Grapevyne’s Post

#Pediatrics is a profession that is fast becoming obsolete. #PrivateEquity replaces doctors in lower reimbursing fields, like pediatrics, with nurse practioners and physician assistants. Example where pediatricians were fired and replaced: https://lnkd.in/eQV4qeg6 This is even true in non-profit children’s hospitals. Across specialties this is true as those who see #healthcare via balance sheets will cut costs aggressively and labor or salaries is always the top line item on operating expenses. https://lnkd.in/emS4Zhzj A nation that does not value #children or #childhealth will drive child health specialists out of job and out of business. People get shocked when I state it that starkly, but all you have to do is look at reimbursements and budgets to see what we value in this country. Those who own healthcare facilities are just following the numbers and doing the math. The fiscal “logic” behind replacing doctors became clear to me in my #MBA and with the rise of AI to lower labor costs and replace jobs ranging from lawyers to consultants to doctors. It is the same way that everything you buy now is made in China and “made in the U.S.A.” is rare. Across all industries cost of production is lowered to increase margins and increase executive pay and bonuses. #Burnout in all clinician types keeps worsening. Once healthcare workers are devalued and seen the same as “fast fashion” from Zara or Target (fast and easy to replace), then executives can worsen working conditions further as burnout and attrition are lesser concerns. When human workers are seen as a “cheap replacement”, that not only changes their value but drives poor working conditions. If current trends continue, we will end up with a two-tiered model where in future there will be a handful of doctors and even fewer pediatricians, who work outside of hospitals or private owned equity clinics. Most patients who are on insurance will be seen by those who are cheapest to employ, with 2-4 years of education or training, with most decisions made by #AI, not by the human healthcare worker. Doctors who remain in practice will be independent, operate outside insurance, in the model that existed in the early part of the 20th century. Already in the U.S., any healthcare is treated as “a privilege”, not a right. Seeing a doctor at all is fast becoming the same (a privilege) in the business of healthcare. A few wealthy or elite families will still want board certified pediatricians and child specialists for their children. The rest of America’s children will get algorithms and AI trained for adults then applied to children. I’d love to be wrong on this. Unless trends and reimbursements change, those who own and run healthcare will follow the money and will maximize margins.

Unfilled pediatric residency slots are not just a problem for our practice. They are a loud warning signal for our country: The beginning of what will be a growing, widespread public health crisis in years to come if something doesn’t change. Do you know who some of the lowest paid doctors are in medicine? Pediatricians. And that’s not an employer organization problem, it’s a total payor issue, in both the private commercial and publicly funded insurance spaces. Are children the highest spenders in healthcare? Not by any stretch of the imagination. Yes there are chronically ill children who cost payors money, but the vast majority are physiologically healthy (we’ll save their even more concerning mental health for another time!). But guess what children without equitable, high-quality primary pediatric care eventually become? Expensive, chronically ill adults. And guess who pays for those children? The exact same payor systems that refused to appropriately pay for the level of quality ALL children deserve. Are there opportunities in other specialties for myself and the millions of physicians and APPs out there? Sure. But why should ANY health worker - pediatrician or otherwise - have to defer from the passionate, heartfelt desire to care for some of our most vulnerable citizens, simply because they won’t be able to afford to live, much less pay their medical school loans?! I am so glad this issue is garnering national attention, FINALLY. The way our health and societal systems undervalue pediatricians is abhorrent. Something’s got to give. #pediatrics #pediatricians American Academy of Pediatrics American Medical Association Health Resources and Services Administration (HRSAgov), HHS Primary Care Collaborative

There aren’t enough pediatricians right now, and because of that, some kids are unable to get the care they need. And things could get even worse: Less U.S. medical school graduates than we’ve seen in decades want to be pediatricians. Approximately 30 percent of pediatric training programs failed to fill their available residency slots this year, leaving 252 positions vacant — a notable increase from just 88 vacant spots last year. Luckily, pediatric NPs and family NPs are capable of filling in these gaps in care. These NPs are advanced practice registered nurses who are specialized, educated, and trained in providing pediatric care and care across the lifespan. Expanding NP scope of practice would expand access to NP-led care, helping kids get the quality, timely health care they need — especially in rural and underserved areas. #NursePractitioners #CareForPA #HealthcareAccess #FamilyNP #PediatricNP #AccessToCare

Caregivers need help STAT!!! Most of us who are Caregivers & Parents to kiddos that are medically complex don’t have healthcare backgrounds yet we are left to figure it out on our own. This could be life threatening to some kiddos. Speaking as one of those Dads & Caregivers it can be overwhelming to keep up with it all. And it’s coming from all directions. All while we are trying to keep our kiddos medicated, fed, treated, clothed and seen. This is what Bret Koncak and I think about and work on daily. mejo was designed to help caregivers save time, gain peace of mind, get answers (coming soon) and champion better care. #caregiver #pediatrics #mejournal #healthtech

