About one in five pediatricians dismisses families for refusing vaccines, and there is significant regional variation in the practice, according to a new study.
A 2012 survey of 282 pediatricians and 252 family physicians found pediatricians who dismiss families for vaccine refusal are more likely to practice in a private setting, to be located in the South and to reside in states without philosophical exemption laws or more difficult exemption policies.
The results are reported in “Characteristics of Physicians Who Dismiss Families for Refusing Vaccines” (O’Leary ST, et al. Pediatrics. Nov. 2, 2015, www.pediatrics.org/cgi/doi/10.1542/peds.2015-2086).
The survey examined among both groups of physicians the prevalence of parental refusal of one or more vaccines in the infant series; the physician’s response; and the association between dismissing families and physician-practice characteristics, state exemption policies and degree of difficulty in obtaining nonmedical exemptions.
Overall, 83% of physicians said that in a typical month at least some parents refused vaccines, and 20% reported more than 5% of parents refused them. If families refused one or more vaccines, 21% of pediatricians and 4% of family practitioners reported always or often dismissing them.
In states where philosophical exemptions are allowed, only 9% of pediatricians reported dismissing families for refusing vaccines vs. 34% in states that don’t allow philosophical exemptions. Proportionally fewer states in the South and Northeast have philosophical exemption laws than in the West or Midwest.
The regional variation in the results might be because physicians in states allowing philosophical exemptions could perceive vaccine refusal as more societally acceptable. So dismissal of families could be thought of as less acceptable, the authors said.
How practices responded to vaccine refusal also differed. Pediatricians were much more likely than family physicians to address vaccine concerns at a prenatal visit; ask parents to sign a form if they refuse vaccination; and advise parents refusing certain vaccines to inform on-call or urgent care physicians about their child’s vaccination status.
The Academy discourages the practice of dismissing families. A 2013 AAP clinical report says pediatricians “should endeavor not to discharge patients from their practices solely because a parent refuses to immunize a child.”
The authors noted several limitations to the study, including that the results were based on reported practices rather than actual observations. The issue is complex, and more research is needed on vaccine refusers and on pediatric practices, the study concluded.
“The study raises interesting questions in terms of what is the impact for all involved when you have a policy like this,” said lead author Sean T. O’Leary, M.D., M.P.H., FAAP, associate professor, Department of Pediatrics and Children’s Hospital Colorado, University of Colorado. “Do those children end up getting vaccinated or not? If they don’t end up getting vaccinated, you really haven’t accomplished much.”
However, Dr. O’Leary said the practice of dismissing families who don’t vaccinate “does send a strong message to families about how strongly you feel about the importance of vaccination.”