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Opinion After the winter kids just had, pediatricians are not okay

Pediatrician Yadira Caraveo, who now represents Colorado in the U.S. House, examines the 10 members of the Hernandez family at her clinic in Thornton, Colo., on Aug. 17. (Melina Mara/The Washington Post)
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For many parents with young children, this winter was a slog through the “tripledemic” of covid-19, flu and respiratory syncytial virus and other resurgent infections. My own family’s tally: 13 doctors’ appointments since October, eight infected ears, two cases of strep throat, two different strains of pinkeye and one covid infection.

If parents are not okay, neither are pediatricians. These grueling months piled more strain on a pandemic-battered profession. Keeping these doctors going requires a radical rethink.

How nasty a season has it been? Children under 1 made up almost a quarter of emergency department visitors for respiratory diseases in early December, according to the Centers for Disease Control and Prevention, closely followed by children below the age of 11. Liquid formulations of children’s Tylenol and amoxicillin became scarce. And as the RSV surge filled up children’s hospitals, doctors had to turn kids away or send some far from home for care.

For Natasha Burgert, a pediatrician practicing in Overland Park, Kan., it has been tough. She has had to treat some patients in her office rather than admit them to a hospital and make daily calls to local pharmacies to check what is in stock and which shelves are bare.

Burgert’s schedule has also been swelled by illnesses among children who missed the normal round of immune-system toughening because of social distancing. Parents are learning late how kids respond to infections and medications. The rush of office visits for infections that could be treated at home leaves her with less time to educate anxious caregivers.

All this comes after three unrelenting years of covid. Between 2021 and 2022, the virus became the leading cause of death from infectious disease for Americans under the age of 19. Children were the last people to get vaccines and therapeutics. “Pediatricians were actually left being front-line workers longer than other specialties,” says Sandy Chung, the American Academy of Pediatrics president.

Covid compounded preexisting stresses on the profession. A smaller proportion of medical students is choosing to enter the field. Only 5 percent of nurse practitioners are licensed to work with children, and 1.9 percent of physicians’ assistants work in pediatric offices. In 2021, Boston University’s Robert J. Vinci estimated that all pediatric disciplines would face “major workforce shortages” by 2023.

Pay is part of the problem. Pediatricians receive, on average, the lowest salary offers of doctors working in any medical specialty, according to an analysis from the medical staffing firm Merritt Hawkins.

Treating adults is often more profitable. Billable procedures such as surgeries are more common among older people. And as of 2021, 41 percent of American children got health insurance through Medicaid or another public program. For working-age adults the figure is just 16 percent. Medicaid has long paid lesssometimes much less — for care than private insurers. Given those economics, it’s no surprise that administrators didn’t convert back kids’ wards used for adult patients during the pandemic — and no surprise that children’s hospitals overflowed this winter.

Misaligned incentives extend to individual procedures, too. Insurance companies pay Chung, for instance, as much as three times more to remove a wart from a patient — something that takes five minutes — as to spend an hour with a suicidal child and her parents.

That feels especially obscene, given teenagers’ deteriorating mental health. Chung now spends up to half her day with children who are experiencing emotional issues. Colds and ear infections used to make up much of her practice. She often has no available psychiatrists or psychologists to refer these patients to. Yet mental health treatment is not a mandatory part of pediatric medical training.

Changing these dynamics won’t be easy — or cheap.

“Having about a million nurses fall from the sky to be able to fully staff all our clinics would be super great,” deadpanned Burgert. Eventually higher demand and pay will pull more people into that crucial profession, she believes.

Even better would be if pediatricians were compensated not on a test-by-test basis, but on a scale that acknowledges their key role in creating generations of healthy adults. Trials of such strategies are happening in Ohio, Oregon and New York.

Meanwhile, pediatricians such as Chung and Burgert urge parents to remember that pediatric care is a partnership. Coming to an appointment with the right health forms for day care can save a practice hours when multiplied over dozens of children. Giving grace to pediatricians trying to meet the needs of all those patients and parents crammed into their schedules is a small investment in their sanity.

As the seasons change, I’m welcoming spring and a possible respite from illness like a shipwreck survivor sighting land. Parents made it through this winter thanks to our pediatricians. The least we can do is show them the same care they give our kids — even if the larger health-care system can’t or won’t.