Kids' Medical Care Is No Small Business

Survey of Pediatricians Shows Quality of HealthCare Delivery in Crisis

By Jim Kling
WebMD Health News

Feb. 4, 2003 -- Mounting economic pressures are forcing pediatricians to run their practices more like a business than a healthcare provider, and they aren't happy about it. That is the conclusion of a survey of 400 pediatricians in 38 states, released today by Children's National Medical Center in Washington, D.C.

Among the findings: 88% believe that factors such as insurance coverage, local availability of specialists, and lack of transportation prevent children from receiving quality healthcare. The majority of pediatricians surveyed said time constraints on patient treatment lowered the quality of care children receive. Seventy-five percent said that children with complex medical and behavioral problems don't get the help they need.

The study indicates that the issues are not limited to the poor or underinsured but instead cut across all economic boundaries.

The problem traces in large part to the introduction of managed care in the late '80s and early '90s, according to Peter Holbrook, MD, chief medical officer at CNMC. The reimbursement amounts from HMOs are based on market forces, leading to tighter profit margins for doctors. "Pediatricians are among those having to scramble to make ends meet," Holbrook tells WebMD.

The survey shows that the average time a pediatrician spends with a child is eight to 12 minutes. Most respondents said that was too short to provide high-quality care. "The pace in a pediatrician's office is incredible. The survey indicates that pediatricians feel as though they are not able to deliver the kind of care they want. That's a subjective impression, but it was shared by so many respondents that I think it is probably an accurate representation," Holbrook says.

The survey also shows:

The majority of doctors said that time constraints lessened the bond between doctor and family.
Most felt a loss of control because of managed care and insurance restrictions, rules, and regulations.

Holbrook and CNMC are calling for an overhaul of the current reimbursement system, calling it "broken." CNMC is considering the launch of a panel of pediatricians, healthcare administers, insurers, policy makers, and patient advocates to study the problem and recommend changes. "We need to ask ourselves, what are the principles we need to build around?" Holbrook says. He says he hopes the results of the survey will help guide such decisions.

In the meantime, it is important for parents to head into appointments with pediatricians with as much preparation as possible. "(You) should try to get questions organized because there is going to be limited time," Holbrook says.

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