The Issues

Featured Essays on…

1. Health Care Reform

2. Poverty

3. Social Media

4. Work-Life Balance

 

1.  How do you see the future of the specialty of pediatrics in the era of health care reform?

Pediatricians have a renewed opportunity to strengthen our roles in improving child health outcomes in the era of health care reform. Emphasizing access, quality and cost, health care reform promotes longitudinal, integrated and family-centered care. This approach reinforces core pediatric care systems including the multidisciplinary medical home, health homes, community health teams, and community based collaborative networks, all of which are integral to the AAP’s socioecological model of child health. The challenges of providing care and sustaining practice in evolving systems are clear. The AAP should continue actively improving economic modeling , practice integration, and practice networking strategies to assist pediatricians in emerging health care systems. Our unswerving commitment to the needs of children must be front and center in any clinical services delivery platform. We will need to successfully negotiate with adult focused systems and develop models that clearly demonstrate our value in improving the health of the children and families we serve. Whether in accountable care organizations (ACOs) or accountable care communities (ACCs), we can effectively and efficiently lead care processes relating to health supervision, prevention, wellness, growth and development. We are positioned to forge links between community pediatricians, pediatric medical subspecialists, pediatric surgical specialists, therapists, hospitals and an ever expanding team of health professionals. No other medical specialty has this unique focus on overall health and integrated clinical care. This positions us for leadership roles in the next generation of care organizations. The AAP must continue to develop and provide education, training and tools that will assist pediatricians in achieving this leadership role. At the same time we must engage in intraprofessional education with medical students and residents as they build skills in communication, IT, leadership and team-based care. Doing so will help pediatricians excel in their practices while assuring that our children continue to thrive. We will expand family engagement at every level of health care and be seen as experts in family centered care. The specialty of Pediatrics will be seen as an integrated cohesive system of experts prepared to address every aspect of child health at the family, community, health system and population level.

2.  Poverty impacts virtually all aspects of children’s health.  What role should pediatricians play in addressing the effects of poverty on children?

Over 32.4 million (45%) US children live in low-income families, 16 million (22%) live below the federal poverty level. Children are disproportionately affected by poverty, with infants and toddlers more likely to be poor than any other segment of society. Poverty is a major determinant of health and a significant factor in perpetuating health disparities. Understanding the role of poverty in the lives of children is crucial to our practice and advocacy as pediatricians. We are the experts in child health and cannot ignore the call to respond to the needs of children created by adverse social and economic conditions. We must attend to the impact of poverty on the individual children we care for, crafting our medical homes to eliminate barriers to care, and identifying gaps in prevention and treatment based on our understanding of the populations we serve. Child poverty calls us to expand our definition of pediatric practice. The factors contributing to increased rates of asthma, obesity, dental caries, injuries, mental health diagnosis, HIV infections, and tobacco exposure in children in poverty reside not only with the individual or family but in the community, environment, and policy arenas. In our mission to attain optimal physical, mental, social health and well-being for all children pediatricians should operate in a socioecological model, connected to families, community resources, public health and policy. We need to understand population health and how to use community level data to assess the needs of our patients, barriers to care and available resources. We must also incorporate our understanding of life course medicine and the emerging role of epigenetics into advocacy for children in an increasingly complex system of health care. We need to foster research to help create new approaches to address these complex issues.  Chapters and sections are ideally positioned to help members use quality improvement to accomplish practice change, provide leadership training to foster intraprofessional teams and community collaborations, and education to incorporate principles of population medicine, public and community health into practice. We not only have a role in addressing the effects of poverty on children, we must take the lead.

3.  What is your opinion on the appropriate role of social media interactions between patients and pediatricians?

Social media “refers to the means of interactions among people in which they create, share, and exchange information and ideas in virtual communities and networks” (wikipedia.org). As social networks become established the “value” of the network goes beyond sharing personal information to being a venue for marketing, social outreach, information exchange and co creation of content. Pediatricians may be participating in social networks as individuals, as practices or within medical educational settings. Professional and state licensing boards recommend that providers keep personal and professional personas separate and social media use be incorporated into professional training. Pediatricians should familiarize themselves with hospital and state medical board social media policies which recommend that electronic communications should only be used with patient consent in an established patient-physician relationship. It is clear that the impact of social media on health and medicine is only just starting to be realized. For example, text messaging has been used to successfully increase teenage vaccination rates and parents surveyed prefer text messaging to phone or written reminders. Text4Baby is a text messaging service for pregnant women and new parents with over 500,000 subscribers. Internet searches and tweets have been used to track outbreaks of disease such as influenza, within a field called infodemiology. Pathologists have used social media in forensic investigations and tweeting has been used as a methodology for tracking community dietary patterns.  Patients increasingly search the internet for health information and information about their doctors. Patients are also participating in online communities focused on specific diseases and conditions.  Discussion of management plans, treatment, providers, and clinical trial options are shared and patients may request specific treatment and tests that they learn about from sources other than their own physician. Researchers are working with “real” communities to establish wiki’s to share information about health and health care access among community members.  Mobile apps are being used to enhance self management skills among patients and social media interactions are being used to reinforce patient group meetings. As pediatricians we need to creatively leverage the power of social media communication and connectivity in our work to improve child health.

4.  What do you feel is the greatest challenge facing pediatricians in balancing their personal and professional lives, and how do you think we can help our members navigate these challenges?

The AAP must make helping pediatricians achieve work life balance a core organizational competency. Creating an individualized approach to professional development which incorporates strategies for work life balance will help members respond to the demands of delivering the best possible care for children and demonstrate membership value along the continuum of practice.

Work life balance is a fundamental issue for all physicians. Medical students consider work life balance as one of the factors in choosing a career path. Residents may evaluate  residency programs based on flexible training options. Work life balance has been found to be one of four factors that affect success of female physicians in academic medicine. Both male and female mid career surgeons rated work life balance as one of the key factors in coping with job stress and burnout.

Solutions to improve work life balance are often focused on individual change; this strategy is important but cannot address the broader professional and organizational issues that involve the dynamic interplay of work and family.  It is clear residents are carrying an increasing burden of debt through residency and into practice at the time when they most need flexibility to meet the demands of young families and establishing practice.  A close look at how graduate medical education is being financed, options for loan forgiveness, loan consolidation and financial counseling for medical students are all issues that demand continued AAP focus.

Workplace family leave, on-site 24 hour child care, opportunities for short sabbaticals, and targeted support for researchers with child care responsibilities are all strategies that are being piloted and should be supported. Health care organizations can offer group mentoring and publicize leave policies which help pediatricians to achieve increasing balance.  Programs that help mid level and senior department/division chiefs, and heads of practices create workplace cultures that support work life balance should be supported by the AAP.

Both the senior section and the section on young physicians have addressed self-care and work life balance as key issues and the PLACES study of factors acting longitudinally on graduating residents should provide critical information to inform AAP priorities and action.

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