Survey: Pediatricians reeling from pandemic’s sustained impact

As the number of positive COVID-19 cases in children surpassed 1 million, pediatricians continue to grapple with the pandemic’s impact on their patients, practice, work-life balance and finances, according to preliminary data from the AAP Pediatrician Life and Career Experience Study (PLACES).

The new PLACES data provide a snapshot of COVID-19 issues affecting a national sample of 730 early and mid-career pediatricians in primary care practice who were surveyed in August through October. Those issues relate to practice and personal finances, impact on the practice community, and preparedness and access to testing and personal protective equipment.

Severe illness due to COVID-19 remains rare in children, and there have been 133 pediatric deaths, according to the AAP and the Children’s Hospital Association. However, the pandemic has taken a toll on the health of children, families, communities, physicians and frontline medical teams in other ways.

Eighty-six percent of primary care pediatricians surveyed have had patients diagnosed with COVID-19. See Figure 1 for estimated average severity.

Figure 1

Widespread concern was shared by nearly all PLACES participants about the pandemic’s social and financial impact on their practice community. Many commented that families are hard hit by financial and medical stress, and patients need help connecting with mental health services and other resources.

Pediatricians are experiencing high stress in their professional and personal lives during the pandemic, too.

“Having to be a full-time physician, full-time mom and full-time teacher during our surge was unbelievable,” said a PLACES participant who is a primary care pediatrician in group practice and mother of two. “I felt pulled in all directions and didn’t do anything well.”

Two-thirds of primary care pediatrician respondents reported practice visits are down. One-third of these pediatricians reported visits are down more than 25% since before COVID-19 (see Figure 2). Three-fourths are worried about the financial impact on their practice. One in four strongly agreed they are concerned about the financial impact on their family.

Figure 2

“Patient visits fell dramatically, and money flow stopped. My income was greatly impacted and continues to be now because my own children are not in school full time and I cannot work full time as a result,” said a primary care pediatrician in a small practice and mother of two children.

While 68% of primary care pediatricians agree or strongly agree that they are prepared to address clinical needs of their patients with COVID-19, just about half say they are prepared to tackle nonclinical COVID-19 needs of patients and families, including mental health and financial strain.

A majority of pediatricians had access to test kits, while fewer had access to all necessary personal protective equipment (PPE).

• 49% could access some PPE, 46% could access all PPE and 6% said they could not access PPE.
• 91% could access test kits for patients with symptoms, and 78% could access tests for asymptomatic patients. Results usually were available in three days or less.

The COVID-19 survey was sent to 2,711 PLACES participants, and 75% responded. Analyses focused on participants who provide primary care. The average age of respondents was 40 years old. Future analyses will focus on those who provide hospital-based care.

PLACES is an AAP cohort study that tracks the career and life choices and experiences of pediatricians across their careers. Cohorts include 2016-’18 residency graduates, 2009-’11 residency graduates and 2002-’04 residency graduates. For more information on PLACES, visit www.aap.org/places.