Most children get their health care from a primary care provider, known as a PCP, but when there are signs or symptoms of a more serious illness, the PCP often refer kids to a specialist. According to this month’s poll, it’s a common occurrence. Among the 1,232 parents surveyed in this poll, 46 percent report that at least one of their children has been referred to a specialist. But when asked about the process of getting specialist care for their child, parents had a wide range of views, says Sarah J. Clark, M.P.H. , associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics. Parents are divided over who is responsible for choosing the specialist: 52 percent say the PCP and 48 percent say the parent. They also differed in who should verify insurance coverage: 55 percent say the PCP and 45 percent say the parent. Forty percent of parents say the PCP should make sure the wait time isn’t too long for a specialist appointment, but 60 percent say that’s the parents’ responsibility. “This poll shows a wide range of views about who is supposed to do what, so it’s not unexpected that sometimes the process doesn’t work well,” says Clark. “If a referral is delayed or it doesn’t happen at all, a child’s health can be put at risk.” The poll also found that parents of children with Medicaid insurance coverage are more likely than parents of privately-insured children to say PCPs should be responsible for choosing the specialist, calling to set up the appointment, and verifying that insurance will cover the specialist care . Clark says this indicates that PCPs should understand that their Medicaid patients may have different expectations about their roles. Parents also were asked to rank the importance of different characteristics of specialists, and rated the following as very important: knowing how to take care of the child’s specific condition (89%) having training in pediatrics (80%) being affiliated with a highly-rated hospital (62%) being involved in research so child has access to latest treatment (50%) appointment time convenient for the family schedule (43%) drive time to the specialist (38%) other parents recommending the specialist (38%) “For a parent, hearing that a child needs to see a specialist is often cause for concern.
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The paradox of the unemployed medical specialist
He says the Royal College survey has a significant bearing on wait times, and acknowledges that many people will compare their own life experiences to the survey results, and find the whole thing absurd. aWhat a lot of people will say is awhat are you talking about?a My father has waited two years for his knee replacement, so how can you possibly have unemployed orthopedic surgeons?a Simpson says. aIt ties the wait times problem with the health human resources problem and the resources issue.a Simpson, who is also the president-elect of the Canadian Medical Association, says the Royal College study reveals the conundrum at the heart of the wait times problem. People wait a long time for treatment not only because there are often few specialists to go around, but more crucially because the resources the specialists need to complete the treatment cycle are not available. For surgeons in particular, the problem is operating room time. Simpson says a careful examination of the study shows that most of the new specialists who canat find work are in fields where hospital resources are needed but not available. The budget squeeze hospitals now operate under has forced them to cut back significantly, and now there is a cap on operating room time. The lifeblood of a surgeon is operating room time, but once what is available is taken up by the senior neurosurgeons, orthopedic surgeons or other such specialists, there is nothing left for new ones coming into the field, and they are left out in the cold. aEven though we have the physician resources to take care of the need, the physical resources and operating budgets to do the cases isnat there any more. The result is that wait times go up or fail to improve,a Simpson says. Dr. Sudhir Sundaresan, chief of The Ottawa Hospitalas surgery department, acknowledges whatas happening in the medical field today, and says dealing with wait times is not just about hiring more surgeons. The key to reducing wait times is to combine new hirings with more hospital resources so the specialists can work to their potential. aItas not as easy as hiring more neurosurgeons or orthopedic surgeons,a he says.