This is alarming. Imagine if your child were sick and you couldn't find care in your community. As they say, the struggle is real. Policies and practices that help children help us all. Dr. Sallie Permar and Dr. Bob Vinci nail it in this op-ed. "The decline in interest in pediatrics as a profession should serve as a significant warning sign to the U.S. health care system. At a time of rising education debt and inflation, the root cause of this challenge is clear: low compensation. Pediatricians make approximately 25% less than doctors who treat adults; all train for the same number of years. The reasons for the lower compensation are simple economics: Pediatricians are not reimbursed by private and public insurance at the same level as adult providers and other specialists for similar services." Weill Cornell Medicine #childrenshealth #pediatricians #pediatrics #childrenswellbeing #pediatricworkforce

Earlier this year, *a third* of paediatric registrar positions in Auckland were not filled. At one of the hospitals, a colleague of mine said that consultant doctors (senior doctors, often aged 40+) will have to come back to doing night shifts to fill the rather vacant roster. The impact on patient care is monumental. A third of staff down means more gaps in the acute roster as well as the day to day. It means more workload on our senior doctors and less care available for our patients. It means cancelling outpatient clinics because of increased inpatient acuity. It means an unsupported, burned out workforce ready to resign at any moment. Wait times growing, and growing, and growing. Training then becomes less about learning and more about service provision as less time is available as looking after the sick kids remains the priority. Less training for our trainees has a trickle down effect to less training for our medical students and then, ultimately, less well trained 'senior doctors' who didn't receive the same mentorship, guidance and learning opportunities as our forbearers. While the funding system in the USA is not the same as NZ, the problems are eerily similar. Poverty still significantly affects health access and inevitably, overall health outcomes. Much of the 'paediatric' care is provided for in primary care, a specialty that is becoming increasingly stretched and facing increasing challenge in accessing support from us hospital doctors. Families simply aren't able to access continuity of care from a GP that knows them and GPs are barely reimbursed to provide the 'free GP visits for under 14s'. These aren't free, they are just partially funded by the state and subsidised by the copayments of others. The paediatrics I started practicing in 6 years ago is not the same paediatrics we are working with today. I'd like to encourage more people into paediatrics but it seems almost selfish to ask others to come into a system so flawed its making me question my life choices. But there's a heck of a lot of fixing we need to do and I am not leaving just yet! Hopefully you can read this as an article gifted by me :) #paediatrics #pediatrics #medicine #health #publichealth #prevention #primarycare #aotearoa #newzealand #nzpol #politics

I often get asked why I don’t see patients as a pediatrician. Aren’t the little ones so cute? It's fulfilling to help a mother breastfeed or a dad become a strong, emotionally-safe role model, right? Sure! These and knowing a 2nd grader lost weight and gained self-esteem, or a teen stopped taking dangerous or harmful risks because of our efforts, are all rewarding and enjoyable. But the reality is, pediatrics was largely ruined for me by the accepted lack of money. When I graduated residency I asked the chair of my division how anyone affords to stay on as faculty with what was paid. “Oh. Don’t you know?” he said. “No male breadwinner actually affords to work here and live in Los Angeles. We’re all in real estate.” So totally matter of fact (and discriminatory against the 95% women in our workplace.) 😔 I fell in love with pediatrics, as with public health, because of the promise it held for better lives and healthier, more equitably resourced communities, starting from our very beginnings. Becoming a wealthy, white real estate mogul felt somehow antithetical. 🏡💰➡️👶🏾🩺❓ Pediatrics was next ruined for me by model wars. As we made integrated behavioral health and parenting supports for low-income families a sustainable Medicaid benefit (it now is across the US!), I found difficult how often colleagues derided (and wouldn’t share donor or Medicaid largesse with) other models of support for families in communities. Things like home visiting, CHW’s, doulas, childcare, faith-based orgs, lactation consultants, etc. Straight snobbery really. Given the real estate advice I should’ve understood pediatricians' “ours vs. theirs” mentality. Inadequate reimbursement has fomented starvation or tribal-like behavior. But it's counterproductive to ignore or put down other professionals who’d support families when all of us simply want educated adults raising healthy and well children. This great op-ed by Aaron E. Carroll in The New York Times considers the recent inability to refer to behavioral health, for lack of professionals, as a reason for pediatrician burnout. And while true, I would ask, how much of that is our own fault for having marginalized them as team members? Where do pediatricians lobby for social workers or psychologists that practice outside our clinics? You don’t hear about it - when I led mental health services I more heard crickets from colleagues. “So, why don’t you practice again?” 🙉 Come on, now! #mentalhealthishealth and foundational for #healthequity. What if #payparity among child-serving professionals actually needs more teamwork than self-lobby? Might a rising tide float all boats? And to honor the first person to earnestly ask us residents whether staying in broken, abusive health systems was wise - a social worker - I now ask: what if social workers are the key to filling those empty pediatric residency slots in the US...? Maybe it's time we listened.

