Few pediatricians had planned for a worldwide pandemic before the novel coronavirus led to quarantines and social distancing in March 2020. But suddenly, without much warning, the world changed. Parents feared bringing their children to pediatric appointments, yet the need for sick and well-child care continued. And pediatricians responded — with amazing resourcefulness.
On the Road
General pediatrician Greg Gulbransen, MD, practices on Long Island in New York — close to the epicenter in the early days of the pandemic. COVID-19 had hit New York City with a vengeance, and Dr. Gulbransen sprang into action.
“It was scary, but it was also an amazing time to be a doctor,” he says. “I’m so proud of all of us for hanging in there doing what we had to do. I’m proud that I’m a pediatrician, and that I was able to serve the community.”
Dr. Gulbransen’s patient load exploded during the height of the pandemic in New York. Not only did he gain about 30 families who temporarily relocated to Long Island from Manhattan, but he also saw patients from other practices that closed, including some adults who had no other options.
“Lots of offices closed because the numbers were so high,” he says. “Everybody knows someone who died, and people were so petrified. Anyone who wanted to come in, we saw them.”
He also made house calls to keep children out of emergency rooms where COVID-19 patients were being seen. When a 3-year-old patient dislocated her arm, he told her parents to meet him on their front lawn where he popped the girl’s joint back in place.
“It is a very easy thing to do, but it made a huge difference for them,” he said. “I really wanted to keep everybody out of the ER.”
The pediatricians at Fairfax Pediatric Associates in Virginia, concerned about the potential consequences of a decrease in well visits, also made house calls, traveling up to 15 miles from any clinic location to give vaccinations and screen for developmental and behavioral issues. The team rented and equipped a van to take the office to their patients for well-child checkups and vaccinations.
“A reduction in well visits also means a reduction in vaccinations,” says Sandy Chung, MD, who also was president of the Virginia Chapter of the American Academy of Pediatrics (AAP) in 2020. “The response has been tremendous, and families are incredibly grateful.”
On the Phone
Nearly overnight, many practices that had never seen patients via video were providing telemedicine. An American Medical Association (AMA) survey shows that before the pandemic, about 20% of practices used telemedicine, but within months, the use of telemedicine surged to 77% of practices.1
“We had to do something to see those kids who needed to be seen but would not come in,” says Rebecca Reddy, MD, who practices at Redbud Pediatrics in Wichita, KS. “And we needed to do something to keep our practice viable. We knew there was going to be fear of contagion for a long time.”
Dr. Reddy says she has discovered some hidden benefits to telemedicine, such as being able to see the child’s home environment. For example, she can caution parents of children with asthma if she sees doors or windows open during pollen season.
Under a Tent
In Meridian, ID, Thrive Pediatrics also recognized the need to adapt to ease fears.
“Our office is on the second floor,” says Steve Smith, MD. Sick patients and well patients used the same small elevator, and the medical team thought disinfecting the office was not enough. “We saw a need to keep the germs downstairs.”
Soon, Dr. Smith and the practice’s other pediatrician, Brandon Taylor, DO, set up a full clinic in a tent in their parking lot to see and treat sick patients, leaving the second-floor office open for well-child visits.
Children loved the idea and soon dubbed them “the camping doctors.”
What to Expect
When the pediatricians at Piedmont Pediatrics in Charlottesville, VA, saw visits to their practice drop about 70% in March, they began screening patients over the phone and meeting parents in the parking lot, in addition to making other practice changes. To help parents understand the new safety precautions, they created a short, entertaining video to show parents exactly what to expect.
“The video allowed all of the parents to not just hear or read what precautions they had implemented,” says Gracie Steljes, the parent of a newborn and toddler, “but actually watch how well visits and sick visits would be exercised. It was filmed in the hallways we recognize and acted out by the friendly faces of doctors and nurses we know and trust.”
The video, created before Virginia’s statewide mask mandate, can be viewed at bit.ly/piedmont-video.
Flu Shots in the Fall
To prevent the double threat of both influenza and COVID-19 in the fall, pediatricians looked for new solutions.
Jocelyn Schauer, MD, from Piedmont Pediatrics, says their entire staff developed a “Flu-Thru” (drive-thru) influenza vaccine clinic. During one Saturday morning session, they vaccinated more than 380 patients with almost no wait times.
“The ‘Flu-Thru’ was such a success that COVID or no, we want to keep doing it this way,” Dr. Schauer says.
1American Medical Association. Physician survey details depth of pandemic’s financial impact. www.ama-assn.org/practice-management/sustainability/physician-survey-details-depth-pandemic-s-financial-impact. Accessed Dec. 17, 2020.
Top Photo: Dr. Greg Gulbransen (left) from Oyster Bay, NY, after performing a swab test to see if his patient had COVID-19
Second Photo: Pediatric nurse practitioner Melodie Wuorinen (left) greets a patient in Fairfax Pediatric Associates’ well-child van.
Third Photo: Dr. Rebecca Reddy (center) from Wichita, KS, with colleagues Kally Richardson (left) and Katrina Hinds (right)
Fourth Photo: Dr. Brandon Taylor masks up for a well-child checkup in Idaho.
Bottom Photo: Piedmont Pediatrics’ video is styled as a “silent” film.