I think that the individual stories about independent pediatricians are most interesting and inspiring. I particularly applaud the efforts by Dr. Sutter in his long-term battle against OxfordUnited Healthcare. Pediatricians have not made much of a concerted effort to stand up for our rights. All too often the big insurance companies say jump and we just say, “how high?” Usually, we ask how we can adjust to accommodate their demands.
I am board certified in pediatrics and pediatric cardiology and have been mostly in solo practice for forty years. I have seen our profession decline from being well respected and admired in our communities to now being “providers” serving “members” or consumers. In the eyes of the big insurance companies, we are just easily replaced cogs in a machine, rather than well-educated, highly skilled individual professionals.
We have seen the insurance companies gradually whittle down our reimbursements. We are reimbursed based on an “allowed” amount or “negotiated” rate. Negotiated by whom? Not us! As a result, it is becoming increasingly difficult for the independent, small pediatric practice to render the highest quality care that our families expect and deserve. This is especially the case with vaccines. We are paid separately for administration and receive a ridiculously low dollar amount for the vaccine itself. In some cases, we are paid at cost or even below cost despite belonging to vaccine purchasing groups.
If current trends continue, we will see fewer and fewer independent pediatricians and narrower panels of pediatricians with fewer choices for families. In addition, we face competition from urgent care centers and national chain pharmacies with minute clinics where patients are treated by a “doc in the box,” or who knows what else?
The fact is that we have the goods. Our health care system cannot function without us. I believe it is high time that we band together and help ourselves and our patients. We are being shortchanged while the insurance companies are profiteering big time. If we do not help ourselves, who will? If we want our best and brightest young adults to chose careers in pediatrics, we need to act.