Vaccines, family doctors, and health departments

I just made an appointment for next Tuesday for my kids at the county health department, to get a couple of vaccines each. (Shh--don't tell them!) We've always gotten vaccines done at the doctor's office, but the family physician we use is discontinuing most of her childhood vaccines.

That sounds weird, huh?! Vaccines tend to be a pretty major part of childhood well checks. But this article from the American Association of Family Physicians makes it clear that it's becoming more common for family physicians in America to stop offering childhood vaccines.

You might think this had something to do with the ongoing vaccine safety debate. Nope. It's about money. You see, our nurse explained to me that some vaccines cost them over $100 a dose! That means that once they get reimbursement from insurance companies, they are often losing money doing vaccinations. That's just crazy!

So my doctor's office is sending us to the county health department for immunizations. Get rid of the insurance middle man--everyone there either gets free vaccines (if their income level qualifies them for that) or pays $10 per child, per visit. And if you don't officially qualify for free vaccines, but can't pay the $10, they'll still give the shots. There are probably a lot of tax dollars subsidizing this, but I bet the county is also paying a lot less than $100 a shot, with the volume they have to purchase.

It's okay with me that we have to go to the health department. We go to a small family practice with one doctor, and family physicians who own their own practices don't usually make a whole lot of money. I certainly don't want our wonderful doctor losing money by vaccinating my children.

But it just seems like there's something wrong with this picture. Shouldn't our primary care physician be able to give us basic care, including routine vaccinations? I'm not even sure if it's the pharmaceutical companies or the insurance companies who are more at fault here, and I certainly don't know what the solution is. But family physicians fill such a wonderful niche in our health care system. I wish they weren't being pushed out of the vaccination business.

For the first two years of her life, Chickie went to a local pediatric practice. It was a good-sized practice, with an adorable office. If we were still going there, the kids would probably get their vaccines in the office. They're probably in the position to buy enough doses to keep it affordable.

But we just didn't get the same type of service there that we get at the little office of our family doctor. Our doctor is friendly, gentle, and knows us. Our whole family goes there (with The Engineer alternating between her office and a clinic close to his work.) I always have time to ask the questions I need to ask. Our Christmas card is on the wall of the child examination room!

So we're sticking with our family physician. But according to the article I read, some patients are leaving their family physicians because their doctors can't afford to keep doing childhood vaccinations. That's hard on families and on doctors. Dr. Andrew Macintosh in Ohio put it this way:

Offering pediatric care in a family setting is what keeps me going in my practice. A well-child check erases the pain of seeing the patient with 15 meds and twice as many complaints....Children provide young, motivated patients that make the job more fun.

I hope that something changes, so that family doctors can keep doing what they do best--treating whole families.