Background: In 1976, to provide access to modern treatment for children with cancer in a rural setting, a system was designed to divide treatment responsibilities between university-based pediatric oncologists and community-based primary care physicians. Under this system, the diagnosis and assignment to a treatment regimen is carried out at the university while community-based physicians delivery over 75% of the chemotherapy. Because managed care limits access to subspecialists and reduces the flexibility for collaboration between subspecialists and primary care physicians, assessment of the shared management system was undertaken.

Methods: Ninty-seven of 137 physicians who participated in the system during the past 15 years responded to a questionnaire.

Results: Analysis of the responses show that primary care physicians believe shared management is of economic and psychosocial benefit to their patients, improves the treatment choices available to their patients, does not require excessive time, nor result in loss of practice income. The system strengthens their relationship with university-based subspecialists and results in additional referrals to the university. It is of educational value, is personally satisfying, and provides relief from the stress associated with caring for these families. Primary care physicians, particularly pediatricians, would like to see this system expanded to include other children with special health care needs.

Conclusion: The shared management system is a viable, attractive option in health care delivery for children in a managed care environment. The subspecialist should assume the role of gatekeeper, but transfer much of the care to primary care providers.