October 13, 2021
Note: This article originally appeared in the Fall 2021 issue of Under the Rainbow, the biannual magazine for children in Mississippi.
When the babies Dr Renjith Kalikkot is caring for come home, he is worried.
A neonatologist, Kalikkot cares for some of Mississippi’s smallest and most seriously ill babies at Children’s of Mississippi. Some of these children return home to towns and counties without a pediatrician.
“As neonatologists, we take care of premature babies and babies with complex medical conditions. Even after leaving the NICU, we have to make sure they receive continued care.
Paediatricians are trained in the specialized care of babies, children and adolescents. In some areas, pediatricians have expertise compared to other types of primary care providers, said Dr. Jeffrey Crout, professor of pediatrics in the University of Mississippi Medical Center School of Medicine.
“In infant feeding, for example, or in vaccinations,” Crout said. “There are areas where pediatricians are experts because they specialize in caring for children from birth to young adults.”
Dr Blair Batson, the first president of pediatrics at UMMC, “used to say that 2 days is different from 2 months, and 2 months is different from 2 years, and it’s different from 18”, said Crout, who studied under Batson at UMMC. “Each age has different needs.”
Pediatrics has changed since 1955, when Batson first arrived at UMMC. Children born with a low birth weight may not have survived. Decades ago, surgeries to correct many congenital heart defects did not exist.
“Years ago there wasn’t as much need for pediatric subspecialists because so many children with medical issues didn’t survive,” Crout said.
Today, neonatologists, pulmonologists, cardiologists and other pediatric subspecialists are helping children overcome medical crises to return home from the state’s only children’s hospital with their families.
Kalikkot wants babies to continue to thrive after they leave Children’s of Mississippi, and that includes getting pediatric and subspecialty pediatric care close to home, through telehealth, or at Children’s of Mississippi in the clinic space. Eli Manning Children’s and Kathy Clinics and the Joe Sanderson Tower.
“We need to make sure they grow and develop appropriately while receiving ongoing care with their pediatricians and other pediatric subspecialists like pediatric neurology, pediatric surgery, pediatric cardiology, pediatric endocrinology and pediatric nephrology, among others, ”Kalikkot said.
The needs of children who start life with medical problems can be countless.
“A significant number of these babies will need careful management of their nutrition and close, ongoing monitoring of their neurodevelopmental progress,” Kalikkot said. “They will need therapies such as occupational therapy, physiotherapy and speech therapy. Some of these babies are going home on oxygen or on home breathing assistance which requires close follow-up with the home ventilation and pulmonology team. , in addition to ongoing nursing care and medical supplies in the home. “
Children’s of Mississippi’s pediatric specialists follow infants who begin life in the NICU until the age of 2 to monitor their progress and ensure they receive the specialized care they need.
“If we are not able to provide their continued care, we will not be able to ensure that they grow and develop to their full potential, despite all the hard work we do at the NICU,” said Kalikkot.
“Pediatricians have a very important role in the care of these babies once they leave the NICU,” he said.
Although Children’s of Mississippi follows up NICU patients at a high-risk clinic, having a pediatrician near them can help ensure they receive the care they need. This can include nutritional management, growth monitoring, vaccinations and more.
“Pediatricians are able to provide a higher level of care,” Kalikkot said. “During the residency, they spend several months in the NICU and the nursery, which allows them to learn about the complex issues these babies face. Their focused training and knowledge enables them to provide ongoing care to complex issues. of these babies. “
Is there a shortage?
According to the United States Bureau of Labor Statistics, 27,550 people identified as general pediatricians in 2020, and thousands more provide child care as pediatric subspecialists.
Across the country and in Mississippi, there are areas that are pediatric deserts, where there are few or no pediatricians.
Crout noted that doctors often choose where to practice based on personal reasons.
“Like everyone else, pediatricians can choose where to live and practice depending on the amenities of the area, the quality of the schools and the environment,” said Crout. “They can look where they want to raise a family.”
At the state and national levels, paediatricians are not distributed evenly. In Mississippi, there are 24 communities with a single pediatrician in the area. Big cities like Hattiesburg, Biloxi, and Tupelo have more – 55, 26, and 29, respectively.
The city of Jackson has the largest number of practicing pediatricians, at 192, and its suburbs such as Brandon (60), Madison (122) and Ridgeland (48) have a good number of pediatricians available to families.
The state has 932 pediatricians looking after its children. These numbers are not enough, said Dr. Anita Henderson, president of the Mississippi AAP chapter.
“Less than half of the counties in Mississippi have an OB-GYN, and some don’t have a pediatrician either.”
The American Academy of Pediatrics, on its website aap.org, notes that there is a shortage of pediatric subspecialists and pediatric surgical specialists.
“The AAP believes that the current distribution of primary care pediatricians is insufficient to meet the needs of children living in rural and other underserved areas,” the organization says, “and more primary care pediatricians will be needed to future due to the growing number of children with significant chronic health conditions, changes in the working hours of physicians and the implementation of current health reform efforts that aim to improve access to healthcare. comprehensive patient and family centered care for all children in a medical center. ”
Specialized care nearby
To bring specialty care closer to the homes of patients and their families, Children’s of Mississippi has opened specialty clinics statewide. Experts in pediatric subspecialties including cardiology, neurology, pulmonology, orthopedics and more provide care at clinics in Tupelo, Meridian, Hattiesburg and Biloxi, in addition to Jackson at Eli Manning clinics for children and in the tower Kathy and Joe Sanderson.
The UMMC, recognized in 2017 as one of the only two national centers of excellence in telehealth, also offers online and telephone care.
These efforts are helpful, Kalikkot said, “to some extent.”
“A lot of these doctor’s visits require hands-on assessment and care,” he said.
A pediatric home
The best-case scenario is for children to have a pediatric home, a clinic where they receive care for sore throats and flu, where their weight and growth are monitored, and where they get vaccinated on time, Dr. Mary Taylor, Suzan B. Thames Chair, Professor and Chair of Pediatrics.
“Having this primary care provider who specializes in pediatric care is reassuring for parents and makes it much more likely that children will receive the care they need.”
UMMC strives to educate the next generation of pediatricians and pediatricians specialists and subspecialists. With research, education joins clinical care as a three-pronged mission of the medical center.
The number of pediatric residents at UMMC has grown to 16 each year, plus approximately five to six internal medicine / pediatric residents and one pediatric neurology resident.
Over the years, just over 50 percent of pediatric residents stay in Mississippi to practice after their residency ends. Why more don’t stay is a complex question, said Crout.
“Some go on the stock market out of state, and some return to their country of origin or settle according to their spouse’s place of work,” he said. “We love to develop our own pediatricians and hope those who take scholarships will come back and improve health care for children in Mississippi.”
This press release was produced by the University of Mississippi Medical Center. The opinions expressed here are those of the author.