family practice versus pediatrician

As I write this, I am in route to the American Academy of Pediatrics National conference in San Francisco. I will spend four days immersed in myriad aspects of child health. As a family practice provider on Maui, I care for all ages, but I am excited to enrich my medical ‘know how’ specific to my littlest patients. Most of the other attendees are pediatricians, which made me consider the other options parents have in where to bring their children for medical care.

I often hear of parents carefully considering their choice of pediatrician, or other qualified health care provider for their child. I see them seeking advice on Facebook and asking other moms about their experiences. As I prepared to discuss these options, I thought back to my experiences with my own four children, prior to my formal medical education. I graduated around my 44th birthday, so during my early years of mothering I was not a licensed health care provider.

I only had regular pediatric well checks with my first child. I carefully followed the “horrible” advice given to moms back in 1977 e.g., spoon fed my baby at 2 months, etc. (Now as a clinician, I love doing well child checks. I feel there is value in addressing day-to-day parent questions and offering health related “anticipatory guidance”.) By the time my oldest daughter was two, we lived near Hana and were patients of the family doctors at Hana Clinic. With the rest of my four children, I skipped the regular check ups and only made sick visits with family practice doctors. I sometimes consulted pediatricians for more complicated  issues. Perhaps my second daughter’s “disabilities” might have been addressed sooner if she had had regular check-ups.   

In Hawaii, most families work with pediatricians, and some people don’t realize that other healthcare providers are also qualified to treat children. Family Practice physicians, nurse practitioners, and physician assistants are all trained and licensed to care for babies and children. Likewise, naturopathic doctors’ training includes pediatrics.

Pediatricians spend years in a pediatric residency after their general medical training. They have extensive training in normal development and parenting concerns, as well as expertise in disease and injuries. They see all children, all the time, lots of them, and they see all kinds of unusual pediatric health conditions. If your child has it, they have probably seen it before. On Maui, virtually all of the pediatricians work at the large medical groups. This can mean that getting called back may involve several staff members. Access to your child’s doctor may be difficult, and same day visits may be relegated to urgent care departments.

Family practices and naturopathic doctors may be in a private or small office, with a more personal touch and easier access to the provider. One benefit of a family practice, rather than a pediatrician, is that the same practitioner can see the whole family. This may help that provider better understand the lifestyle and values that influence the family’s health choices.

Currently, only pediatricians are on the list of providers the Maui hospital “requires” new parents to schedule a follow up ‘well baby’ check with. The local Child Protective Service also does not seem to recognize Family Practice offices as qualified to be primary care providers for children. I hope this will change, and parents will be more supported in their choice of qualified medical care.

Medically caring for sick and injured children is a huge professional responsibility. There is a need to not over treat conditions that will resolve with monitoring and supportive care, while always staying vigilant not to miss a more serious problem that requires greater medical intervention. For parents, choosing a healthcare provider for your children whom you like and trust is an important personal decision. I support all parents in making the informed choices that are right for their families.

I also look forward to sharing more on what I gather at this pediatric conference with the experts on your child

I hope you and yours have a very happy and healthy 2017.

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Shannon Ray is a family practice Physician Assistant at Pueo Family Medicine in Makawao. She leans toward an holistic approach supported by medical science. She was a lay midwife prior to embarking on her clinical medical education, and still has close ties with the birthing community. Shannon is currently working on establishing another family practice affiliation for the Makawao office in order to resume taking medical insurance.


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