Pediatricians are now treading water. What we need is a life preserver — not a cheerleader encouraging us to run faster.
Recently, the White House released its plan to vaccinate children ages 5 to 11 with the COVID-19 vaccine. An integral part of that plan are general outpatient pediatricians — like me. It all sounds pretty rosy:
“The Administration, in partnership with states and localities, will make vaccinations available at physician offices across the country — more than 25,000 pediatric offices and other primary care locations in all. Pediatricians and other physicians are some of the most trusted sources for families when it comes to COVID-19 vaccines for children. These providers will play a critical role in the nationwide effort to get children vaccinated. To facilitate this, the administration is working with states to increase the number of pediatric and primary care providers enrolled to administer the vaccine. and provide the training and resources they need – including the vaccine stock in smaller packages and with easier-to-handle storage requirements.”
Getting vaccines in pediatric practices is absolutely ideal for our patients, but let me outline some of the challenges we’ve faced in ambulatory pediatrics over the past 20 months.
In the early days of the pandemic, with schools closing and parents sitting at home with their children on the couch, many pediatric offices struggled to keep their doors open. With sharp declines in revenue due to a massive drop in both in-patient and in-patient visits, some pediatricians had to lay off their employees or worse, close their doors completely, forcing thousands of children to seek care from other tethered and struggling practices. In the fall of 2020, we not only joined forces to vaccinate more patients against the flu (in anticipation of a possible “twin disease” of COVID-19 and flu) than I have ever seen in my 18 years as a pediatrician, but we have also worked tirelessly to help with the thousands of children who have fallen behind on routine vaccinations due to missed spring visits.
Throughout the winter of 2020-2021, outpatient pediatricians faced an uphill battle to encourage parents to bring children in for routine care, while doing our best to ensure the safety of our patients by donning personal protective equipment, providing sick and separating wellness visits, seeing patients outside in their vehicles and conducting telehealth visits – all while facing severe COVID-19 test shortages.
And then came the summer of 2021.
Summer in pediatrics is generally a time of well visits, many swimmer’s ear and injury visits, and a handful of “childcare” illnesses. It is usually busy, but not overwhelming. This summer, however, we faced an onslaught of respiratory syncytial virus (RSV), COVID-19 (thanks, Delta variant), Coxsackie virus, and more — on top of our schedules that got out of hand with source visits (as we’re still were catching up with 2020). In addition to this unexpected onslaught from patients, some practices were still not financially recovered and had to work with staff shortages.
So, what does all this have to do with the COVID-19 vaccine rollout for children ages 5 to 11? In May, my private pediatric practice began offering the Pfizer COVID-19 vaccine to our patients ages 12 and older. To arrange this, our staff took countless hours of organizing, planning, scheduling and training. We held vaccine clinics in the evenings and on weekends—clinics that had to be staffed by our already overworked medical assistants. We paid them overtime and offered various incentives to those who wanted to work voluntarily. And of course, just as the COVID-19 vaccine clinics started to slow down, we had to open up our flu vaccine clinic schedules. Again, we’ve called on our employees to volunteer for those services, outside office hours or on their days off. And while we’re still in the midst of flu vaccine clinics, we’re preparing to offer COVID-19 vaccines to our 5 to 11-year-old patients. We struggle to staff these clinics with medical assistants who are exhausted and overworked.
Please don’t get me wrong — I’m thrilled to be able to provide COVID-19 vaccines to our young patients as soon as they’re authorized. This has been a long time coming for so many parents and I can’t wait for them to finally feel a sense of relief when their children have been vaccinated. I also believe that a child’s medical home is the ideal place for them to receive the COVID-19 vaccine. Our patients are familiar with us, we are incredibly comfortable with vaccine storage and handling, and we have easy access to their medical records.
But I also ask my already stressed, overworked and overworked medical staff to again voluntarily set aside time from their own families to work in clinics to provide these vaccines. We use our own money (nothing provided by the government) to incentivize our employees to work in the evening and weekend clinics. We spend our own time planning, scheduling and training our employees.
So while I appreciate the White House’s efforts to obtain and distribute COVID-19 vaccines for children, we, in outpatient pediatrics, could really use a life raft.
Nicole Baldwin, MD, is a general pediatrician in Cincinnati, Ohio. She is an owner and managing technology partner at Northeast Cincinnati Pediatric Associates. Baldwin is also active on social media as an educator and advocate for children.