The Pandemic Pediatrician: What We Know Now

William T. Basco, Jr, MD, MS


December 04, 2020

The Effects of the Pandemic on Pediatric Practice

A recent brief report from JAMA reviewed clinical visits to community health centers across 21 states. Although business activity in the first 2 months of 2020 was essentially unchanged from the same period in 2019, to no surprise, that changed dramatically when comparing March with May in the 2 years. Almost every type of clinical visit for preventive care took a marked dive in 2020.

Although the initial decline in preventive care included adult preventive care (A1c tests, mammograms, etc.), the data for children were what frightened me. Completed well-child visits dropped by almost half! I suspect most of us experienced similar precipitous drops in patient volume during the same time. However, the missed opportunities to vaccinate and screen for developmental problems are exactly what Dr Christakis discussed in his essay I cited previously.

More worrisome are recent data released from The Commonwealth Fund. Their estimate of ambulatory clinical visits, updated through mid-October, underscored this concern. They noted that when all ambulatory providers are taken together, visits nationally have essentially returned to prepandemic levels. However, for 3- to 5-year-olds, visit rates are still 10% lower than they were before the pandemic. For the youngest kids, those younger than 2, visit rates are still almost 20% lower than they were before the pandemic.

Obviously, children in these age groups make up a large portion of the visits to any pediatric practice, and it also means that a disproportionate number of those missed visits were likely well checks. Ironically, visits to dermatologists are now 17% higher than prepandemic levels, and adult primary care visits have increased 13% above the prepandemic baseline.

Knowing about the changes in visit volume won't necessarily help your individual practice recover. But it does provide evidence that if it has been difficult to get your youngest patients back into the office for these important visits, you are not alone.

William T. Basco, Jr, MD, MS, is a professor of pediatrics at the Medical University of South Carolina and director of the Division of General Pediatrics. He is an active health services researcher and has published more than 60 manuscripts in the peer-reviewed literature.

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