Public Health During the Pandemic
The COVID-19 pandemic upended the learning environment in many ways. For a period of several months in early 2020, rotations for medical students were suspended. Lectures and other educational experiences transitioned to a virtual model. Although some residents rotating in hospitals continued to see patients in-person, Dr. Peltier says many outpatient settings put a hold on any educational activity as they prioritized protecting staff and patients from the potential spread of COVID-19.
The fall-out from the pandemic continues to affect medical education, he says. The cohort of learners who rotated through clinical settings during the pandemic haven’t had the opportunity to see and treat the typical number of patients with common diseases like the flu and bronchiolitis. The adoption of social distancing measures and the emphasis on hand washing and mask wearing have translated into a low volume of ill patients.
“We now have an entire class of first-year pediatric residents who have completed their first year of training without really touching patients with bronchiolitis or influenza,” he says. “Soon they are going to be supervising junior learners, so there’s definitely some concern about how the pandemic has affected learning because some of the typical diseases that we see in the wintertime, we just weren’t seeing this last year.”
While the volume of patients presenting with infectious diseases is down, there’s been a spike in inpatient psychiatric admissions, an uptick hospital leaders attribute in part to stress from the pandemic. Dr. Peltier notes an increase in the intensity of the disorders he is seeing; for example, more severe anxiety and depression requiring a higher level of clinical care.
“Cincinnati Children’s has one of the largest inpatient child psych facilities in the country,” he says. “About a month or so ago, there were 26 patients either on a traditional medical floor or holding in the ED, waiting for a psych bed. And that hospital has probably about 100 psych beds.”
As president-elect of the Ohio chapter of the American Academy of Pediatrics (AAP), Dr. Peltier sees opportunities to address major challenges like mental health. A new project, called Store It Safe: Adolescent Suicide Prevention Program, aims to raise awareness as well as promote depression screening and prevention. The chapter has partnered with pediatricians, gun advocacy groups, police departments and schools to distribute gun lock boxes and information about the risks related to teens and firearms. Evidence shows that if guns in the home are appropriately stored and locked, teens suffering from depression or other mental health issues are much less likely to engage in a fatal suicide attempt.
Dr. Peltier has also served as part of the team presenting COVID-19 information to the public during press conferences with Ohio Governor Mike DeWine. Part of his message has been the importance of routine care for children, including well-child visits and developmental screenings, even during the pandemic.
“We created a toolkit for pediatricians and marketing to families,” he says. “Our hashtag was #SafePedsHealthyKids.”
In addition to public health messaging, he’s focused on giving voice to independent practices, amplifying what they need to survive during a time when the pandemic has put pressure on businesses already straining from hospital take-overs and other financial challenges.
“Many general pediatricians [and] primary care pediatricians have been president of the Ohio AAP,” he says. “I’m probably the first in 25 years that is an independent practice pediatrician.”
Part of the solution is to introduce new pediatricians to independent practice, says Dr. Peltier. When they have the opportunity to get to know this type of practice during their training, they’re more likely to consider it as a career.
“It is vital that we expose pediatric residents to what we do,” he says. “The majority of their time they’re spending in a hospital setting or a clinic that’s owned and run by a hospital. When I graduated residency, I had no clue how to run a business. I’m still not sure I know how to run a business, but I’ve learned a lot in 22 years. One of our goals, especially here in Cincinnati, is to try to show the benefits of owning your own practice. And that it’s not as scary as it may seem, and that we want to teach you.”
The strategy has paid off, as his practice recently recruited a physician who completed rotations at Pediatric Associates at Mt. Carmel during her child psychiatry residency.
“She was with us once a week for five years,” he says. “We’ve hired her to be our first child psychiatrist. And it was because we had that relationship with her. That’s the goal as we see more and more practices close or sell. We’re starting to see Cincinnati Children’s start to acquire some practices here in town and we really want to advocate for keeping practices independent.”
Supporting preceptors in the community by helping them to fine tune their teaching skills is one more way to keep independent practices strong, says Dr. Peltier. Through these rotations, members of the next generation of pediatricians learn the business of pediatrics as well as appreciate the rewards of running a practice.
“Eventually I’m going to retire and I want somebody to take my place,” he says. “We want independent practices to thrive and continue. So that, to me, is a huge plus of why we do what we do.”
Dr. Peltier recommends that community pediatricians interested in precepting reach out to their local medical school or pediatric residency program/children’s hospital. He’s also available to answer questions at chris.peltier@cchmc.org. He’ll be presenting a virtual on-demand session at the American Academy of Pediatrics National Conference and Exhibition in October titled “How to Effectively and Efficiently Teach Students and Residents in the Busy Community Office Setting.”
