Interview with M.D. Deborah Buchman from Southdale Pediatric
Hey Debbie so who are you?
“I work outpatient general peds, so literally every single day is based on our wellness checks and are your vaccines up to date? It is what I do for a living, the hard part is that I don’t have the statistics of well what is it like in general but I know the places you can find the specifics”
Which clinic or office do you work with?
“Yup, Southdale Pediatric. So we’re a private group, so we might work slightly different than Health partners, those kinds of groups, but we are private so we can make different types of decisions which is nice and we prioritize getting all kids vaccinated”
What is the difference between a private practice and Health partners?
“So those are huge corporations, there’s like health care corporations, for example Health partners and Fairview systems, and Methodist, and Park Nicollet those are these huge healthcare systems. But Southdale Pediatrics we are one of these, not as common anymore, private groups, that we as a group of physicians we own our practice and we buy into the practice and we own it. So we have a little bit more ability to kinda choose how do we want our practice to work? That being said, the private practices, whether its pediatrics or anything else, we all have contracts with insurance providers and they set the goals and the criteria and the pricing. Unless someone is paying out of pocket for care, we don’t even set the pricing for what people pay to come to us. But vaccines are always provided and covered, regardless of insurance status.”
How do vaccinations work in the US, are they covered under insurance?
“So it depends on where a family lives. All vaccines are –at least in Minnesota– there is a
‘no shot no school’ rule that is optimally upheld and every single child regardless of insurance status is able to get vaccines free of cost. So if there is a family that has private insurance, private insurance covers it. If they are not covered by private insurance, they get public coverage–like Medicaid– or they can go to public health clinics. And we even have at our clinic we are a ‘no questions asked’ vaccine provider that if someone who is not a patient at our clinic comes in just because they need vaccines for schools we absolutely will give it. Like even if they don’t establish care with us or have a visit, yes we will give vaccines.
If a parent or child was first looking to get vaccinated, where could they go?
“It depends, like for our clinic optimally we like to have the kids patients who are established with our clinic, they come to us. And we have it set up with the well-child check there is a lot. Because with babies and children there is a lot of checks, the vaccines that we offer are in accordance with what the CDC (Center for Disease Control) makes and then the American Academy of Pediatrics which is our kind of governing body every year there are groups of the experts to get together and take these are the vaccine at these times of life, and that is how we set our well-child checks. So babies come in at 2, 4, 6, 9, 12, 15, 18, you know every several months that they come in. We also offer some vaccines to parents, because we want to cocoon the children with healthy people. So anyone that's not in our practice can get vaccines for things like Influenza, Whooping cough, COVID we were providing to people, so there's some we give to adults too.”
Do you know of any legislative requirements for child immunization in Minnesota?
“So, it’s slippery, it’s really slippery, every state is slightly different and what the requirements are for vaccination status, and unfortunately Minnesota has one of the most relaxed requirements for mandatory vaccinations. Minnesota historically allowed for non-medical and personal exemption, so people can just say “well I don’t believe in this, I don’t want to do it” and they sign a piece of paper and they don’t have to get it. Whereas California, and some other states, they have tighter laws, they say “no you can’t do that, you have to get these things to get your child to go to school”. If you look at the MN AAP website, that lists that immunizations is one of the top 5 priorities at a state legislature level for our group the MN AAP. We go to the capital every spring, we have a day, and we talk with our representatives about vaccines and any legislative options that are on the table.
Is school-requirement the only way to emphasize child vaccination?
“Well, there is a list of recommendations but in Minnesota it is a fairly relaxed thing, and people in MN have the ability to refuse vaccines and still go to school. Which is tough, we’ve had measles outbreaks here when other states didn’t”
What are the most common child vaccines administered?
“So at every visit we give a standard, so it depends on the age, the vaccinations we provide are in accordance with what's recommended for that age. These have been tested for both safety and for ethicacy, you know for benefit at that age, so at 2 months we give different combinations of vaccines. Babies get the DTaP which is Diphtheria, Tetanus, and Acellular pertussis. Pneumococcus that covers 13 strains of a bacteria, Rotatech that covers the Rotavirus, uh, Hep B at that visit as well. And then there’s booster doses that are set up at times that testing has shown that babies most benefit from getting boosted at certain intervals. Most of the early childhood vaccines are given within the first 2 years of life, because that's when they’re most at risk of having serious outcomes with the diseases that we can help modify their response to.”
Are there newer childhood vaccines as of scientific innovations today, or in the past decade?
