California
Chapter 1
News Update February
1998
San Francisco Immunization Coalition
Pediatrician – an Endangered
Species
Adolescent Health: 1998 & Beyond
Chapter Retreat Summary
Letter to the Editor
Chapter Website
Children’s Health Award
In Memory of
Annual Spring Chapter 1 Meeting in
Monterey
1997-98 PL-1 Membership in the AAP
San Francisco Immunization Coalition
The development of vaccines has decreased many childhood diseases and conditions. Smallpox was eradicated worldwide by 1977 and invasive hemophilus influenzae B markedly decreased after 1988. “Iron Lung” due to polio, myocarditis or “bull neck” associated with diphtheria is rarely seen.
San Francisco’s Kindergarten retrospective survey shows the 2 year old immunization rates (4 DPT, 3 OPV, 1 MMR doses) as 49% in 1993 and 65.1% in 1996. Inappropriate intervals occurred in 11% of doses administered. Incidence of pertussis has risen and sporadic cases of measles, rubella (including congenital), and mumps still occur.
The 1994 Childhood Immunization Initiative created Health 2000 goals of 90% vaccination rates in 2 year old children by the year 2000 and decreased rates of vaccine-preventable diseases. In October 1996, the San Francisco Immunization Coalition (SFIC) met and established its mission statement:
“The San Francisco Immunization Coalition is comprised of diverse public and private interests collaborating to achieve and maintain full immunization protection for each child in San Francisco in order to promote community health and wellness.”
The coalition has 6 working committees:
This is a wonderful opportunity to network and exchange information among the medical community in public and private organizations. A “Virtual Shoebox” quick user friendly “Immunization Recall Tool” is being developed to identify those children behind on their immunizations, and catch any missed opportunities. An automated registry for San Francisco is in the planning stages and input is needed from the practicing pediatricians. If you are interested in participating in a committee, please contact Janet Zola (415) 554-2625, San Francisco Department of Public Health, or myself (415) 752-8038.
Pediatrician – an Endangered Species
By Tom Long, MD
It’s true. I heard it said. Now this is some paradox. Pediatricians are valued marketing features of every health care plan in these United States. Once the plan is sold the value of the pediatrician plummets. Or does it? This marks the 50th anniversary of the Journal of American Academy of Pediatrics. How many generations will our organization survive?
Edward O’Neil, Ph.D. from the UCSF Center for the Health Professions presented a Visions of Managed Care talk at the Annual Winter Meeting, Saturday January 17, 1998. The Bay Area and California are vastly oversupplied with specialty physicians and to a lesser degree with primary care physicians. Why is there such a health care need when there is such an excess medical supply? In the United States health care is a $1.1 trillion dollar industry, the highest per capita cost in the world and yet there is incredible need. Jackie Noyes, the Director of the AAP Washington Office made it clear that we have an opportunity to fix the system by getting involved in the legislative process. Our Children’s Health Award recipient Liz Figueroa, Assemblywoman from Fremont, clearly asked that we pediatricians help educate term-limited legislators about health care priorities.
These are just a few of the highlights of our Winter Meeting. The day was packed. Every speaker brought a poignant focus to the Pediatric Challenges of the 21st Century. None more so Richard Behrman M.D., who described an abused, neglected child Lucy and her premature compromised son, Jack. This young, modern day, single parent and her son represent the total failure of a system with excess resources, and a personal failure for every pediatrician who claims to be a Fellow of the American Academy of Pediatrics. Evolution and progress expect a failing system to collapse.
Soul searching was not the topic of the day. In addition to social and legislative challenges we had practical lessons in antibiotic quandaries and glimpses of computer applications for the future. Molecular biology applications as described by Bruce Blumberg, MD bridged the present day with a future beyond our imaginations. Childcare discussed by Peter Michael Miller, MD and real advocates for children such Drs. Cathy McDonald and Barbara Staggers rounded out the experience. Could you have been there? There was no talk about reimbursements or long hours. This was about advocacy for children, the role of a pediatrician, changing times – survival of an endangered species.
