Editor’s Note: This post is adapted from The Break Room podcast episode on elevating independent pediatricians to improve healthcare and has been edited for length and clarity. Listen to the full episode below.
Pediatricians play a pivotal role in children’s physical and mental health, especially during this time of skyrocketing rates of adolescent anxiety and depression. However, experts worry that the pediatric workforce is too small to serve patients and families. An article by the American Academy of Pediatrics noted: “There is a growing concern that we could face a diminishing number of pediatric healthcare professionals to meet the clinical, research, educational, and advocacy missions that are critical to sustaining and improving the health and wellbeing of all children.”
Additionally, the number of independent physicians has dwindled in recent years, with the majority of pediatricians now employed. The American Medical Association has proposed several threats to private practices: greater administrative burdens, lower payments and contracting leverage, expensive technology, and more.
Here, we explore the state of pediatric value-based care, the changing partnership landscape, the empowering role of physician governance, and the tools and strategies that help independent pediatricians and their patients thrive.
Our guests are Melissa Montague, Senior Vice President and General Manager of Privia Women’s Health and Privia Pediatrics, and Elizabeth Flynn, MD, an independent pediatrician with Manassas Pediatrics in Virginia.
What trends in healthcare impact independent practices, and how have they affected Manassas Pediatrics?
I’ve been in practice for 25 years, and it has changed a lot over those years. In the early 2010s, we were at a crossroads deciding whether and how we were going to proceed. We had a couple of aging providers. We had some changes to technology that we did not necessarily feel equipped to undertake. We had a lot of competition with urgent care and increasing requirements for compliance in every aspect of medicine and business.
Locally, a lot of the smaller practices were merging with or being bought by bigger hospital systems. We knew that we didn’t want to do that. We were looking for something that allowed us to still be independent and make our own decisions — what hours we work, what services we provide. We had to find a way to keep our independence and also access the benefits of being part of a larger organization, like billing and negotiating prices for ancillary services.
The biggest thing with us is that we have to be able to change.
There is certainly a movement — both regionally and nationally — toward hospital consolidation. Physician practices, including pediatrics, are starting to be employed, either through a hospital or even what some might deem a “single-specialty aggregator,” where you pull all of one specialty together. That certainly is changing the industry. More and more physicians are moving in that direction, and it’s harder and harder to remain independent.
Another factor that is (and will continue to be) very impactful is the labor shortage. Certainly, burnout of staff — given recent times and trends — is a hot topic that we all must consider. Then there’s the heavy burden of electronic health records and technology. While those tools are good resources that can bring a lot of value to clinicians, they also come with a cost; one more click, one more thing you have to do.
Pediatrics is particularly unique in that you see patients based on age rather than gender or specific conditions. What are the implications and challenges of this unique quality?
Dr. Flynn: You have to know a bit of everything in pediatrics. There’s a big difference between caring for a newborn and caring for a late teenager. You have to know what you don’t know as well. Having good relationships with the parents and caregivers is an important part of being a successful pediatrician. Sure, you can give them the medicine and do the day-to-day stuff, but really, you have to forge that relationship.
I always say, “If I wasn’t a pediatrician, I’d be a first-grade teacher.” That’s what we do in pediatrics every day. We’re teaching these kids, these families how to be patients. They are the next generation of adult patients, and helping them make that transition is good.
The adoption of value-based care and rapid advancement of healthcare technologies have been slower to take hold in pediatrics. What is it about the specialty that slows this adoption and progress?
Dr. Flynn: It comes down to money. There are not a whole lot of procedures that pediatricians do, and we don’t have the voting block that senior and some adult medicines do, which I think has been a barrier. Caring for children doesn’t usually require a lot of technology or expensive medicine, and with so much focus on innovation in those aspects of medicine, we kind of get forgotten. Insurance companies are also much slower to adopt some of the changes for pediatrics, and it takes longer for a new technology or recommendation to be added.
There’s also just the overall lack of valuing keeping a child healthy and how that can impact them not only at that time, but in their future and their family’s future.
Montague: It really comes down to pediatrics being a small part of the healthcare continuum and the healthcare dollar. If you think about our system overall, we tend to be reactive versus proactive. In the case of pediatrics, you’re trying to be preventive, and I don’t think, as a healthcare system, we’ve put an emphasis on that just yet. But I would argue that pediatricians have — without it being set up as such — provided value-based care for years. Value-based care means greater access to your physician, trying to be proactive and preventive, trying to get to your doctor more quickly when you need them. That’s how many pediatricians already function. They’re available for phone calls. They do telemedicine. They often provide weekend and after-hours support. So most pediatricians are really functioning at that higher level and doing all of the things that you would see in value-based care anyway.