By Amy Mansue, CEO of Children’s Specialized Hospital
"The passage of the health care reform act was not the hard part—now the work begins." This message was articulated to the congressional staffers who work on Capitol Hill during a recent health care reform briefing. Over and over again, I, on behalf of NACHRI, drove the point home, as did representatives from the American Academy of Pediatrics and First Focus, a non-provider advocacy organization. The differences between strategies to address the needs of the newly insured children versus strategies to address the needs of adults couldn't be more different. Start with the basic fact that there is a critical shortage of specialists in pediatrics, where the biggest issue facing adults is how to access primary care. There can be a utilization of physician extenders in the short run until more primary care physicians are trained; there is no similar "quick fix" in pediatrics.
When staffers asked "why aren't physicians choosing pediatrics?" the answer was simple—it is all about math. There is no incentive to go through an additional decade of training to get paid less than what a pediatric nurse practitioner is now demanding in my home state of New Jersey. You can't pay your student loans, support your family, let alone live in the way you had hoped if you make this choice. The question isn't why aren't physicians choosing pediatrics. The question is for those who do, how are they affording it? The short answer is us. Children's hospitals are supporting fellowships and employing physicians and then taking on the losses when reimbursement doesn't cover their salaries. In order for us to be able to continue to improve the health of children, we have to be in business. The health care reform package which mandated that the reimbursement adjustment for pediatricians be equivalent to the Medicare floor is a step, but it is not the only step that needs to be made.
In the next 48 months, there will never be a more important time for N.A.C.H.'s voice to be heard and therefore we all must be vigilant in telling our message, over and over again. As the reality of 32 million people accessing the health care system hits us, there will be chaos and probably panic as the system strains to meet this new demand. We know that in these times of crisis that there are opportunities for those who remain steadfast in their message and focus to make progress that we cannot even imagine today.
Whether it’s continued participation in Hill advocacy efforts or other public policy work—never has there been a more important time to ensure that our message of creating the best possible health care system for children is heard above all the other noise in the halls of Congress. The voice of the voiceless will be ours to bear. And if we do it well, we will have invested in this next generation in a way that no other has done before.
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