A model of paediatrics: Rethinking health care for children and youth

Question 1

What is the current role of a pediatrician?

Answer 1

1. Provide emergency and critical care to acutely ill children and youth
2. Work in tertiary care hospitals and clinics
3. Provide consulting care in their offices or in regional and community hospitals, treating patients referred from diverse sources e.g. family physicians, nurses, and school authorities
4. provide comprehensive care to children and youth living with complex chronic conditions or developmental challenges
5. provide primary and preventive care in the community
6. work in community organizations such as children’s mental health centres
7. work in academic settings providing patient care while teaching medical students and residents, and/or doing research
8. work in administrative roles within hospitals and universities
9. work in public health departments and other areas of government
10. work in child protective services, assessing and treating children and youth who have suffered abuse or neglect

Question 2

What accounts for increasing pediatrician workload as per pediatricians?

Answer 2

1. increasing complexity of patient caseload
2. management of patients with chronic diseases or conditions
3. increasing patient expectations

Question 3

Why are the health needs of children and youth increasing and/or changing?

Answer 3

1. Many children now survive extreme prematurity
2. The number of children and youth with chronic conditions is steadily rising
3. the rate of obesity continues to rise
4. more children and youth experience mental health problems
5. many children with malignancies, chronic cardiac problems, diabetes and severe behavioral challenges receive their ongoing medical care in the community
6. many conditions that once required treatment in a pediatric teaching hospital are now being handled closer to home, coordinated by community pediatricians

Question 4

What care for acute and chronic health problems do children and youth need?

Answer 4

1. Appropriate hospital care
2. Newborn care
3. Critical care
4. Child/youth protection services
5. Palliative care services

Question 5

What specific populations have additional care needs?

Answer 5

1. First nations, Inuit, and Metis
2. Vulnerable populations: low SES, new Canadians
3. Developmental problems
4. Mental illness
5. Serious acute or chronic illness
6. Adolescents

Question 6

What are the recommendations for provincial/territorial governments and health care planners?

Answer 6

1. ensure access to a regular primary health care provider
2. the number of pediatricians required to meet the needs of children and youth should be established for each given jurisdiction and should specify those required for special populations
3. Consider the broad scope of pediatric expertise and leadership
4. meet the unique needs of communities
5. establish appropriate on-call services
6. facilitate health care teams
   7 re-examine models of remuneration
7. ensure access to appropriate care in a timely manner

Question 7

What recommendations are there for pediatric leadership?

Answer 7

1. ensure pediatricians play a leadership role in complex care
2. facilitate the involvement of pediatricians in undergraduate and postgraduate education
3. facilitate the involvement of pediatricians in continuing professional development
4. Ensure appropriate standards of care are in place
5. Transition of care

Question 8

What recommendations are there to ensure continuity of care?

Answer 8

1. ensure enough primary care providers in each region to provide services
2. a full complement of child and youth health professionals must be properly resources to meet health needs of children and youth
3. remuneration models must recognize the time required to provide optimal care to children with chronic or acute health care needs
4. remuneration models must recognize the contributions pediatricians make to education, research, public health projects, and continuing education