Interview with American Academy of Pediatrics President Renee Jenkins

Key Points

Q: What do you believe is the most pressing issue in child health care?

Q: What kind of feedback are you hearing from the local and state chapters of the AAP? Is there a common thread?

Another area that many states are engaged in is the reimbursement levels for public programs. There are some states in which pediatricians cannot afford to take publically covered kids because the reimbursement levels are so low, and they take these children at a loss. Pediatricians are the white-hat people, and many of them operate with a very limited margin in terms of their businesses, and they can't continue to do that. The good news is that there are state efforts around some of these reimbursement issues.

One of the newer things that states are involved in are quality improvement programs. We know that quality is going to be a really important issue in health care delivery, largely because the payers are demanding it (ie, pay for performance programs), and also to maintain your certification as a boarded pediatrician, there will be more requirements for being able to document that you practice high-quality care. We are promoting chapter-oriented quality improvement projects, so that pediatricians who practice in small practices can use their local chapters' quality improvement resources to satisfy these requirements.

Q: What quality improvement efforts are being made in regards to pre-practice training, ie, residency programs?

A: Organizations such as the American Board of Pediatrics (via their Residency Review and Redesign in Pediatrics Program [R3P]) are really looking at how we train pediatricians now. They are saying that perhaps the cookie-cutter strategy or templates that we've had where you had to do a two-month rotation here, one month there, should have a shift in focus, and instead look more at what kind of product we are producing. Indeed, the measure has always been what's the input, eg, "are you giving everybody all this stuff," rather than saying "so what are we producing as a result of giving people all this stuff?" I believe these "templates" need to be more flexible, and focus more on the quality of the output.