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Pediatricians Are Burned Out And They Are Pleading For Our Help

A remarkable new statement from the American Academy of Pediatrics draws a picture of how the pandemic pushed children’s health care to its limits — and what needs to happen now.

From collective screams to virtual kindergarten, the absurdities of pandemic parenting and its toll on kids and their caregivers can feel like old news. However, in a sweeping new statement on the impact of Covid-19 on pediatricians and the families they care for, the American Academy of Pediatrics (AAP) argues that we have only just begun to reckon with the hardships of those intense first years of Covid. But reckon we must — and urgently so.

Offering a prismatic view of what children and their caregivers experienced from March 2020 through May 2023, the statement makes the case that pediatric care in our country is in crisis. “The COVID-19 pandemic brought to light long-existing disparities and the historic underinvestment in children and those who care for them,” it reads. “The COVID-19 pandemic has additionally highlighted longstanding strain to systems of education and child care. Teachers, school staff, and child care workers have long served essential roles in pediatric health. The value of these services was fully recognized with the pandemic stretching these systems of pediatric care past their limits.”

Dr. Lee Ann Savio Beers, who was an AAP president during the pandemic and who contributed to the statement, tells me she considers the pandemic to be a “large, national trauma” — words that a doctor of her standing would not use lightly. But she emphasizes that the collective trauma is not the end of the story. The urgency of this AAP statement is rooted in a call for resources directed toward recovery. “You can have a terrible traumatic event that is buffered by supportive, kind, caring relationships and a supportive community — that makes a tremendous difference,” Beers says. “What’s important is how we all respond moving forward: the care we give each other and the resources and investments we make in that recovery.”

“I often joke that my main role in any meeting is to be the person who says ‘Hey, what about the kids?’” — Dr. Lee Ann Savio Beers, former AAP president

Typically, policy statements from the American Academy of Pediatrics are narrow in focus and measured in tone; and their purpose is both to offer its members guidance and to impact policy decisions made at a federal level. They cover almost any topic that impacts the “well-being of infants, children, adolescents and young adults,” and must be evidence-driven and nonpartisan. They are tirelessly vetted by the AAP’s board of directors as well as its membership of 67,000 pediatricians. The process of crafting them is a slow, exacting, bureaucratic dance. Finally, sometimes years later, they are reviewed by the AAP’s executive leadership and, if approved, published in the AAP’s journal, Pediatrics. Readers can trust that each word has been carefully chosen and is used pointedly. As with so much bureaucratic output, they demand that the reader reads between the lines — and some of that is simply knowing that words like misinformation, disinformation, and trauma are weighted, honed, and highly purposeful.

As a parent and writer covering parenthood in America today, I have read a lot of AAP policy statements. This one feels different. It’s the most emotionally resonant one I’ve ever read. If a bureaucratic body can be seen as making an impassioned plea, the AAP is doing so here. Whether lawmakers will rise to the occasion remains to be seen.

The statement makes the case that pediatricians need structural help to facilitate real pandemic recovery, and they cannot do it in a crumbling system of care. The case is laid out by meticulously documenting the avalanche of stressors that fell on pediatricians during the pandemic years — which the statement measures from the first official AAP communication about Covid-19 on Feb. 28, 2020, until the end of the official public health emergency on May 11, 2023 — when the already cumbersome burden of care that pediatricians carry was “exponentially heightened.” The result is near endemic burnout.

During the pandemic, many pediatric clinics closed under the financial strain of reduced operations, leaving the remaining practices with overwhelming workloads.

The field of pediatrics in general is framed as an underdog in the statement; there is clear frustration that the needs of children and families are often an afterthought for policymakers. “I often joke that my main role in any meeting is to be the person who says ‘Hey, what about the kids? Hey, what about pediatrics?’” says Beers. “As pediatricians, our job gives us a bit of a bird’s-eye view on how systems work for children and families, which is often not optimally.”

Particularly in the first year of the pandemic, the statement asserts, pediatricians offered treatment and expertise as best they could, trying to care for an anxious population of young families and pregnant people in what was effectively an information void. As they did, they juggled the stresses of moving suddenly to virtual care, implementing new protocols and workflows, as well as communicating these massive changes to the employees and families they served. Many pediatric clinics closed under the financial strain of reduced operations, leaving the remaining practices with overwhelming workloads. In fact, by 2022, hospitals reported that there were 32% fewer pediatric services available than there had been to the year 2000 because of the elimination of hospital-based pediatric services and clinics that had gone out of business.

Pediatricians, the statement adds, increasingly dealt with the “emotional burden of having their expert training and advocacy for their patients questioned and even vilified,” as masking and vaccination became highly politicized.

Meanwhile, pediatricians had to manage the demands of their own personal caregiving duties at home, as well as the stress of being at higher risk of catching Covid as health care workers. For pediatricians, who were often fighting uphill battles to care for families before the pandemic, it was a perfect storm. “It was important to make sure that [pediatricians] had the resources they need to take care of children during the surge,” said a previous AAP president who is quoted in the statement. “But it was also important not to forget that part of the reason we were in [this] situation is because we’ve been underinvesting in pediatric health care for decades.”

The health emergency may be over, but the impacts are only beginning to come to light. “Financial strain, personal losses from the pandemic, and the toll of regularly addressing misinformation and disinformation led to significant physician and staff burnout that continues to stretch the workforce to this day,” the statement concludes.

So what does the AAP suggest we do? Many of the greatest threats to the well-being of children, their pediatricians, and other caregivers are well beyond the reach of the individual. For example, the “social factors” that the AAP has identified as active threats to kids’ health — poverty, racism, discrimination, and violence — are forces that, the statement reiterates, must be addressed at a policy level. Increasing childhood immunizations and reopening pediatric inpatient units that closed or were reallocated to adult care during Covid are the kinds of systemic, structural changes that the AAP believes will create a healthier, more resilient system of care for kids and families postpandemic.

Individuals can make a difference, says Beers. She suggests that parents and caregivers can support pediatricians by raising these issues with local policymakers and by supporting organizations that advocate on behalf of children and families. On a one-on-one level, she suggests just expressing your appreciation of your pediatrician can go a long way. “As a parent, recognize that we’re really working with much more limited resources than we would like, and we really are trying our best to give everything we can to every patient, but sometimes the resource and systems barriers are really high,” Beers says.

Essential change and trauma recovery can happen on a community level, too, she adds. “Each one of us, as a community member, has a role in creating a positive environment for our youth and the families around us. Each one of us can share kindness,” Beers tells me. “It can be as simple as thinking about how you can contribute positively to creating a more supportive and healthy environment for kids and families.”