I had an opportunity to shadow Dr. Baranwal at Cardinal Pediatrics (www.cardinalpd.com), where I gained valuable insights into a pediatrician's day-to-day responsibilities and challenges. During this time, I observed and participated in various activities, including: 1) Patient Interactions: Observed consultations and learned how to effectively communicate with patients and their families. 2) Clinical Procedures: Gained firsthand experience in observing routine check-ups, vaccinations, and other pediatric procedures. 3) Medical Documentation: Learned about the importance of accurate medical record-keeping and the use of electronic health records. 4) Team Collaboration: Witnessed the collaboration between pediatricians, nurses, and other healthcare professionals to ensure comprehensive patient care. 5) Professional Development: Discussed career paths and received mentorship on pursuing a career in pediatrics. This experience enhanced my understanding of the medical field, reinforced my passion for healthcare, and provided me with practical skills that will be invaluable in my future medical career. I thank Dr. Purnima Baranwal for allowing me to shadow her. #pediatrics #medicalterminology #clinicalobservations #Healthcare #Aspiringmedicalprofessionals

Insightful article Our healthcare system does not support pediatric care as it should. Drs. Satyan Lakshminrusimha, David Lubarsky, @Rhae Gamber & @Sherin Devaskar nicely highlight the significant issues associated with the current state of #Pediatric #Healthcare, focusing on reimbursement which is a cause for many downstream issues. It is an article filled with solid and important information and a call to action. https://lnkd.in/g8ZNkYQT More than half of babies less than 34 weeks, the most fragile and care complex newborns, are covered by Medicaid across the U.S. There is disparity as more than half of Black, Hispanic, native Hawaiian/Pacific Islander, American Indian, Alaskan native babies covered by Medicaid in the NICUs across the U.S.. Fee for service (FFS) is the most common form of reimbursement for providing NICU (many have rightfully so pointed out that this is a perverse payment model). In many cases FFS reimbursement rates do not cover the cost of an NICU hospitalization and are below payment rates for comparable Medicare services. The authors highlight the impact that low reimbursement for nonprocedural, cognitive-based specialties is having on Pediatric subspecialty access-- a trend that appears to be worsening with recent data demonstrating a decrease in residents matching in various pediatric subspecialties. For the recent pediatric subspecialty match in 2023, there were unfilled fellowship positions. 56% genetics, 47% nephrology, 52% ID (among many others) slots were unfilled. That is an alarming percent for specialties that fill a very necessary role if we are to provide the best care possible to newborns and children. I do disagree with one of their statements that "supply-demand will increase pediatric subspecialty salaries over time." I do not think that physician salaries lies within a truly competitive market that would follow the laws of supply and demand. We also need to be aware of the fact that Pediatric care access, both inpatient & outpatient, is decreasing over the past decade and really accelerated during the Pandemic when many Pediatric beds were converted to adult beds which have not transitioned back because more $ can be made from a adult occupying a bed than a child. Many community hospitals have closed their small, but important Pediatric units. Rural & critical access hospitals have closed with many teetering. Access to Pediatric primary care is becoming more limited, especially in those unfortunate patients with Medicaid coverage (which is a majority)-- creating widening and disheartening Pediatric Care deserts across the U.S. Their take-home message: "Increased Medicaid reimbursement is critical to the sustainability of high-quality pediatric subspecialty workforce that is family-centered, timely, effective, efficient, equitable." #UsingWhatWeHaveBetter

"Dr. Tothy said fair pay, reimbursements, loan repayment and burnout are just some of the key factors causing a pediatric shortage." Great insight here from Madeline Ashley as to how the ongoing reimbursement issues are affecting pediatrics. Ensuring fair and timely reimbursements is crucial for a thriving healthcare system, across provider types. Adequate reimbursements empower healthcare providers to offer quality care, invest in advanced technologies, and enhance their services. By supporting financial sustainability, reimbursements contribute to the well-being of young patients, fostering a healthier future for our children. We must prioritize fair reimbursements to fortify healthcare and ensure the best possible care for our little ones. This shortage, unfortunately, is not just limited to pediatrics, and so we must continue to be vigilant about addressing the issues across all provider types. #HealthcareReimbursements #PediatricCare #ChildHealth