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What is one of the most important issues facing today’s pediatricians, and how would you work with the Board and CEO to address it?
Andrew D. Racine, M.D., Ph.D., FAAP
Bronx, N.Y.
One of the most pressing problems confronting practicing pediatricians today is the issue of burnout: the experience of emotional exhaustion and a lack of sense of personal accomplishment at work. The interposition of technology, particularly the electronic medical record, is an important contributor to this. Thanks to platforms designed by engineers, we have become the most expensive data entry people on the planet. What was once a source of joy and professional fulfillment can often now feel frustrating and alienating.
How can the AAP help? Calling upon our storied legacy of designing tools, policies and advocacy resources to address many issues vital to clinical practice, the AAP can sharpen its focus on to how to improve the use of technology in the office.
The recently created Center of Excellence on Social Media and Youth Mental Health offers an excellent blueprint. Young patients and families are benefiting from the expertise this center has marshaled to understand and guide interactions with social media. By convening a broad range of user experiences and offering nuanced, well-designed interactive resources, the center is having a nationwide impact.
Let us create a parallel enterprise within the AAP – a Center of Excellence that focuses on technology in practice: platform design and user interfaces to accommodate the needs of pediatric practice, workflow modifications to automate burdensome documentation, billing simplification and addressing acquisition and implementation costs. Such an AAP center can coalesce expertise within our ranks and in the broader digital community to help alleviate this pervasive source of burnout among pediatricians.
Dr. Racine at a glance
Professional titles
System senior vice president and chief medical officer, Montefiore Health System, Bronx, N.Y.
Executive director, Montefiore Medical Group, Bronx, N.Y.
Medical school and post-graduate education
M.D., New York University School of Medicine, New York City
Ph.D. (economics), New York University Graduate School of Arts and Sciences
Residency program and fellowship
Boston Children’s Hospital
Lily J. Lou, M.D., FAAP
Palos Park, Ill.
The biggest challenge pediatricians face today is the fact that our country’s decision-makers are adults. These policymakers, legislators and voters naturally support the services that adults need, and those include reasonable payments for adult health care when the very same services for children are paid at a substantially lower rate. This is true for general pediatricians and for pediatric subspecialists, who have committed extra time to their training and have deferred full salaries for additional years.
The challenge in making a living as a pediatrician is a significant reason we are seeing decreasing numbers in applications to pediatric residencies, along with workloads that are magnified by higher acuities, increasing electronic health record work and a growing understanding that balance and sustainability are key to a healthy and adequate workforce.
Strategies like the Pediatric Subspecialty Loan Repayment Program are important in addressing this inequity. The AAP’s major focus on Medicaid reform (with federalization) and equitable payment for pediatricians is essential. A solid system of support for the health of our children is clearly a good investment; the Academy can play an important role in shaping society’s understanding of The Unique Value Proposition of Pediatric Health Care.
I also think that some shortage areas are in subspecialities that have not crossed trainees’ minds early in their career navigation. The AAP could incentivize choosing to serve in areas of need by sponsoring internships in particularly scarce fields, especially in under-represented trainee populations.
Pediatricians deserve continued focus on the issue of fair payment.
Dr. Lou at a glance
Professional titles
Professor of pediatrics and director of government relations, University of Illinois Chicago
Medical school and post-graduate education
M.D., University of North Carolina School of Medicine, Chapel Hill
Residency program and fellowship
University of Minnesota Hospitals & Clinics, Minneapolis
Fellowship in neonatal-perinatal medicine, Yale School of Medicine, New Haven, Conn.
Fellowship in medical education, University of New Mexico, Albuquerque
