In the 26 years that I have practiced pediatrics, the landscape has changed considerably. Children with life-threatening conditions are living into adulthood. Prevention of illness through standardization of evidence-based guidelines in practice has informed a view of health from a population focus. Discoveries in genomics, pediatric pharmacology and pediatric devices promise new understanding and treatment of disease.
Yet, both our children and our pediatricians have significant challenges. The rate of childhood poverty is at its highest in two decades. Families are struggling with increasing economic and environmental threats. Pediatricians feel discouraged by all these changes, including excessive data entry in systems that do not communicate; programs designed to improve care that actually distract from care; measures dissociated from how pediatricians practice; screening for multiple determinants while developing a therapeutic relationship with a family; and managing all this in an era of increasing market competition from sources of questionable quality.
To paraphrase Andy Slavitt, acting director of the Centers for Medicare & Medicaid Services: We have to get the hearts and minds of pediatricians back. I think we’ve lost them.
My focus as president of the AAP will be to “empower pediatricians on behalf of children.” While the AAP will continue to be the voice for our most vulnerable citizens, we need to advocate for technology that is user-centric, capable of integrating practice electronic health records for communication and population health measurement, and relevant to pediatric specialty and primary care practice. We need education for pediatricians regarding value-based payment and implementation of practice changes that prepare us for measures of outcomes and cost, rather than relative value units. We need to leverage high-functioning chapters to mentor those who desire this training using AAP chapter liaison positions. And finally, we need to work with the American Board of Pediatrics on measures of practice change that reflect the spirit of Maintenance of Certification Part 4, adopting, adapting or abandoning what exists in the current program in response to the concerns of our AAP members.
Our greatest strength lies in the hearts and minds of our pediatricians. As AAP president, I will work to realize our organization’s value to our members to be empowered on behalf of children.
Dr. BradyMichael T. Brady M.D., FAAP
Despite new technologies and remarkable biomedical advances, fundamental challenges remain for children’s health and the profession of pediatrics. Attending the Annual Leadership Forum (ALF) reinforced my belief that AAP and its members are best equipped to meet those challenges. The resolutions at ALF focused on the most pressing issues for children, targeting the most vulnerable, such as children in poverty, undocumented immigrant children, and those exposed to violence, drugs and other toxic stresses.
As president, I would use that platform to create best strategies ensuring essential health care for all children and advocating that it is delivered by those best prepared to provide it: AAP members. Since many of the root causes impacting children’s health are not within the control of pediatricians or the AAP, it is imperative that we work diligently to identify and engage external partners. Together, AAP and those partners can collaborate to provide necessary resources and eliminate barriers so children have equal access to services helping them achieve good health and optimal development.
As pediatricians, we know the best care for children occurs in the medical home. As president, I will work tirelessly to ensure that the medical home is valued for delivering optimal care and providing it cost effectively. As health care financing changes, the medical home must be established as the focal point of future delivery systems with appropriate payment to ensure pediatricians have the time and resources to address all essential health care needs of children. To accomplish this goal, services provided by the medical home need to be expanded and paid for appropriately. Financial disincentives to discourage care outside of the medical home should be one option.
The AAP is the premier advocate for children. To maintain this legacy, the AAP must engage all members, particularly young physicians. As president, I will work to help members recognize the value of the AAP to them and their practices. We will develop strategies that encourage greater member participation in local and national activities and provide opportunities and training for leadership. Most importantly, AAP will continue to supply the support and resources needed to help pediatricians address their clinical and financial needs.