On PedTalk a pediatric mailing list for those that don’t know – another discussion erupted concerning vaccines. As usual, the topic was about insurance companies not compensating pediatricians enough to cover the cost of vaccines. One person asked why pediatricians were not fighting this issue and why the American Academy of Pediatrics was not doing more to help pediatricians in this regard.

Dr. Hershel Lessin responded… and boy did he respond. I thought his response was so good, that I asked his permission to repost his comments on the blog.

It was important for me to share this discussion as well as Dr. Lessin’s response because I think:  1) the discussion brings awareness to a fundamental challenge pediatricians face, which is, vaccine management; 2) the response also brings awareness to various resources (from the AAP) designed to help pediatricians with this very matter; and 3) Dr. Lessin’s response is a much needed tough love.  And who better to give the tough love than a colleague.

Below is his reponse.

For those who do not know me, I am the lead author of the vaccine coverage policy statement published in Pediatrics in June.  I am a member of a large pediatric practice full time. I am on the executive committee of SOAPM and the editorial board of PMO. I also lecture extensively on vaccine economics, Practice Management and Medical Liability, including recently at the NCE in San Francisco last month.

As the comic strip POGO said decades ago:  We have met the problem and it is us.

Us being pediatricians.  The AAP is working extensively to help this situation.  We have national interfaces with payers. We have established state and local pediatric councils to meet with payers. We have revised the policy statement to recognize all of this issues you

mention. We have SOAPM (Section on Administration and Practice Management) which any AAP member can join for a paltry $35/year for which you get literally $1000’s of dollars of free consulting advice. We have Practice Management Online where nearly everything you need to know about vaccine economics is located. We have developed the business cases for vaccine payment and vaccine administration posted on PMO.

Yet despite all of this, what happens?  The vast majority of Pediatricians pay no attention whatsoever and seem to go out of their way to avoid acquiring any business knowledge whatsoever. As health care economics gradually destroys pediatric primary care, this has improved to a small degree. SOAPM, the only section of the AAP that is growing, has only about 1000 members out of the 60,000  US pediatricians, all of whom, regardless of practice setting ought to be members.  PMO is used a lot, but nowhere near the amount necessary.

Why?  Because pediatricians somehow think paying attention to business is somehow “dirty” and that administration is “simply pushing paper”.  The payers know this.  They reason they do not act is because for everyone in SOAPM, there are 6 pediatricians down the street willing to accept whatever they are offered until they can no longer make  payroll, thus destroying any ability for pediatricians who understand economics to negotiate.


As I say in all of my talks: “Doing Good and Doing Well are NOT mutually exclusive.  Until pediatricians are willing to do more than complain, until they are willing to get educated, until they are willing to join AAP and SOAPM, until they access PMO, until they do not sign every contract that crosses their desk without reading it, until all of this happens, nothing will change.

Payers are businessmen. They are not necessarily (with a few notable exceptions) evil. They do what is needed to assure the health of their business and their shareholders. Pediatricians do not. In fact, we do not even recognize why this is important.

Until we realize the saying:  NO MARGIN, NO MISSION, we will gradually be forced to close our doors. Who will care for the children then?

Time to stop complaining and wake up to reality.  There is no one that help you unless you choose to help yourselves.

What are your thoughts? Do you think Dr. Lessin is right? Does he have it wrong? Or do we all need to wake up and get on board?

Photo Credit: *TreMichLan*

7 thoughts on “This is our core problem: OUR RIDICULOUS ATTITUDE TOWARD BUSINESS”

  1. Bravo to you and Dr. Lessin!
    This clueless attitude toward the business end of health care is why all of us are in the mess we’re in…low reimbursement rates, ridiculous systems to actually get paid, etc. We simply sign all those contracts, lament the unfairness of it all and drive ourselves into the ground. As soon as I stopped taking all insurance, telling patients to advocate to their ins. company on their behalf and insisted on making a decent hourly wage, everything fell into place in my practice.

    Empowerment is a wonderful thing, but it takes courage, doing what others are not and pushing back in ways that I think most of us who trained for over a decade to get the “A” and approval from those in power are very uncomfortable with an unaccustomed to. Hopefully the more of us who start these discussions, the more empowered health care professionals will become.

    1. Well said Susan.

      It is a drum beat that we have to continue beating. Thank you for stopping by and leaving a comment.


  2. Brandon- you are so right. My father was a Pediatrician in a sole practice who cared so much about his patients but not so much about making money. It can be a good thing for the soul but not so much for the family. When it came to real estate, he wanted the best. Why pay for the best toilet on the market? My company handles real estate for physicians. We help them get the best deal for their practices. Doctors need to do what they do best, practice medicine and listen to the business experts on business topics. Delegation is a wonderful thing to handle things you don’t know about.

    1. I encourage delegating, outsourcing and getting consultants to help out with the business. However, to Dr. Lessin’s point, pediatricians need to be more engaged with the business side of their practices.

      Thank you for your comments Lee


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