CME credit is the least important reason for getting together with your colleagues at any medical education meeting. Taking care of influenza is trying, and I know time consuming. That is what we do at this time of year. Colds get better. We need to take time and rub shoulders with one another and especially with some of our senior colleagues who truly put pediatrics into perspective and who will share with us a wealth of lore and love of children to pass along when it is our turn. Life and ediatrics take on a different perspective when you get a chance to mingle with Fellows, Pediatric Nurse Practitioners, and Family Practitioners from other regions. These acquaintances will afford better coalitions as Jackie Noyes recommended. One thousand seven hundred Fellows passed up the opportunity to hear the challenge, especially those who have practiced for less than 10 years.
Isolation will ensure the extinction of an endangered species. One week before the Winter Meeting, the Board of Directors and some proactive pediatricians met in a retreat to consider strategic planning. The mission, the goal is clear. We do have an opportunity to save the species – but only together. I hope to see more of you at our spring meeting in Monterey.
Adolescent Health: 1998 & Beyond
The Adolescent Health Project’s first annual conference comes April 16 and 17, 1998. Don’t miss this important opportunity to join clinicians, policy makers, youth service providers, and public health administrators in an open dialogue about the state of adolescent health services in the Bay Area. A multidisciplinary approach to prevention services and health promotion will be explored and emphasized. Call Jennifer or Anne at the Bureau of Children, Youth, and Families, SF Department of Public Health, (415) 554-8907 for information and registration materials. This conference is sponsored by the Adolescent Health Project.
Chapter Retreat Summary
January 10, 1998
These are some of the issues summarized at the recent Chapter Retreat.
Managed Care Position Statement:
What Managed Care Issues need to be addressed by the Academy?
Managed Care Policies That Need Immediate Change
How Can Academy Represent Interest of Pediatricians in Managed Care World?
External Objectives
Create an objective, which defines the ideal AAP position with legislative bodies
Create an objective that reflects the ideal relationship between the Chapter, District, and National Academies
Create three objectives for promoting healthy lifestyles for children, adolescents and their families
Create an objective that reflects how to work with Managed Care
Rik Kasuga, MD Burlingame
Yesterday, as Member-at-Large from San Mateo County, I attended a retreat for the board members of our California Chapter 1. Our task was to better define the goals of our chapter and to determine the best ways to implement those goals. As a result of the retreat, I felt a desire to write about what I perceive as a loss in the practice of medicine. And though it may not be obviously connected, I wanted to write about a personal gain that I experienced, as well.
Recently, pediatricians in my area have given up the privilege of caring for newborns at our local hospital. We have not technically given up the privilege, but we have, in spirit. At present, by the pediatricians’ request, a neonatology group provides the service of attending all high-risk deliveries and caesarian sections. In order to make it financially viable, the neonatology group also needs to bill for routine newborn care. As a consequence, if we use the group to attend deliveries, we give up the right to bill for routine newborn care, as well. I should make it clear that we had a choice. Our group (my side was outvoted), as well as all the pediatric groups that attend at our hospital, made a choice to give up newborn care. I understand the reasons: attendance at deliveries disrupts the office; attendance at deliveries disrupts sleep; attendance at deliveries is not adequately compensated; newborn care is not adequately compensated; care is better given by specialists.
Let me address the latter, first. The neonatologists oversee the care, but hired pediatricians give the care. Yes, if we give up attending deliveries, our skills will diminish and the hired pediatricians may better give technical care. But, at present, we not only have the technical skills, but also the ongoing relationship with the families, which I believe enhances the care given to our patients. Yes, our jobs are sometimes disruptive to schedules and sleep; but, if we do primary care, that’s life. Yes, we are not adequately compensated, but when are we?
What I am talking about is caring. What happened to the caring? This has been my loss. What about my gain? I would like to say at the outset, that deep down, I am not a committee type person. I don’t really like speaking up at meetings and, most times, I’d rather spend free time in private or with family. But, I look upon having had the opportunity to serve on the AAP California Chapter 1 board as a plus in my life.
Personally, it has been enriching. It has been inspiring to be around pediatricians who have a real commitment to advocate for children. It has been comforting to know that others are experiencing the same problems with managed care.
