I practiced general pediatrics for about 40 years, with 35 of them in small practices I owned all in the Cleveland, Ohio area. So I personally experienced purchasing vaccines to administer them. I paid for them, and billed for them, so I can attest to what you have posted Katelina.
Immunizations were, second only to wages and salaries, by far the most expensive item we had in our office. I my own particular experience, we did not lose money on giving vaccinations, but the fees we collected for administering them were not much more than the cost. To my mind this was all quite reasonable and fair.
I would ask any who wonders if its OK to charge fees for services, how else could one afford to provide the service? Does a florist charge for flowers, does a taxi driver charge for the ride, does a restaurant charge for a meal? Of course they do, and everyone knows if they didn't there would be no flowers, rides, or restaurants.
I don't know any pediatricians who got "rich" giving vaccines. It is a service we treasure, and the treasure is seeing the babies and children we care for live a life free of the scourges that defined the central tragedies of family life across human history, until vaccines stepped in. We are honored to deliver this historic protection. And if we make the process financially viable, that is a good thing for us all.
On the broader point, hearing that many fellow pediatricians are finding the practice not viable, I must say our nation must one day become a place where money does not determine if life saving health care is available.
I managed my own solo pediatric practice for many years. Vaccine reimbursement never covered the many hours of reassuring and answering questions from concerned parents. But immunizing children had more impact on their health than all the late-night ER trips and solving weird diagnoses I ever did.
I see Projection in these hysterical claims that we put money over ethics.
For sure, if you count the hours of counseling everyone with questions and concerns and suspicions, it cost more than made. All the time counseling beyond the routine advice was done essentially free.
As to the fluff up about us being paid to immunize, I find it derives from a deep suspicion across the nation that health care has been corrupted by the large sums flowing through it, and I do believe there is much to say on that point. But not in pediatrics. Health care costs way way more than it should in the US, profit considerations have infiltrated most medical centers. But in pediatrics, immunizations are a very old basic, they do not generate anywhere near a major chunk of medical inflation, and as noted, no pediatricians get rich giving them.
I have been a Pediatrician for over 30 years. There isn’t much else to add, (I agree with all the comments!), I can add a little more detail about managing vaccines:
They are not kept in a Costco freezer! We use very expensive specialized refrigerators and freezers that have to be monitored daily to make sure temperatures remain in a narrow bandwidth. If not, the entire batch of vaccines are lost. Some practices have backup power in case of a blackout and an alert system for the manager if something happens nights or weekends. Then there is the need to record every vial for inventory and every vial number for each patient dose in their chart. Records need to be accessible for state. In our state, to qualify for their programs, several hours of education about storing and managing vaccines is required. Patients need records printed for schools….. The work behind each dose is complex! So again, NO profits made….
Indeed, I work in the finance department of a healthcare provider and we once had a vaccine fridge fail. The insurance claim for the wasted vaccine was 10s of thousands of dollars.
As a primary care NP, I do not profit at all from vaccines. My most valuable resource is time.
The time it takes to have open-minded conversations about vaccines, or to address confusion and misinformation around mammograms, colonoscopy, PSA levels etc, is not insignificant. The more time I spend in the room, the more time I spend outside my 8-5 schedule charting and managing necessary administrative work. As a salaried employee, that time is uncompensated “pajama time.”
I am not complaining. I am passionate about preventive care. That is why I went from ER RN to primary care NP, to help people live healthier, longer lives. I will keep doing whatever it takes. My bank account is not any fuller, but my heart is. I am grateful to live in a time where vaccines allow more humans to live than ever before.
Thank you, Stacy. Your patients are fortunate to have you. You and many others like you are helping us get through this dark time of health care in this country. We appreciate you.
My group pediatric practice has a policy to ask the family to find another practice if, after 3 well visits with objective vaccine education, the parents still refuse to vaccinate their child. We do this not to “improve our quality measures”, but to keep the rest of our patients safe from exposure during visits and because our philosophy is that “if you don’t trust me on vaccines, then how do you trust me on anything else I do for you”. BTW, we break even on cost as you described. It’s a service to our patients issue, not a profit center!
