Why parents aren't taking kids to the pediatrician

The Flora family no longer visits the pediatrician as often as they used to.

“We used to live in our pediatrician’s office,” said Jennifer Flora, 36, a Greensburg mother of three. “I would say, in the past two years, we have finally cut out the doctor visits, outside of yearly check-ups. I do find myself using (urgent cares) more frequently just because I can get right in and still pay the same amount.”

A recent JAMA Pediatrics study shows that the Flora family’s pediatric care habits are far from unique.

It showed that overall visits to the pediatrician declined by 14% — a number that reflects a 10% increase in pediatric check-ups and a 24% decrease in sick or injured visits.

The study’s lead investigator was Dr. Kristin Ray, an assistant professor of pediatrics in the University of Pittsburgh School of Medicine.

Krista Boyer, a 44-year-old mother of two who lives in O’Hara, weighs several factors before taking her kids straight to a doctor’s office. “It’s a combination of experience as their mom, kind of knowing when it’s worth the trip and when it’s something that will pass on its own.”

While Ray’s study wasn’t designed to uncover the causes of these trends, it discovered that visits to “acute care settings” — emergency rooms and urgent care centers — account for about half of the lost primary care visits.

“I don’t see those sick visits anymore,” said Dr. Joseph Trompeter, physician and owner of Carnegie Pediatrics. “They were seen very often at the same time that I was having office hours and had time to see them, but they go to the urgent cares.”

Marijke Kane, a Mt. Lebanon mother of three, prefers to use urgent care clinics, when she seeks care at all.

“I rarely take my kids to the doctor when they’re sick,” said Kane, 38. “I don’t feel like the doctors take the time: They do a simple ear check and then kick you out. I sometimes feel like MedExpress is more helpful.”

The use of non-pediatric urgent care centers should come with some caveats, according to pediatricians.

“An individual trained in adult medicine doesn’t, or shouldn’t, feel comfortable taking care of a 2-year-old or a 1-year-old,” Trompeter said. “But, they’re required to do so because of the nature of the urgent cares or the walk-in clinics.”

Dr. Scott Tyson is the owner and physician at Pediatrics South, which has offices in Mt. Lebanon and McMurray. He echoes those concerns.

“I think that the MedExpresses and Express Cares are not great certainly for kids under the age of 5,” said Tyson, referencing non-pediatric-specific urgent care centers. “I just don’t think they have the expertise. That would be like me seeing someone with chest pain. I just don’t have the expertise to do that.”

MedExpress officials say the health system works best when providers collaborate.

“At MedExpress, we strive to work closely with local primary care providers, including pediatricians, specialists, and area hospitals,” said Anne Jamieson, a MedExpress spokesperson. “Pediatricians, in particular, play an absolutely critical role in ensuring proper, healthy childhood development. Urgent care centers offer a convenient option, particularly on evenings and weekends, for timely, unscheduled, non-emergent issues.”

The JAMA Pediatrics study proposed cost as a potential reason for decreased pediatric primary care visits.

While the study looked at commercially-insured patients, high-deductible insurance plans and increasing co-pay costs have led to a 42% increase in out-of-pocket costs associated with ill visits, as the investigators found. And, worsening the problem, inflation-adjusted median household income increased by only 5% over the same period of time.

Sherri Mikula, a Pleasant Hills mother of three, understands this well.

“It began two years ago. So, we are in our third year with it,” Mikula, 40, said of her family’s high-deductible insurance plan. “I was shocked and ticked, but we don’t have much choice.”

More positive reasons for fewer appointments — like parent experience and education — may also play a part.

“I think parents know that if it’s a viral illness, they’re not going to get (any medication), so, they’re not going to come in,” said Tyson.

The trend identified in Ray’s study is one that Trompeter believes is only beginning.

“I think the trend is going to accelerate,” he said. “The McDonald’s philosophy of having everything ready and convenience and no wait is very important to a lot of people. So, I think the role of the pediatric primary care private practitioner, such as myself, is going to be constrained.”

Ray isn’t prepared to speculate about where the trend is going, she said, but she does look at this study as a jumping-off point for more qualitative research on how patients feel about their pediatric primary care experiences.

“If we’re seeing this decline in visits and families are feeling like, ‘OK, but my kids’ needs are still being met,’ then that’s fine,” said Ray. “But, if, increasingly, parents are feeling like their kids’ needs are not being met, then that’s something that I want to make sure that we’re aware of and trying to remedy and rectify.”