Pediatricians are losing a turf war

I am responding to Dr. Horst D. Weinberg’s thoughtful and well-elucidated letter to Contemporary Pediatrics (“Pediatrics, then and now”; Contemp Pediatr. 31[2[:10-12).

I have been in private practice pediatrics since 1983. Dr. Weinberg probably spent many years in an era of medicine that was peaceful and without the intrusion of government and the health insurance industry. I remember the first managed healthcare company that wooed our group practice. We were naïve. We didn’t investigate. We didn’t have an attorney read the contract. Yes, it was our fault. Maybe the American Academy of Pediatrics (AAP) should have warned us of the risks of signing up with the evil empire, but who knew. If only we all had held our ground and didn’t sign with them, perhaps our world would be different than it is today, where the government and insurance companies hold our patients hostage, tell us how to practice medicine, and force us to have large overheads to run our practices and collect the elusive and stagnant fees that are due to us.

I agree with Dr. Weinberg that the AAP seems to turn a blind eye to the plight of the practicing pediatrician and focuses mainly on the academic world of pediatrics. If not the AAP, then who should carry the torch for pediatricians and pediatric subspecialists? The AMA?

We pediatricians have unwittingly allowed this to happen. Like Dr. Weinberg, I don’t see any solution[s] because government and the health insurance industry are so closely intertwined. There is just too much money involved. Basically, it is a turf war that we have been ignoring and losing.

Dr. Weinberg points out that we pediatricians don’t treat the patient problems from beginning to end in a disease process, and he may well be right. I[W]e need to see volume on a day-to-day basis to make ends meet. How do you evaluate a patient with new onset ADHD in 15 minutes or even 30 minutes? A new-onset type 1 diabetic is handled much more efficiently by the pediatric endocrinologist.

In spite of all of this, I truly enjoy my patients and families, and love the actual practice of pediatrics. That has not changed. The love of medicine is bound tightly with a quest for knowledge. The new generation of physicians will still this quality, and will be indoctrinated into the business of medicine as their careers progress. If young people steer away from medicine because of the problems we might have prevented, then a great disservice will have occurred. [Only we] can make our professional lives better, and as a united group we should find a way.

Innis O’Rourke III, MD

Glen Cove, New York