Thank you for doing this. My PCP, who is board certified in both pediatrics and internal medicine, has a similar policy. As one of her latter patients, I am grateful.
I am old and my medical insurance is Blue Cross Medicare Advantage. For my prior 10 years I had UHC Medicare Advantage. Each month I receive in the mail a small collection of papers called Explanation of Benefits (EoB). This lists all claims submitted by any providers I've seen. These show if the claim was paid or denied. And what claim for payment was submitted and how much insurance paid.
If people such as the Texas attorney general or better still the MAHA crowd would take a look at EoB's he/they would be able to quickly determine that very little money is paid to providers for a vaccine regardless of patient age.
Stunts and theatrical political performances is doing more harm than even the rot and decay of so–called "social media".
The practice where I work stopped giving pediatric vaccines years ago due to the fact that we were losing money from providing this service. Now, all patients are referred to the local health department for these to be administered.
I practiced for 52 years and we either lost money or broke even on vaccines.
The insurance companies did not match the federal guidelines for administration charges. When vaccine costs, to the physician, rose it could take thirty or more days for insurance to raise reimbursement leaving us to pay the difference. New vaccines were often paid below cost and you had to argue to get the reimbursement higher (but there was no retro payment.
Each vaccine required paperwork for consent and our protection. Each vaccine required notifying the state (NJ) registry. Each vaccine required often long discussions with the parents.
Added to this was the threat of a lawsuit even if the parent refused the vaccine and the child became ill, plus the threat of being sued for complications.
Often, with VFC and Medicaid if was better to send the child to a community run vaccine clinic. However, you could not guarantee that they would go.
Each unvaccinated patient posed a threat to other children arriving at the office.
There was no profit just the realization that you were saving children from the threat of death or long term complications.
Vaccines were the greatest public health accomplishment of the twentieth and twenty first centuries. They have probably save more lives and prevented more significant health damage than any other single advance in medicine
We should do whatever it takes to make vaccines to be effective, economical and available. I can see no logical reason for roadblocks to good public health.
Good grief- People don't choose to be Pediatricians for the Money- average salary- $92,000. For those who want to make money, they choose Cardiac Surgeon or Orthopedic surgeon- $500,000.
The people pushing this are telling you a number of things about them, one of which is that they literally can NOT understand why anyone would do anything if it didn't make a profit for them. They are blind to the concept and assume that anyone who says they are doing anything for any other reason is just lying.
Now that my PCP private practice no longer must complete an onerous number of reports to State and Federal Health agencies for ordering and administering COVID-19 vaccine boosters, they are able to provide that service at a break-even cost. They also provide full laboratory services at zero expense to the practice. How, you might ask? Because they discovered that the requirements for having their own lab required an enormous amount of paperwork, personnel expenses and ongoing certifications that it was actually a losing proposition so it is now owned an operated by a commercial lab in its entirety. The physicians practiced the kind of medicine they desire even if the margin profits are only modest. They are not beholden to corporate mandates and bureaucratic demands. I continue to marvel at their resilience and resolve in this era of the corporatization of medicine. Disclaimer: I practiced with that group for 26 years before I retired on my terms. I am proud to have been a partner in general internal medicine with a fine group of people.
Excellent post as always!
I practiced general pediatrics for about 40 years, with 35 of them in small practices I owned all in the Cleveland, Ohio area. So I personally experienced purchasing vaccines to administer them. I paid for them, and billed for them, so I can attest to what you have posted Katelina.
Immunizations were, second only to wages and salaries, by far the most expensive item we had in our office. I my own particular experience, we did not lose money on giving vaccinations, but the fees we collected for administering them were not much more than the cost. To my mind this was all quite reasonable and fair.
