Pediatrics Has a Branding Problem

In a recent interview with American Academy of Pediatrics (AAP) News, Dr Susan J. Kressly, current president of the American Academy of Pediatrics, urged all individuals who are committed to the care of children to “really promote the value of pediatrics.” Kressly also encouraged us to inform everyone we meet “about how health insurance works and how children are undervalued and pediatrics is underresourced and underpaid.” In the language of marketing, Kressly is essentially recommending a stronger effort to promote the pediatric brand, because if pediatrics continues to be undervalued and underpaid, the health of our children in this country is destined to continue its recent decline.

But do we have a brand? Before we try to answer that question, let’s first ask: Who is our target audience? In most business environments, the target audience is the consumer. However, in our health system, the consumer — also known as the patient — is seldom the payer, in the traditional sense. Therefore, the shortest path to increasing our value would be to target the major payers, such as insurance companies and the government, as Kressly suggested. For these payers, we must highlight the obvious fact that children in poor health are going to grow into adults with worsening health, and the failure to support pediatric health will cost this country far more than it should.

You could also argue that even though patients don’t directly pay for their care, if we can demonstrate the value of pediatric care to parents/patients, they will eventually put pressure on the major payers to address the situation. Although this may be true in theory, “eventually” could be a very long way off. Nonetheless, it doesn’t hurt to consider whether our brand is really working for us. 

So, what is our brand? If our focus is on primary care (where the situation is most critical), I suppose we would say our brand is the “medical home.” The medical home is a term that was first coined in 1967 by the AAP, and their policy statement published in 1992 further defined a medical home as “an approach to providing comprehensive care and high-quality primary care.”

The AAP goes on to say that the medical home should at its core be accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective. Of these other more peripheral attributes of primary care, continuity is the one which has been shown to increase vaccination coverage, improve health outcomes, and reduce hospital admissions and emergency department visits. Whether we call it a medical home or something else, the core of our brand is quality, accessibility, and continuity.

First, let’s take a closer look at what “high quality” means. The major payers are looking for performance metrics, such as immunization rates, hospital admissions, and prescribing habits (that some believe are correlated with the poorly defined concept of quality). However, let’s not lose sight of the fact that the payers must also focus on saving costs — so this concern is likely to influence their definition of quality.

Parents/patients are also interested in receiving quality care. But what criteria will they use to determine quality? Will they be satisfied if we just simply tell them their care will be better if they go to see a pediatrician? Do we have the data and metrics to support that claim? And do we have the ammunition to get into a public relations war with other provider groups if they contest our assertion? Many common pediatric illnesses (eg, cold and flu) are self-limited and often resolve without intervention. Metrics such as post-op infection rates and mortality statistics seldom apply.

From the parent/patient perspective, quality is often more of a popularity contest and is generally reflective of provider personality and customer service. If you take your child to the doctor for a sore throat, you’re probably not as concerned about whether the provider did a strep test or used an otoscope. You’re probably more concerned about whether your child was treated efficiently and effectively. Which brings us back to the other two core components of our brand. Have we been living up to the medical home’s claims of accessibility and continuity? 

When I hear complaints from parents, they generally fall into three major categories. First, parents often report that they find it difficult to get their questions answered. There may be a long wait to reach someone who will understand the question, and then another long wait until the answer is returned — leading them to suspect it may have passed through several hands. 

The second major complaint is that it can be extremely difficult to have their child seen in a timely manner, even for a minor injury or illness. It is not unusual for parents to be told to take their child to an urgent care center or the emergency room, even when their pediatrician’s office may have been open. The dramatic growth of pediatric urgent care centers (which now have their own journal and AAP section) is more than a subtle hint that the medical home brand is not keeping up with its commitment to accessibility.

The third most common complaint I hear from parents is that they seldom see the primary care provider they have chosen or been assigned to. Although they don’t have any major complaints about the physicians they end up seeing, they feel unsettled when they have to give their child’s history over and over again with each visit. This suggests that the medical home brand’s promise to support continuity in care is faltering as well.

So, does primary care pediatrics need a new brand, or does it just need to make a more robust commitment to supporting the one it already has? From the very beginning, the medical home has leaned too heavily on an unrealistic concept of comprehensiveness. Most small- to midsize practices I am familiar with simply don’t have the resources to provide in-house or even closely affiliated support services, such as social work and counseling. 

Parents/patients want accessibility. And there are solutions. The recent progress in artificial intelligence holds real promise in answering those hundreds of phone and email questions that can overwhelm even the most efficient triage nurses. Ambient scribe systems have been successful in freeing providers of some of the burden of electronic medical record entry. 

If a practice doesn’t offer appointments on weekends and some weekday evenings, it stretches the definition of accessible. Providing accessibility for those families that need to be seen during off-hours requires providers who are willing to work those hours. The growth of urgent care centers is evidence that those providers exist. Welcoming/recruiting those providers into a pediatric medical home could provide a double-win situation. The parents/patients get improved after-hours accessibility, and the practice can oversee the quality of that urgent care in-house. 

And continuity is more of a mindset. Parents/patients understand that they can’t expect to see the same provider with every visit. Providers have families and other obligations too. However, I’ve found that very few practices make (or maintain) a commitment that prioritizes true continuity — meaning the same provider, not just a member of the same team. This may require adopting practice policies that encourage providers to develop customer-friendly schedules. For example, providers who prefer to work part-time should be encouraged to see patients 4 half-days per week instead of 3 full days.

So, there you have it. Pediatrics does have a brand — it just needs some fine tuning, a recommitment to its core principles of accessibility and continuity, and a continuing emphasis on quality. I’ll leave it to the PR professionals to wordsmith it more eloquently, but perhaps the brand should be “compassionate and easily accessible care from the professionals who are committed to the healthcare of all children and who know your child best.” We can talk about quality all we want, but we need to start demonstrating real customer service.