Are we keeping up with the times?

Recently Dr. Maggie Kozel wrote an excellent post for Huffington Post regarding the need for evolution in the way that we deliver health care in pediatrics.  This is a very timely article in an area that needs attention.  She responds to a recent study out of UCLA that found that well child visits are shorter than we would hope- one-third last less than 10 minutes.  There’s been a lot of talk about this study, but to be honest, I’m not at all surprised.  And, Dr. Kozel is the first I’ve heard truly address the reasons behind this problem.  The current structure of medicine forces primary care physicians to see more and more patients per day.  She points out that the study showed that this problem is especially notable in private practice.

As a pediatrician working in a federally qualified health center (FQHC), I appreciate the focus that this post provides on what we do well.   However, all is not rosy, even in publicly funded clinics.  I am proud to say that we provide excellent care to our patients, but the time and productivity pressures reached us long ago.  In the current economic climate this is only getting worse.

I currently have 15 minutes to see each patient for a well child visit, and that dwindles to 7 minutes when slots are double booked, which happens almost daily.  During these difficult economic times, more and more patients seek care with us and we attempt to maintain adequate access.  In addition, I could easily spend 30 minutes or more with each family talking about the social factors behind the child’s health problems- the father lost his job, a sibling is failing in school, the family has food insecurity, the services for a child with chronic health needs were cut, they lost their insurance and are having trouble navigating the system.  And then. . . . development, nutrition, immunizations, breastfeeding, safety, etc, etc.

So, currently my patients often wait for me.  They know that if they wait they’ll have my full attention and receive good care.  But still, they wait and, I’m sure, wonder why.  The system is doing us all a disservice- physicians, nurses, and most of all the families.  Dr. Kozel is right.  We must do better.  We must evolve.