I would ask any who wonders if its OK to charge fees for services, how else could one afford to provide the service? Does a florist charge for flowers, does a taxi driver charge for the ride, does a restaurant charge for a meal? Of course they do, and everyone knows if they didn't there would be no flowers, rides, or restaurants.
I don't know any pediatricians who got "rich" giving vaccines. It is a service we treasure, and the treasure is seeing the babies and children we care for live a life free of the scourges that defined the central tragedies of family life across human history, until vaccines stepped in. We are honored to deliver this historic protection. And if we make the process financially viable, that is a good thing for us all.
On the broader point, hearing that many fellow pediatricians are finding the practice not viable, I must say our nation must one day become a place where money does not determine if life saving health care is available.
Thank you for sharing. It is a service we treasure for the children and families we care for.
Thank you for your thoughtful comments.
I managed my own solo pediatric practice for many years. Vaccine reimbursement never covered the many hours of reassuring and answering questions from concerned parents. But immunizing children had more impact on their health than all the late-night ER trips and solving weird diagnoses I ever did.
I see Projection in these hysterical claims that we put money over ethics.
For sure, if you count the hours of counseling everyone with questions and concerns and suspicions, it cost more than made. All the time counseling beyond the routine advice was done essentially free.
As to the fluff up about us being paid to immunize, I find it derives from a deep suspicion across the nation that health care has been corrupted by the large sums flowing through it, and I do believe there is much to say on that point. But not in pediatrics. Health care costs way way more than it should in the US, profit considerations have infiltrated most medical centers. But in pediatrics, immunizations are a very old basic, they do not generate anywhere near a major chunk of medical inflation, and as noted, no pediatricians get rich giving them.
I have been a Pediatrician for over 30 years. There isn’t much else to add, (I agree with all the comments!), I can add a little more detail about managing vaccines:
They are not kept in a Costco freezer! We use very expensive specialized refrigerators and freezers that have to be monitored daily to make sure temperatures remain in a narrow bandwidth. If not, the entire batch of vaccines are lost. Some practices have backup power in case of a blackout and an alert system for the manager if something happens nights or weekends. Then there is the need to record every vial for inventory and every vial number for each patient dose in their chart. Records need to be accessible for state. In our state, to qualify for their programs, several hours of education about storing and managing vaccines is required. Patients need records printed for schools….. The work behind each dose is complex! So again, NO profits made….
Indeed, I work in the finance department of a healthcare provider and we once had a vaccine fridge fail. The insurance claim for the wasted vaccine was 10s of thousands of dollars.
As a primary care NP, I do not profit at all from vaccines. My most valuable resource is time.
The time it takes to have open-minded conversations about vaccines, or to address confusion and misinformation around mammograms, colonoscopy, PSA levels etc, is not insignificant. The more time I spend in the room, the more time I spend outside my 8-5 schedule charting and managing necessary administrative work. As a salaried employee, that time is uncompensated “pajama time.”
I am not complaining. I am passionate about preventive care. That is why I went from ER RN to primary care NP, to help people live healthier, longer lives. I will keep doing whatever it takes. My bank account is not any fuller, but my heart is. I am grateful to live in a time where vaccines allow more humans to live than ever before.
Thank you, Stacy. Your patients are fortunate to have you. You and many others like you are helping us get through this dark time of health care in this country. We appreciate you.
My group pediatric practice has a policy to ask the family to find another practice if, after 3 well visits with objective vaccine education, the parents still refuse to vaccinate their child. We do this not to “improve our quality measures”, but to keep the rest of our patients safe from exposure during visits and because our philosophy is that “if you don’t trust me on vaccines, then how do you trust me on anything else I do for you”. BTW, we break even on cost as you described. It’s a service to our patients issue, not a profit center!
Thank you for doing this. My PCP, who is board certified in both pediatrics and internal medicine, has a similar policy. As one of her latter patients, I am grateful.
