SECOND OPINION

Shortage of Pediatric Primary Care Providers

In your opinion, would a shortage of pediatric primary care providers result in more children being referred to subspecialists?

4 Responses
Charles Elmaraghy, MD
January 6, 2016

It is certainly possible that children may be routed to specialists for problems typically cared for by pediatricians and primary care providers. We see this with ear infections and tonsil problems as some parents may bypass their primary care physician to be seen in Otolaryngology. This could affect our clinical volume by increasing the number of non-surgical patients seen with issues typically seen by a non-specialist.
Charles Elmaraghy, MD

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Bethany Peri, MD, PhD
January 6, 2016

Pediatric endocrinologists have already seen a rise in referrals due to a shortage of both primary care providers and the time that primary care providers can spend with their patients. Primary care providers have limited time and resources to be able to handle complex medication conditions and those that require significant time spent on education. One clear example is the obese child or adolescent. We have seen a tremendous rise in these referrals when the best care for this disorder is significant education and follow-up for the child and his/her family. As the primary care provider does not have this time, he/she refers the problem out to a specialist. This can be confusing to families, as it implies there is a medical problem when almost all obesity is due to excess calorie consumption. Families travel great distances for these visits when they would benefit from more frequent, close-to-home care.

There is also a shortage of pediatric endocrinologists, although this is not as obvious in metropolitan areas with large children’s hospitals. As we specialize in chronic disease, endocrinologists want to work together with primary care doctors to figure out the best strategy for caring for their patients. Often a phone call between colleagues may save health care dollars and the family’s time and enable the subspecialists to focus on those patients with endocrine dysfunction.

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Amy L. Dunn, MD
January 6, 2016

If there is a shortage of primary care providers, that would impact referral patterns. However, there is also a very real chance that there will be a shortage of subspecialists as well, which will compound the issue.

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Anup Patel, MD
January 6, 2016

I do think there will be an additional burden placed on all primary care providers. They will have even less time to provide patient care and serve more of a triage for issues which will potentially increase referrals to subspecialty care. It could lead to a higher number of inappropriate referrals that would potentially delay necessary care for children with epilepsy. I really hope this does not happen.

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