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Assessing hospital involvement in pediatric primary care


Children’s hospitals are acclaimed for their outstanding care, and they would be my absolute choice for my child’s hospital needs. Nevertheless, there is a pressing concern that the underlying philosophy of these institutions is shifting, with financial pressures incentivizing competition rather than cooperation in the field of pediatrics. If hospitals were to dominate primary care, it could potentially exacerbate the departure from a value-driven approach, which is crucial for advancing superior care for a greater number of children across wider areas. At this critical juncture, our collective focus must be on fostering a philosophy of collaboration that upholds our dedication to excellence and value in pediatric care, thereby ensuring the well-being of all children.

In the realm of pediatric care, the sustainability of independent practices is increasingly under scrutiny. The notion that such practices can thrive in isolation, driving the transformation required for value-based care or population health, seems unrealistic, especially when considering the need to ensure access for the most vulnerable. There is a clear need for financial partners and investment, but the pivotal question remains: are these partnerships fostering the long-term enhancement of pediatric primary care?

Reflecting on my years on the hospital side of health care, I’ve observed a shift in the relationship between primary care and hospital systems. Starting as a pediatric emergency physician, then as a hospital-based service founder and leader of service lines, I’ve seen primary care move from the center stage of my early career—where interactions with primary care providers were frequent and personal—to a landscape where these connections are scarcely found.

The evolution has been stark: from a vision of collaborative pediatric care to a fragmented service offering. Hospitals themselves have developed urgent cares, telemedicine services, and primary care clinics that often compete with local providers. The emphasis has shifted towards specialized care, leaving primary care to face a future fraught with competition and a focus on service expansion over community-based care. Nonprofit motives have evolved into investment strategies that influence hospital decisions, dictating where and how resources are allocated and how competition with other hospitals and primary care providers is approached.

Seeking comprehensive insights

My experience is but one viewpoint in a vast health care panorama. Seeking a broader perspective, I engaged with a variety of experts, including artificial intelligence, to understand the implications of hospitals and health systems venturing into the pediatric primary care sector. Concerns have emerged:

Prioritization shifts. Hospitals may prioritize broad health care goals, potentially marginalizing the unique aspects of pediatric primary care.

Economic efficiency vs. care quality. The pursuit of economies of scale could compromise the specialized attention required for pediatric primary patients.

Resource allocation. Hospitals might funnel resources to more profitable departments, leaving pediatric primary care vying for necessary support.

Clinical autonomy. Pediatricians could encounter new limitations on their clinical decision-making due to overarching hospital policies.

Cost implications. The integration of services under health systems might drive up costs, impacting the affordability and accessibility of pediatric primary care.

Longevity of commitment. Health systems, while more enduring than private equity firms, might still divert attention from pediatric primary care based on profitability metrics.

Risk of standardization. As health systems grow, the personalized nature of pediatric primary care could be compromised in favor of uniform protocols.

Ethical dilemmas. The goals of large health systems could come into conflict with the nuanced requirements of pediatric primary care, posing ethical challenges.

Reflecting on pediatric primary care

Pediatric primary care is predicated on continuity and an in-depth understanding of patient needs over time—ideals that may not align with the strategic objectives of some health systems. The stewardship of pediatric primary care demands a mindful, patient-centric investment philosophy, which may contrast with the operational strategies of larger health entities. Hence, my cautionary stance is grounded in several considerations:

Service integration vs. specialization. Health care consolidation might dilute the focused and continual care that is the hallmark of pediatric primary care.

Service quality impact. Initiatives aimed at productivity could prioritize throughput over the quality of care, to the detriment of pediatric primary care.

Investment focus. Misaligned investment priorities risk neglecting the foundational needs of pediatric primary care in pursuit of broader financial goals.

Provider satisfaction and autonomy. Pediatric primary care physicians may face diminished job satisfaction and autonomy within the constructs of larger health system frameworks.

Patient cost concerns. The amalgamation into larger entities may escalate costs for patients, challenging the affordability of pediatric primary care.

Community health implications. Decisions by large health organizations significantly influence the local availability and quality of pediatric primary care.

Family-centered care preservation. The intrinsic family-centered approach of pediatric primary care must be safeguarded against the push for standardized health system processes.

Ethical priorities. Upholding accessible and equitable pediatric primary care is a moral obligation that should guide any integration with larger health systems.

Concluding guidance

Pediatric primary care physicians considering alliances with hospitals and health systems must engage in thorough due diligence. Understanding the commitment of potential partners to the core values of pediatric primary care is crucial. Discussions with colleagues who have undergone such integrations can provide invaluable insights into the breadth of consequences.

Informed caution is imperative. The ideal partnership for pediatric primary care is one that will nurture and protect high-quality care for all children, particularly those in underserved areas. Such a union will underpin the development and endurance of pediatric primary care.

Children’s hospitals, while delivering the best care, are not immune to the mission drift as financial pressures mount, nudging pediatrics toward competition rather than collaboration. If hospital systems were to take over primary care, the shift toward value-driven care could falter, potentially compromising the mission to deliver better care for more children across larger geographies.

Mick Connors is a pediatric emergency physician.






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