I am old and my medical insurance is Blue Cross Medicare Advantage. For my prior 10 years I had UHC Medicare Advantage. Each month I receive in the mail a small collection of papers called Explanation of Benefits (EoB). This lists all claims submitted by any providers I've seen. These show if the claim was paid or denied. And what claim for payment was submitted and how much insurance paid.
If people such as the Texas attorney general or better still the MAHA crowd would take a look at EoB's he/they would be able to quickly determine that very little money is paid to providers for a vaccine regardless of patient age.
Stunts and theatrical political performances is doing more harm than even the rot and decay of so–called "social media".
This needs to reach more than 425,000 people. My social media is minimal, so I hope those with more a significant presence share this newsletter.
The practice where I work stopped giving pediatric vaccines years ago due to the fact that we were losing money from providing this service. Now, all patients are referred to the local health department for these to be administered.
Thank you for sharing. Your experience is far more common than many people realize.
I am just very thankful that we still have an accessible health department that is able to provide vaccines to our pediatric patients.
Excellent explanation to a somewhat complex issue. I appreciate you doing it.
Thank you, Katelyn! Great information to share.
Someone needs to tell RFK,jr. to stop spewing inflammatory rhetoric about physicians making a profit off of vaccines.
It's rather scary how quickly folks pick up on that misinformation and share it with whoever will listen.
Hearing that RFK Jr. was talking about following money instead of science was shocking. Since when does he follow science, or see it as valuable?
How sad that a pediatric practice stopped providing vaccines because they were losing money.
.We need to get for-profit out of health care.
I practiced for 52 years and we either lost money or broke even on vaccines.
The insurance companies did not match the federal guidelines for administration charges. When vaccine costs, to the physician, rose it could take thirty or more days for insurance to raise reimbursement leaving us to pay the difference. New vaccines were often paid below cost and you had to argue to get the reimbursement higher (but there was no retro payment.
Each vaccine required paperwork for consent and our protection. Each vaccine required notifying the state (NJ) registry. Each vaccine required often long discussions with the parents.
Added to this was the threat of a lawsuit even if the parent refused the vaccine and the child became ill, plus the threat of being sued for complications.
Often, with VFC and Medicaid if was better to send the child to a community run vaccine clinic. However, you could not guarantee that they would go.
Each unvaccinated patient posed a threat to other children arriving at the office.
There was no profit just the realization that you were saving children from the threat of death or long term complications.
Vaccines were the greatest public health accomplishment of the twentieth and twenty first centuries. They have probably save more lives and prevented more significant health damage than any other single advance in medicine
Thanks for the post!
We should do whatever it takes to make vaccines to be effective, economical and available. I can see no logical reason for roadblocks to good public health.
I’m just a parent, but I so appreciate this info. Thank you!
Good grief- People don't choose to be Pediatricians for the Money- average salary- $92,000. For those who want to make money, they choose Cardiac Surgeon or Orthopedic surgeon- $500,000.
The people pushing this are telling you a number of things about them, one of which is that they literally can NOT understand why anyone would do anything if it didn't make a profit for them. They are blind to the concept and assume that anyone who says they are doing anything for any other reason is just lying.
Right?!? Any stereotypical “rich doctor” joke is not about pediatricians, ffs.
Now that my PCP private practice no longer must complete an onerous number of reports to State and Federal Health agencies for ordering and administering COVID-19 vaccine boosters, they are able to provide that service at a break-even cost. They also provide full laboratory services at zero expense to the practice. How, you might ask? Because they discovered that the requirements for having their own lab required an enormous amount of paperwork, personnel expenses and ongoing certifications that it was actually a losing proposition so it is now owned an operated by a commercial lab in its entirety. The physicians practiced the kind of medicine they desire even if the margin profits are only modest. They are not beholden to corporate mandates and bureaucratic demands. I continue to marvel at their resilience and resolve in this era of the corporatization of medicine. Disclaimer: I practiced with that group for 26 years before I retired on my terms. I am proud to have been a partner in general internal medicine with a fine group of people.