Pediatric Care Isn’t Free, But it Is a Bargain
I would not trade being a pediatrician for anything, because there is no better way to make a difference in the lives of children and families. Yet, like many physicians in the U.S., I struggle with the business of medicine—the complications involved in getting paid for doing what we love to do—serve patients.
Primary care providers in particular—internists, family practitioners, and pediatricians—have seen their inflation-adjusted incomes erode over recent years, and most are not in the upper income brackets that many Americans associate with physicians.
Comprehensive pediatric care remains one of the biggest healthcare values around, but I am concerned about how long we can go on providing this excellent care in the current healthcare environment.
Many pediatricians across the country administer vaccines to children at no profit, and often at a loss, because they know how important immunizations are to America’s health. This is not fair and probably not workable in the long term, and we are looking for ways to improve payment for this service. Pediatricians cannot continue subsidizing the nation’s health for much longer.
Pediatricians also provide the full spectrum of preventive, or “well child” care, including developmental screenings, tests for infectious diseases, and consultations, usually at a very low out-of-pocket cost to the patient. This also is a bargain for insurance companies, because good well-child care prevents a host of potential illnesses and injuries that could be costly.
Changing healthcare venues and business models, paired with consumers’ interest in convenience, have recently contributed to fragmentation of care. Children may be taken to one place for their vaccines, another for their sport physicals, and yet another with an earache or sprain. Healthcare businesses in strip malls and discount marts are promoting the idea that minor problems should be taken care of in the corner of a drugstore, and pediatricians need only be used for chronic health conditions.
This is not conducive to follow-up of treatment, and it is counter to the comprehensive, continuous care that is optimal not only for the individual child, but for the public health of this nation. Sadly, it also doesn’t work as a business model for pediatricians, many of whom are struggling to maintain a profit.
It’s time to look at this nation’s payment practices and business regulation with an eye to the survival of children’s best advocates in healthcare—pediatricians. We want to be here for our patients for a long time.