As we approach the end of summer and the new school year, we would like to take a moment to share some thoughts on the state of Westwood-Mansfield Pediatrics.
The past few years have presented enormous challenges that have created stress on everyone in our medical practice, our patients, their families, and the communities we serve. Everyone reading this knows how hard things have been and that we have all suffered. Add to this war, political unrest, inflation and economic concerns, and it is easy to see how we are all nearer our breaking points.
Westwood-Mansfield Pediatrics has worked hard to meet this challenging time. Among our successes we count developing a Virtual Visit program, providing COVID self-testing to patients, achieving high COVID vaccination rates in our patients, maintaining a high degree of staff retention, and rising to the challenge of an adolescent mental health crisis (more on this below).
We are proud of our team's efforts and appreciate the hard work that everyone in our office has contributed to.
We are aware, however, that there are some areas where our practice has struggled, most noticeably in limited availability of visits of all types (but especially acute/sick visits). We are sorry that we have not been able to accommodate all of the people who have called for appointments and have been working hard to improve this. We would like to explain some of the factors that have contributed to this failure.
But first, a word about aggressive behavior
Sadly, we have seen a significant rise in the mistreatment of staff members, mostly around appointment availability and the completion of forms. This behavior will not be tolerated.
We have instructed our staff that, should they receive any aggressive or abusive behavior, they are to end the interaction and report the patient to our practice manager. Upon review, patients or family members who are found to be inappropriate may be asked to leave our practice.
Additionally, we ask that all families allow 2 weeks for the completion of forms. Please be on the lookout for a future e-mail outlining an updated form policy.
Now, about the limited availability of visits...
Prior to the pandemic, it was very unusual for us to need to see a patient in the first 3-4 days of any fever or illness. We had a robust education program designed and dedicated to empowering families to care for their mildly sick children at home. Included in this program were our Home Strep Kits, Home Croup Protocol, Educational E-mails and Videos, and a very large team of triage nurses who were trained and instructed to spend the time needed to help families feel comfortable managing their child's illness.
Safe and effective home care advice has been a hallmark of our care since the founding of our practice, saving families both time and money. Successful home care also enables us to reserve office visits for more acute sick visits as well as for routine check-ups and mental health issues.
With the arrival of COVID, our entire model of practicing pediatrics had to be revamped overnight. Now, suddenly, kids with even the slightest of symptoms are being kept out of school and required to be tested for COVID. This resulted in huge numbers of minimally sick children (often those in daycare or preschool whose families are too young to remember the “before times” of our practice) calling for visits and filling up our daily availability (often early in the morning). Patients needing to be seen for testing (in order to return to school as soon as possible) therefore have needed to be shunted to Urgent Care Centers in order to be seen promptly.
With the advent of home COVID testing and relaxing rules for school attendance, the demand for visits has not decreased. Families have been resistant to the reassurance and self-management strategies provided by our triage team, requesting (and, often, demanding) appointments. Thus, while many of the illnesses we are seeing could safely and easily be managed at home (as they were pre-pandemic), they are now taking up visit spots.
In the next few months, we plan to begin re-emphasizing the importance of home care and to help families know when a visit is needed. In doing so, we hope to have better availability for those visits that would truly benefit from our care.
Adolescent mental health crisis
Last October, the American Academy of Pediatrics declared that adolescent mental health was a National Emergency. It is alarming and upsetting to see the rapid rise in teenage (and younger) anxiety, depression, eating disorders and self-harm. While Massachusetts is the state with the highest ratio of child psychiatrists to population, there is still nowhere near enough to care for all the kids who want one. As a result, primary care providers have become the front line of managing this epidemic.
In addition to our physicians and nurse practitioners, we currently have three behavioral health clinicians, one part-time social worker/substance use clinician, and one part-time psychiatric nurse practitioner (with advanced education in psychiatric prescribing) in addition to two full time support staff working on our behavioral health program.
Approximately 30% of our office time is now taken up by potentially life-saving behavioral health care. This rise in visit demand has taken away availability for other visits (making wait times for check-ups longer and same-day sick availability less). This is our front line and we are dedicated to providing this care. It does, however, contribute to the availability of our office visits.
Over the past year, we have had an unpredicted rise in retirement, change of career, and medical leaves amongst our providers. While we are very happy to have welcomed two physicians during this time (the excellent Dr. Emily Cross and Dr. Peter Roman!) we have, at times, been three or four providers short of our goal. We have hired two new nurse practitioners but, because all must be vetted and credentialed through Boston Children's Hospital, this process takes time (additionally, due to insurance company bureaucracy, it generally takes 4-6 months from the time of hire to the time they can start seeing patients).
We are constantly working and trying our best to provide the best and most effective care possible.
Remember that yelling and abusive language in the office or on the phone/email only exacerbates the problem!
While things have not been perfect, we are hopeful that the next few months will see improvements. Thank you for your continued patience!
We appreciate the trust and responsibility you place in us to care for your children.
All of Us at Westwood-Mansfield Pediatric Associates