On the night of the presidential election in 2016, I was working in the pediatric ED. I took a deep breath, preparing myself based on the chief complaint of my first teenage patient: “toxic ingestion.” After I introduced myself as the resident doctor on her care team, the adolescent confessed that she had taken the bottle of pills after her family threatened to kick her out of the house when she came out to them as gay. She looked up at the TV, then back at me, a look of terror in her eyes as we saw another state turn red on the map. As I left her room, I worried what the next presidency might mean for kids like my patient. While I knew then that this new administration would enact policies that significantly impacted kids, I could not have predicted how those impacts would specifically affect my pediatric residency training.
Since the inauguration last year, each day has brought new executive orders, and with them, new concerns presenting to my office. A well visit for a four-month-old was spent not just talking through her developmental milestones or the new rash on her neck, but comforting a mother breaking down in tears, sobbing through the interpreter that she was afraid of being deported and being forced to leave her American citizen children behind. “What should I do, Doctor?” she begged, as though medical school could have taught me the answer. Or the mother of a teenager presenting for painful periods, who spoke in a hushed voice to her daughter: “You should have your birth control implant replaced soon, before they take your rights away.”
When I entered pediatrics, I was prepared to spend my career participating in advocacy. I planned to use data to explore the impact of policies on the health outcomes of America’s children. I imagined myself going to the statehouse to advocate for better coverage of medical care for transgender adolescents. I did not expect that the datasets that allow us to evaluate the impacts of structural factors on kids’ health would disappear from government websites, and the grant funding for their analysis pulled. I had not allowed myself to fear that lifesaving medical care for trans kids would become illegal in many states, pushing my patients into depressions so deep that my interventions felt futile.
Residency training is a time of the most rapid growth and learning for a budding pediatrician. With ongoing policy shake-ups, our training has shifted dramatically. Medical evidence remains central to our learning; however, more and more time is spent battling a system that makes it increasingly difficult to deliver evidence-based care to our patients. While we once memorized recommended vaccine schedules and gained experience talking to families about the risks and benefits, we now watch the Secretary of Health and Human Services fire all of the experts on the Advisory Committee on Immunization Practices, hear newly appointed officials with no expertise in vaccines make false statements, and worry about how our patients will pay for these lifesaving preventative interventions if the government eliminates the Vaccines for Children program in the wake of the new scaled-back guidelines. While we previously gained expertise in identifying developmental delays in young children, we now spend more time attempting to help our patients identify resources while funding is cut off to the programs that serve these kids in need. Our curriculum includes sessions with educational experts on how to ally with public schools to ensure that children with medical problems have equal access to education — soon no longer possible with the plans to eliminate the Department of Education. We take care of kids in the ICU and cardiac center with complex medical problems, supporting them and their families through months-long hospitalizations resulting in bills previously paid in part by Medicaid, a key source of funding for pediatric care that will soon be significantly cut.
To say our young pediatricians feel demoralized is an understatement. I’ve seen the tears shed when yet another young person is brought into the trauma bay after firearm violence, had dozens of worried conversations about whether the careers we’ve dreamed of will even exist with cuts to health care and research funding, and wondered aloud about our collective powerlessness.
Yet in between the wondering, “Will it even matter?” there are glimmers of hope. My colleagues created a coalition to advocate for bike and pedestrian safety in our city, effectively changing local policy. My peers organized phone banking to tell our representatives about the impacts of the new spending bill on the health of our patients. My co-residents created a curriculum on how to support immigrant patients in knowing their rights. My fellow trainee physicians across Philadelphia organized to improve the working conditions of resident and fellow physicians so that we can show up for our patients when they need us most.
My fellow pediatric residents remind me that pediatricians will always be here, showing up for our patients, stepping beyond the bedside to take care of our patients in the ways they need it most. Pediatric trainees will keep fighting for what is best for kids.
How have you seen your practice change with new health policies? Share in the comments.
Dr. Natalie LaBossier is a pediatric resident based in Philadelphia. Her research explores the impact of policy on health outcomes with a particular focus on adolescents, sexual health, and substance use.
Image by artbesouro / Getty
