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Dr. David T. Tayloe Jr.

As president-elect of the American Academy of Pediatrics, David T. Tayloe Jr., MD, will be taking the reins of the Academy as a new administration takes hold in Washington.

Regardless of the outcome of November’s elections, Tayloe and other AAP leaders are working now to educate government officials on how healthcare reforms can affect America’s children. Among the top goals is bringing parity to the way the government administers funding for kids’ health in relation to that of groups like the elderly and disabled.

Having to push the federal government to keep Medicare fees rising with inflation is struggle enough. Having to fight the same battle on so many different fronts with state-run Medicaid and SCHIP programs multiplies the frustration.

Tayloe is the founder of Goldsboro Pediatrics PA in Wayne County, N.C., where he has served on local school boards and is a frequent speaker on child advocacy concerns. He will focus on AAP efforts full-time when he takes the chief post in October.



Tell us about the current focus on childhood mental health.

“We in pediatrics know that somewhere around 20 percent of children have a mental disorder — everything from Attention Deficit Hyperactivity Disorder to depression and anxiety, then some hard-core things like schizophrenia or bipolar disorder. But if you take that group, only 20 percent of those kids have access to mental-health professionals. There are only 7,000 child psychiatrists in the entire country, so we will never have enough child psychiatrists.

“Pediatricians see these kids on the front line. The AAP has a task force on mental health that is developing a toolkit, so pediatricians will have user-friendly screening materials as they encounter families, so they can at least ask the right questions.”



How does that interaction work in your own practice?

“We run four offices in a large rural area east of Raleigh, so we may have 500 to 600 encounters a day. We rub shoulders with a lot of families whose children have mental-health problems.

“In our practice, we have a full-time PhD-level clinical psychologist — and she has recruited some help, because she is so busy. She provides care of our patients and also meets with us at least once a month, to talk with us about how we can do a better job with mental health. If you look at child-health outcomes in things like substance abuse and drop-out rates, the mental-health problems that start in early childhood can flourish through adolescence and adulthood if we don’t reach them with the services, support and sometimes medications they need.

“So we at the AAP are accepting the challenge of developing networks of pediatricians and mental-health professionals, and involving the schools so that more children will have better outcomes.”



How are schools involved?

“We have a council on school health at the Academy, and they produce policy for pediatricians to involve themselves with the schools. There are all sorts of varieties of involvement. I am medical director of the Wayne Initiative for School Health, a private nonprofit which operates six school-based health centers. We provide comprehensive health services on-site in these schools where there are lots of at-risk children.

“Our community and our schools have accepted this, and our practice has put our electronic medical records system in the school-based health centers. We’re a unique practice, because we don’t have another pediatric practice in this county, so we’ve accepted responsibility in this. But I think a lot of pediatricians are seriously integrated into their communities, especially in rural communities.”



More broadly, what is the AAP’s focus in the current debate over healthcare reform?

“Pediatricians are very frustrated that they do the same work as doctors who look after the elderly, and yet there exists this double standard that we have to argue with state governments to get paid fairly. Some states will go 15 years without changing the rates, unless somebody does a lot of lobbying and educating at the state level.

“We really think Medicaid is a dinosaur, and children suffer because of these 50 state programs. Children should have something like Medicare — especially those under 200 percent of the federal poverty level. There’s a lot of discussion now about how we might better structure Medicaid and SCHIP and Vaccines for Children.”



What are you proposing as a change?

“We would like to see the federal government become much more active in this. They give each state three-quarters of its SCHIP dollars. They give most states two-thirds or better of Medicaid dollars, and they provide all of Vaccines for Children.

“But whether children get the services the federal government thinks they need will depend upon whether states actually pay physicians well enough to allow physicians to see the kids. I’ve got colleagues in other states who limit their Medicaid population severely, because otherwise they can’t pay their rent. It’s a broken child-health system, and the Academy is very involved in the promotion of reforms.”



Where do you think this effort is headed?

“Well, we’re going to get a new administration, and I think most people agree the new one cannot be any worse than what we have now. So we are talking with both Republicans and Democrats, trying to make sure they understand what the AAP’s principles would be for health coverage for children.

“They need comprehensive benefits on par with Medicaid, and access to physicians and sub-specialists, which also means we have to have good graduate-education programs to keep the pipeline full of primary-care and specialized physicians.

“The Academy is not against co-pays and premiums for families over the 200-percent threshold. So we would meet Congress in the middle on this, to ensure families who really need help paying for good health insurance can get the care they need.”



August 2008

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