Thursday, June 17, 2010

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.


Unknown said...

Wow, that really is a shame. I think we will be seeing a lot more changes like this in the future with the economy in the state that it is currently. At least you do have other options to get your children the vaccinations they need to grow up healthy.

Eternal Lizdom said...

We also go to our family doctor and not to a pediatrician. We did the ped thing for the first 18 months of Teagan's life but I felt like a number and often felt that my questions were met with a mild disdain offered to first time, know nothing parents. I also felt like we weren't seen as individuals- everything felt scripted and prescribed. And I loved my doc and still do and now he treats our entire family.

And I don't know what I would if I couldn't get our vaccines from him anymore. Trying to schedule the time it would take to deal with our local government... that would suck a lot. My doc is part of a large network of docs through a local hospital so my hope would be that he could just partner with another office. But I'm also wondering if things like vaccines are puchased by the hospital network and not priced by unique location...

Sasha said...

I've used many services at our county health dept over the last few years- the child development specialist was invaluable to me while we were figuring little miss WC out. But she was recently laid off... they are down to one CDS and I just hate that because I knwo the caseload is huge.

We also used a more metro health dept for a closed-room hearing test. We recently found out that the audiologist got moved... they closed the hearing screening at that office and several others and consolidated it to the state capitol area.

I hate that all these cuts are happening..... I'm grateful for the services they provide because they are obv needed. But I hate that they aren't getting the funding they need to make that happen.

Lara said...

I tend to think the whole insurance industry in general is evil. I took mine to the Health Dept for vaccines and it was a lot simpler.

Unknown said...

That is a shame. It's sad...but I think we will be seeing much more of this. Good luck at the health department. I don't know about yours but I refuse to go to the one here; it's scary. I hope yours experience is much better!

Mellodee said...

I find going to a doctor who is a "family practitioner" is very reassuring. Specialists all tend to look at things only related to their specialty and totally miss unrelated but important information. Family docs are adept at seeing the bigger picture!

As for the vaccine cost issue....just another proof that American healthcare is just a mess, and getting worse!

SurvivorBlessing said...

Since living in American, I never had a family physician here. Only dealt with, and still only dealing with, specialists! And I can not say that I don't like it. I mean the pediatrician here is not as good as the one where we come from, but oh well.... I found the best oncologist that I can imagine!!! And my hubby is pretty happy with his numerous specialists.... We are just a 'special' family!!!