As I complete my sixth and final year as Chairperson of District IV, and wind down my campaign for President-elect of the Academy, I must reflect upon the opportunities I have had to participate in all five District Meetings in 2007.  There are three topics that stand out for me as I think about all that I saw and heard during these meetings:  1. An awareness of what our colleagues in the armed forces are experiencing in their daily lives; 2. The chaos that exists in our Chapters as they struggle to assist pediatricians in negotiating fair payment from private and public sector third party payers; and, 3. The power of the “open forum concept” as a mechanism through which Chapters can reach their goals.

During the Districts I and X Meeting in Burlington, VT, a presentation by pediatricians of our Uniformed Services East Chapter included an overview of military pediatrics, the plight of the families of deployed service men and women, and the tragic effects the wars in Iraq and Afghanistan are having on children who reside in those countries.   As a pediatrician who has never served in the armed forces, I was humbled by the sacrifices being made by all members of our armed forces, and felt an obligation to at least contact my local military base pediatric clinic to see what our practice might do to assist the families of deployed individuals.  Many of these families need community-based mental health, and other health and human services that we understand better than the health professionals who work on base.  I was also inspired to commit my time, talents, and energy to making sure that all our children become the “best that they can be,” to assure a strong future for our troubled nation.

During all of the District Meetings, pediatricians expressed extreme frustration with Medicaid, SCHIP, and private insurance plans, and a feeling of hopelessness as the profession of pediatrics finds negotiating with these payers to often be impossible.  I think our Chapters need to form larger alliances within the “house of medicine,” by becoming actively involved with their state medical societies.  State medical societies usually have more money, staff members, and political clout than individual Chapters.  There are often health insurance, Medicaid, and SCHIP experts, along with state government lobbyists within the medical societies that can assist all physicians in addressing third party payer issues.  “Physician Advisory Groups” are mandated by Medicaid and the state medical society is the perfect group to assure that physicians are as involved as possible in the decision-making process within Medicaid.  This group could also become an expanded “pediatric council” to assist all physicians with private sector advocacy challenges.  I think the days of pediatricians negotiating alone with third party payers are over, and we must broaden our horizons if we are to be successful in assuring the survival of the practice of pediatrics as we know it.

I was pleased to see a growing interest in the “open forum concept” that the NC Chapter has utilized with great success for about 40 years.  This organizational model for Chapter meetings involves regular meetings of a large group of child health stakeholders (community pediatricians, academic pediatricians, state government administrators and officials, allied health professionals, lay child advocates) in different geographic locations within the Chapter to discuss child health issues and to develop action plans for addressing child health problems.  During these meetings, state government administrators and leaders explain their child health programs to attendees and make attendees aware of the needs of state government, identifying specific needs that can be met by pediatricians.  Pediatricians and other attendees are invited to provide the state government administrators and leaders with suggestions for improving child health.  During these meetings, problems are identified, action plans are formulated, and attendees are encouraged to lobby accordingly for action plans that require state legislation.  In reflecting upon paragraph #2 above, state medical society leaders and staff could be invited to attend the open forum sessions.  The Academy’s Department of Community, Chapter, and State Affairs, led by Judy Dolins, MPH (jdolins@aap.org), has resources to support Chapters in their efforts to implement the open forum concept.

I welcome your input on these issues and any others that may need the attention of the AAP leadership.  It has been a pleasure for me to serve as your District Chair for these last six years.

dtayloe@aap.org
919-580-7209 (office)

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