitioners. The patient may have an unusual condition that needs a workup, or a chronic illness that needs follow-up and coordination with multiple specialists.”

Family-practice physicians do get broad pediatric experience as part of their training, Gaudet said. He coordinated family-practice residents in their pediatrics rotations as chief resident at University of Mississippi Medical Center, where he served on the faculty prior to launching his Hattiesburg practice in 1998.

Although the referral relationship works fine in the case of many kids, those
with chronic conditions like asthma, obesity and diabetes should have a pediatrician as their primary-care doctor, said Gaudet, who is a fellow of the American Academy of Pediatrics.

“I think it’s very important for children who have a chronic illness that’s likely to result in hospitalization to have a pediatrician,” he said. “If they may need hospital care, it’s best that they have someone taking care of them who can also see them in the hospital.”

That dynamic has changed since Gaudet first came to Hattiesburg, he said. At that time, family-practice physicians were admitting patients of all ages to the hospital.

“Family practice has changed in its nature to more of an ambulatory or outpatient basis,” he said. “Pediatrics has meanwhile changed in nature to focus more on inpatient care and chronic-illness management.”

In the latter category, a pediatrician’s specialized focus on the developmental stages of the individual adds a further dimension to the treatment of issues like cystic fibrosis, muscular dystrophy, sickle-cell anemia and developmental delays.

The pediatrician also brings to bear additional training in developmental stages when it comes to well-child checks of adolescents, Gaudet said.

“That should be a fairly detailed visit covering all the physical, emotional, family and social issues they’re going to be dealing with,” he said, “in addition to sex, sexually transmitted diseases and alcohol and drug use.

“A well-trained pediatrician will be focusing on different aspects with a teen than one would with a 10-year-old.”

Although it’s common for pediatricians to stop seeing patients who are entering their teenage years, Gaudet chooses to take new patients all the way through age 21.

“I think there’s an erroneous notion that once your child gets big, he can go to a regular doctor,” Gaudet said.

“The changes and developmental stages continue even in an adolescent, who has
the body of an adult but still the mind of a child. I consider that process to go all the way through the development of the individual until adulthood — which, for all practical purposes, would be age 21.”

Although some teens may feel they’ve outgrown seeing a children’s doctor, pediatricians who have been practicing for many years are likely to have more teenage patients because they’ve grown up with that doctor, Gaudet said.

Some pediatricians in larger cities cater to teen’s sensitivities by providing a separate waiting room for them, he said, including a selection of magazines more suited to their tastes.



August 2008

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