October 13, 2021
Note: This article originally appeared in the Fall 2021 issue of Under the Rainbow, the biannual magazine for Children’s of Mississippi.
If the babies where Dr. Renjith Kalikkot takes care of going home, he is worried.
Kalikkot, a neonatologist, cares for some of Mississippi’s smallest and most critically ill babies at Children’s of Mississippi. Some of these children go home in cities and counties without a pediatrician.
“As neonatologists, we care for premature babies and babies with complex medical problems. Even after they leave the NICU, we need to make sure they receive ongoing care.”
Pediatricians are trained in the specialized care of babies, children and young people. There are a number of areas where pediatricians have expertise about other types of primary care providers, said Dr. Jeffrey Crout, professor of pediatrics in the School of Medicine at the University of Mississippi Medical Center.
“In feeding infants, for example, or with 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 chair of pediatrics at UMMC, “always said 2 days is different from 2 months, and 2 months is different from 2 years, and that’s different from 18 years,” said Crout, who studied under Batson at UMMC. “Every 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, there were no surgeries to correct many congenital heart defects.
“Years ago, there wasn’t much of a need for pediatric subspecialists because so many kids with medical challenges didn’t survive then,” Crout said.
Today, neonatologists, pulmonologists, cardiologists and other pediatric subspecialists help children overcome medical crises to return home with their families from the state’s only children’s hospital.
Kalikkot wants babies to continue to thrive after they leave Children’s of Mississippi, and that includes getting pediatric care plus pediatric subspecialty care close to home, through telecare or at Children’s of Mississippi in the Eli Manning Clinics for Children’s clinical space and the Kathy and Joe Sanderson Tower.
“We need to ensure that they grow and develop appropriately while receiving ongoing care from their pediatricians and other pediatric subspecialists such as pediatric neurology, pediatric surgery, pediatric cardiology, pediatric endocrinology and pediatric nephrology, among others,” Kalikkot said.
The needs of children who start their lives with medical challenges can be many.
“A significant number of these babies will require careful management of their nutrition and ongoing close monitoring of their neurological progress,” Kalikkot said. “They will need therapies such as occupational therapy, physical therapy and speech therapy. Some of these babies will go home on oxygen or home ventilator support that will need to be closely monitored by the home ventilation team and pulmonary medicine, in addition to ongoing nursing care and medical supplies at home.”
Children’s of Mississippi pediatric specialists follow infants who begin life in the NICU until age 2 to monitor their progress and ensure they receive the special care they need.
“If we are unable to provide them with ongoing care, we cannot ensure that they grow and develop to their full potential, despite all the hard work we do in the NICU,” Kalikkot said.
“Pediatricians play a very important role in caring for these babies once they leave the NICU,” he said.
Although Children’s of Mississippi monitors NICU patients in a high-risk clinic, having a pediatrician near home can help ensure they receive the care they need. This may include nutritional management, growth monitoring, immunizations, and more.
“Pediatricians can provide a higher level of care,” Kalikkot said. “During their stay, they rotate through the NICU and nursery for several months so they know the complex issues these babies face. Their focused training and knowledge enables them to provide ongoing care for the complex issues these babies face. .”
Is there a shortage?
According to the US Bureau of Labor Statistics, 27,550 individuals identified as general pediatricians in 2020, and thousands more provide care to children as pediatric subspecialists.
Rural and in Mississippi, there are areas of childhood deserts, where there are few, if any, pediatricians.
Crout noted that doctors often choose where to practice based on personal reasons.
“Like anyone else, pediatricians can choose where to live and practice based on the area’s amenities, the quality of schools, and the environment,” Crout said. “They can see where they want to start a family.”
At the state and national levels, pediatricians are not equally located. In Mississippi, there are 24 communities with only one pediatrician in the area. Larger cities like Hattiesburg, Biloxi and Tupelo have more, 55, 26 and 29 respectively.
The city of Jackson has the most practicing pediatricians, with 192, and suburbs such as Brandon (60), Madison (122) and Ridgeland (48) have a healthy number of pediatricians available to the families there.
The state has 932 pediatricians who care for its children. Those numbers aren’t enough, said Dr. Anita Henderson, president of the Mississippi AAP Chapter.
“Less than half of Mississippi counties have an OB GYN, and some don’t have a pediatrician, either.”
The American Academy of Pediatrics notes on its website aap.org that there is a shortage of pediatric subspecialists and pediatric surgical specialists.
“The AAP believes that the current distribution of primary care pediatricians is inadequate to meet the needs of children living in rural areas and other deprived areas,” the organization states, “and that there will be more in the future. primary care pediatricians will be needed due to the increasing number of children with serious chronic health problems, changes in physician working hours and implementation of current health reform efforts that increase access to comprehensive patient and family centered care for all children in a medical home want to improve.”
Specialist care nearby
To bring specialized care for patients and their families closer to home, Children’s of Mississippi has opened specialty clinics across the state. 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 the Eli Manning Clinics for Children and in the Kathy and Joe Sanderson Tower.
The UMMC, recognized in 2017 as one of only two Centers of Excellence in Telehealth nationwide, also offers online and telephone care.
These efforts are helping, Kalikkot said, “to some extent.”
“Many of these doctor visits require hands-on assessment and care,” he said.
A children’s home
The best-case scenario is for children to be given an orphanage, a clinic where they are treated for sore throats and flu, where their weight and growth are monitored, and where they are vaccinated on schedule, said Dr. Mary Taylor, Suzan B. Thames Chair, Professor and Chair of Pediatrics.
“Having that 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 is working to educate the next generation of pediatricians and pediatric specialists and sub-specialists. In addition to research, education aligns with clinical care as the three-pronged mission of the Medical Center.
The number of pediatric residents at the UMMC has grown each year to 16 plus approximately five to six internal medicine/paediatrics nurses and a pediatric neurology nurse.
Over the years, just over 50 percent of pediatric residents in Mississippi continue to practice once their residency is complete. Why more don’t stay is a complex question, Crout said.
“Some go on out-of-state fellowships, and some return to their home state or locate based on where their spouses work,” he said. “We love to grow our own pediatricians and hope those who go to fellowships come back and improve health care for Mississippi’s children.”
This press release is prepared by the University of Mississippi Medical Center. The opinions expressed here are those of the author.