8 DECEMBER - 2022IN MY OPINIONAs most of us know, in March of 2020, pediatrician and primary care offices across the US saw a drastic drop in patient visits. During those early days of the pandemic, stay at home orders resulted in families postponing routine well care, while routine childhood illnesses were reduced thanks to measures including social distancing, masking and remote schooling. The reduction of visits had immediate financial effects on physicians with eight out of ten pediatricians responding to an American Academy of Pediatric survey in April 2020 reporting they had decreased their office hours, six out of ten reporting they had closed some offices or reduced services, and most reporting they had increased their utilization of telehealth. Throughout this time, physicians had to make tough decisions, with many laying off and/or furloughing staff in order to preserve cash. The US Bureau of Labor Statistics reported a staggering 1.4 million healthcare jobs lost during April of 2020, mostly in ambulatory healthcare services. Fast forward to the fall of 2021, and while pediatric primary care practices have generally rebounded financially from the early effects of the pandemic, the challenges have continued. And although the desire to return to normalcy has been strong, with Delta becoming the dominant variant across the US, recommendations reverted back to more stringent personal protective equipment in healthcare facilities. Throughout this period, many organizations continuously revamped practice operations including new processes such as offering separate spaces for well and sick visits, implementing virtual or telephone check ins, developing parking lot flu vaccinations and offering COVID testing services. As normal community activities, including in-person schooling, have resumed, so has the need for COVID testing, sports clearances, and routine well visits. Even more challenging has been the growing behavioral health needs among young patients. The number of children experiencing mental health emergencies has increased so rapidly that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association recently declared the issue a National Health Emergency. These groups, comprised of more than 70,000 doctors across the US, report that the toll of isolation, uncertainty, fear and grief have resulted in a mental health crisis among young Americans. In some areas, the combined issues above have led to record pediatric primary care visits, during a time when practices are struggling to find staffing. Before COVID, pediatricians, nurses and medical assistants were already in short supply, and with the increasing demands on healthcare workers, the situation has gotten worse. Even in top ranked healthcare hubs such as Massachusetts, the shortages are being called one of the worst US healthcare labor crisis in history. This perfect storm of high patient demand and a shrinking workforce is adding to the overall burnout of clinicians and other healthcare workers and in some cases Pediatric and Primary Care Healthcare Challenges into 2022By Leah Bozza, MBA, CMPE at Boston Children's Hospital Leah Bozz
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