After a legislative meeting we had in Sacramento, I felt impelled to write letters to my assemblyperson encouraging her to support swimming pool safe guard legislation and anti-smoking legislation (I am usually not a letter writer). I’ve learned that change starts at the grass roots level and that making your voice heard does make a difference. As for my job evaluation, I feel that I have been more a Member-at-Small, than a Member-at-Large.
This letter is written, in part, to make up for what I feel has been a lack of outreach on my part. I encourage anyone who has any issues or concerns that they would like addressed by our chapter, to contact their Member-at-Large or me. In addition, if you have any inclination at all of becoming involved with this chapter, I encourage you to do so. In closing, you’ve heard about my pet peeve and what I perceive as a loss in my practice of medicine. You may think differently. Are “hospitalists” the wave of the future? I invite your opinion. Let us keep our chapter a forum for exchange of ideas and a place where “gains” can be achieved, both for us and for the children we serve.
The Chapter 1 Internet pages are active and changing almost daily. There has been some additions and remodeling if you have not visited in a while at http://www.aapca1.org. You can take at look at your representatives and committee chairpersons now. There are links to recommended websites and older issues of the News Update. We even started a section on Chapter 1 member websites as we learn their addresses from you. If there are ideas that you have about the Internet Website please contact Beverly Busher at the Chapter office or Mark M. Simonian, Webmaster.
Cathy McDonald, who has been tireless in her efforts on behalf of children and adolescents, was recognized for her commitment to the anti-tobacco campaign. Cathy prepared materials for the community pediatricians to enhance their anti-smoking counseling and has educated many more physicians in medical grand rounds presentations. Dr. McDonald has been at anti-smoking rallies and taken the campaign to the legislators in Sacramento assisted by some of her adolescent patients. Cathy is currently the chairperson of our Task Force on Tobacco and Youth. In addition she is a member of the National AAP Committee on Substance Abuse. We all do a better job because of Dr. McDonald’s interest and enthusiasm.
Liz Figueroa, State Assembly Representative from the 20th District in the East Bay was honored with a Children’s Health Award for the important role she has played to advance the health care of women and children in Sacramento. She guided the 48-hour hospital stay for mothers and infants through the legislature. That Bill was signed into law in August 1997.
As Co-chair of the Assembly Committee which produced the Healthy Families legislation she met with a number of pediatricians at the time of our Legislative Day Program. She met with us on short notice despite the hectic pace of the last days of the Assembly session. She understood our message and recognized the critical role which CHDP plays for our children. It could be the entry point for many children into the Healthy Families program without compromising continuity of care. She supported easier access to the Medi-Cal system via waiver of the asset test and encouraged that MRMIB (Managed Risk Medical Insurance Board) provide a broad scope of benefits for the newly insured. More than 500,000 children will benefit from her leadership and the new insurance programs.
New Positions Available
Board certified pediatrician available to do locums. NALS/NRP certified speaker Spanish will travel. Please contact Ann Troy, MD (415) 454-9997.
Well established Pediatric Practice for Sale, San Francisco Area. Please fax inquiries to (650) 570-5500.
Alfred Joseph Fisher, MD
A San Francisco Pediatrician who was well known and liked by members in the San Francisco pediatric community, and a regular attendee at Chapter 1 meetings.1914-1997
Carol Davis, wife of Joe Davis (our long-time, former newsletter editor and dear friend of Chapter 1) died on Tuesday. She was quite a lady. They had been married about 60 years. Their son, Lee Davis, is also a pediatrician in Santa Rosa.
Annual Spring Chapter 1 Meeting in Monterey
May 23-25 1998
Educational Objectives
GUEST FACULTY:
1997-98 PL-1 Membership in the AAP
For the second year in a row, we are very happy to announce that all of the PL-1s in Northern California have registered as members of the AAP. The support by each medical institution is greatly appreciated. The Academy and our Chapter look forward to having these housestaff members become active members of the AAP and active advocates for children.
Myles Abbott, M.D. and William Gonda, M.D. Co-Chairs, Membership Committee
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