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Managed care needs 'gate openers,' not 'gatekepers'

For half of my 20 years in pediatric practice, I have been intimately involved with medical liability issues and their effects on physicians, especially pediatricians. Having done an eight-year stint as a member and chair of the AAP Committee on Medical Liability (COML), and currently serving as the only pediatrician on the Pennsylvania Medical Society Liability Insurance Company (PMSLIC) board, I have observed the changes in liability issues that have, in many ways, paralleled the changes in medical practice.

The Vaccine Injury Compensation Act, supported by the Academy, has virtually eliminated vaccines as a liability issue for the practicing pediatrician. A single vaccine, the Haemophilus influenzae b (Hib) vaccine, has dramatically reduced most claims for meningitis complications. It is my distinct impression, although I lack the formal data to support it, that the movement of neonatologists into more nurseries has reduced "newborn" claims against pediatricians, although not against our Ob/Gyn colleagues.

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				Child Life Council and Committee on Hospital Care Child Life Services Pediatrics, October 1, 2006; 118(4): 1757 - 1763. [Abstract] [Full Text] [PDF]