To save money, we’re laying off pediatricians — this will put kids at risk

In the fight over health-care costs, pediatricians are on the chopping block. In hospitals and clinics across the country, pediatricians are being laid off, leaving kids’ care to nurse practitioners (NPs) or increasing the clinical burden on emergency room doctors. These decisions are being made by suits over scrubs, and they put patients at risk of receiving substandard care.

Last week, three pediatric facilities closed in Dallas when MD Medical Group acquired Children’s Health Medical Center and consolidated pediatric operations, terminating dozens of pediatricians. In April, Maryland’s MedStar Health announced the immediate closure of inpatient pediatrics and the pediatric emergency department at Franklin Square Medical Center.

{mosads}Last October, Boone Hospital Center in Missouri announced it was closing its pediatrics unit. Last September, Pottstown Memorial Medical Center closed its inpatient pediatric unit. And last summer, Mount Sinai hospital in Chicago ended its pediatric services.

“Pediatric hospital care is less available than it used to be…” said senior author Dr. Michael McManus, a pediatrician and professor at Harvard Medical School. “Hospitals are paring back on certain lines of business, and pediatrics is one I think they look at very closely…” said Allan Baumgarten, an independent health-care financial analyst.

What’s driving this phenomenon? It’s largely an attempt for providers to maintain — or in some cases, maximize — profitability on a growing share of Medicaid patients. There have been more than 22 million new Medicaid enrollees since the beginning of 2010, when the Affordable Care Act, which greatly expanded the program, was passed.

One in two births in the country is now paid for by Medicaid. Yet Medicaid’s reimbursement rate is only about half that of privately-insured patients. As a result, hospital executives are looking to cut labor costs, which make up about 60 percent of hospitals’ operating costs.

Faced with these dynamics, many providers, including the prestigious Mayo Clinic, have selectively restricted or refused to treat Medicaid patients. Roughly half of doctors are unwilling to treat new Medicaid patients because they are not profitable. But this approach does little more than foist Medicaid patients onto already overburdened emergency rooms.

Laying off pediatricians in favor of NPs and emergency room physicians is an attempt to monetize these patients. But this is also problematic.

Most importantly, it puts patients at risk of substandard care. NPs require four years of college and a thousand hours of clinical experience — significantly less than the eight years of college, three years of residency, and 20,000 clinical hours needed by physicians. While NPs can do a wonderful job caring for many problems, they receive far less rigorous training than even medical students, who would never be allowed to treat any patients unsupervised. Worryingly, there are also signs that NP training is becoming watered down by assembly line programs.   

Of course emergency room and family practice doctors will pick up the slack to some degree. But they also don’t have the same familiarity or training necessary to meet the unique needs of children, whose physiology, treatment, and responses are often different.

In our decades of clinical practice, adult physicians universally recognize the need for pediatric patients to receive care from the doctors who are specially trained to treat them.

Consider an example, which is representative of many other similar experiences throughout our careers. Dr. Al-Agba was able to catch the subtle signs of an unusual condition in an ill toddler during flu season.

She was able to determine that the patient had ingested multiple small magnets, which were then attracted to each other and connected inside her intestines, which could have been fatal. She was immediately operated on and recovered uneventfully.

Missing subtle signs in pediatric patients can lead to deadly consequences. Such cases demonstrate that all children, regardless of income, deserve access to adequate pediatric care.

Is there a solution to this problem short of comprehensive health-care reform? Potentially. Instead of looking to pediatricians and other specialty physicians to cut labor costs, providers should look to cut administrative jobs, which have expanded to the point where there are now ten times as many administrators as physicians.

Many of these bureaucratic positions offer little-to-no value to the patient or the doctor. In fact, they often impede physician productivity, reducing profitability.

But for now, pediatricians must speak for children’s right to access the physicians specially trained to care for them. Because it is increasingly clear that health-care executives will not.

Niran Al-Agba is a pediatrician in private practice and a board member of Practicing Physicians of America. Marion Massis a pediatrician and co-founder of Practicing Physicians of America.