The Barriers to Implementing Change in Pediatrics (And How to Overcome Them)

Have you ever wondered why it is so difficult to get research into the exam room ?

Working in pediatric practice is a privilege, allowing us to profoundly impact lives. As pediatricians, we understand the immense value of preventive care – from routine screenings and counseling to early intervention. Yet, despite our best intentions, implementing these services effectively can be an uphill battle due to significant barriers:

1) The Time Crunch: The realities of running a bustling pediatric office leave little room for in-depth new initiatives or adoption. Between addressing acute issues, managing a full patient load, and handling administrative tasks, there's rarely enough bandwidth for one more workflow change.

2) Financial Roadblocks: Medicaid and commercial payers often inadequately pay for pediatric services, making it challenging for practices to allocate resources and staff to implement new initiatives. The focus inevitably shifts towards revenue-generating services that keep the lights on.

3) Knowledge Gaps: Staying updated on the latest research and evidence-based approaches requires ongoing education and training – a tall order amidst ever-increasing clinical demands and non-clinical checkboxes with little value.

4) Workforce Shortages: The shortage of pediatricians, pediatric sub-specialists, and support staff exacerbates the time crunch, leaving even less capacity for new care initiatives.

5) Difficult Conversations: Providers may experience anxiety about delivering potentially upsetting news, such as discussing mental health concerns, early diagnosis of incurable diseases, or unhealthy behaviors with families.

While these barriers loom large, they are not insurmountable. Overcoming them will require systemic changes, including:

- Improved payment models that value preventive care, early diagnosis, and disease-delaying or altering interventions

- Better integration of preventive services into clinical workflows

- Increased training opportunities to keep clinicians up-to-date and supported throughout their careers, such as ECHO or Mini Fellowships

- Addressing workforce gaps by addressing the burden and length of training, educational debt, nonclinical unfounded mandates like MOC or Prior Authorization, pay disparity between surgical and thinking specialties, and the use of technology such as NLP and AI to shift the clinician away from the clerical, repetitive task and towards building relationships and making the most complicated decisions or crucial communication.

A multi-pronged approach is essential, and each of us has a role in this effort. Prevention and early intervention is the cornerstone of promoting children's health and well-being. By acknowledging and addressing these barriers head-on, we can work towards a future where preventive care is seamlessly woven into the fabric of pediatric practice, leading to healthier outcomes for our youngest patients.

We invite you to join the conversation and share your valuable thoughts on overcoming barriers to preventive care in the comments below. Your insights are crucial in shaping the future of pediatric practice.