“COVID, you know COVID is a moving target and it's a question that I get everyday at work: “When are the little kids gonna get it?” “Is it safe?”. Yeah it is a constantly moving target of we don’t know when it’s gonna get authorized for the 6 month - 5 year crowd”
“Since I’ve been in practice, Chickenpox was a new one, the varivax vaccine, and that one I have only seen 2 cases of wild-type chickenpox since I have been in practice, which is amazing. I’m sure your mom has had it, I had it, but now kids don’t get it. The cases I’ve seen were actually parents who were international and that they moved here with chickenpox. HPV vaccine, it's not a new vaccine, it’s been out maybe 10-15 years but that vaccine is an anti-cancer vaccine that has just been phenomenally beneficial. I mean your generations will not see the cancers that ours did, because of that vaccine. It is most preventative for cervical cancer, but can men carry it, but when men have this cancer they’re obvious but women you can’t tell.”
What are the most common and preventable child diseases you see in Minnesota?
“Yeah, you know all of the vaccines modify risk, they don’t eradicate risk. We still see Pneumococcal infections causing ear infections and pneumonias and you know rarely unfortunately, meningitis. But of those, the strains of Pneumococcus that are covered in the vaccine, they’re far less common, this is also a moving target and if you see new strains of Pneumococcus that are getting prevalent, then they’ll make a new vaccine to cover those strains and make sure kids are protected for those. Whooping cough, people don’t realize how common whooping cough is, there are outbreaks all the time. When we get it, when healthy adults and teenagers get it, it's just an annoying cough but when babies get it can be life threatening. I did see a baby die of whooping cough when I was a resident and it was awful, a healthy 6 month old baby, and it was awful. So we see lots of infections but those are usually unvaccinated or too young to be vaccinated, those are the really sad ones”
“When I was a med student in Wisconsin There was a child that had Haemophilus meningitis, A serious bacterial meningitis, And I remember that That vaccine, the Hib vaccine was new at that point. And they marched us down –I mean I was 20-something– and they brought us all down to the lab and said “look at this organism, you will never see it again” And I’ve seen 1 child with a Hib Meningitis infection since then, and that's it.”
What happens if a child doesn’t have the proper immunizations, can the doctor's office do anything to require or strongly recommend them?
“We will have those conversations every visit, I say “these are the recommended vaccines” but in Minnesota I can’t force anything, it all needs to be consented to. I want parents to be on board and consent, and usually I feel like most of my patients, if I talk with them and talk about risks and benefits that eventually kids end up getting vaccinated. But it's really hard when families refuse vaccines: I had a mom tell me once that I was trying to make money and hurt her child. And it's really hard because we go into Pediatrics because we love children haha, I'm not going to hurt your child. So it is tough, we get a lot of pushback on a daily basis. It’s tough, I think families kind of self-select where they go. If there's a family who does their alternate vaccines, or they don't believe in vaccines they are going to quit coming to our Clinic, because we practice evidence-based medicine and we’re going to tell you that this is the evidence. Then they chose to go somewhere else where they are hearing what they want to hear.”
Are there any initiatives or programs that promote childhood vaccination that you are a part of or would recommend looking at? “So the MN AAP is the primary group because we are the Minnesota chapter of the American Academy of Pediatrics. Within that, if you go to the AAP website it has an immunization work group that is headed up by Dawn Martin and somebody else I can't remember. They have meetings on a semi-regular basis to go over what is new, what are the things we should recommend, and what is the timing for different vaccines. That is the primary source for different pediatricians in the community, I’m sure that the AMA, the adult medicine, have similar work groups for the adult medicine. We at the AAP, we rely on the data that comes through the CDC, the NIH (National Institute for Health), and then the MDH site (Minnesota Department of Health). They have a ton of information, just when I was peeking at it recently the vaccination rates across the state can be wildly divergent, based on where you live, access, views, cultural views, so there is a lot of data out there but it is hard to compile.”
Is access a big causation for people that are under-vaccinated?
“There is a lot of challenge with access. Absolutely, it depends on where you live and how your health care is provided. You know I practice in Suburban, West Metro, affluent neighborhoods. They come in their minivans, get their vaccines, and go back to school. But when I worked in Hennepin County there were kids that would come in for a well-check at random, or they would show up every couple of years because they were really sick, and you try and get them done, or parents don’t have the finances. That might be a barrier that they worry about, not knowing that vaccines will be covered for families that don’t have insurance. If you look at statistics up in far Northern Minnesota, rural Minnesota, reservations, all of those rates for access to Healthcare just plummet.”
How are vaccinations promoted? Do you see the Minnesotan public being shown this?
“All the time, you know it's kind of what we do when we hand out our pamphlets, and if you go to the Minnesota AAP site you can see videos on how we can better promote vaccines to our patients. It's tough, you know most people that are coming in and they want the healthcare, well they are there because they want their kids to be vaccinated. The hard part is that when people are hesitant, the data shows that it is really hard for any physician to change their mind. People will dig in their heels and say “no I don’t believe you” and anything that I say, it’s just going to further discourage sometimes, and that is really tough, that’s a challenge. Well how can I help provide information that is valid. There is so much misinformation out there and fear is a big deterrent, you know people are scared, they are saying “my auntie told me this is dangerous and I’m not gonna do it” and it's scary there’s a lot of scary information out there that may or may not be true.”