Pediatricians Are Doing More Work for Less Pay. Here's Who Decides What It's Worth.
Your kid's pediatrician is doing more work than ever and getting paid less for it.
This week Bloomberg reported that vaccine hesitancy and Medicaid cuts are adding to the strain on US pediatricians. The numbers behind that strain are public, and they point to the same problem we talk about every week: the people doing the work don't get to decide what it's worth.
More Work That Nobody Pays For
The Milbank Memorial Fund published a national survey of 632 primary care clinicians, fielded in March 2026. Among clinicians who see children, 43% said parents are generally less interested in childhood vaccines, and 42% said parents are delaying or refusing immunizations they had previously accepted. At the same time, 33% reported parents asking for the MMR vaccine ahead of schedule.
Either way, the conversation takes longer. 53% of clinicians said vaccine conversations now take considerably more time.
Under fee for service, that counseling time remains unfunded, according to the survey. The doctor sits with a worried parent, answers questions and does the work, and the payment system mostly doesn't count it.
The survey also found 52% of clinicians reporting high levels of moral injury or burnout.
Paying Up Front, Eating the Loss
There's a cash problem on top of the time problem.
According to the Milbank brief, practices buy private vaccine stock weeks to months before they give it, and absorb the loss when demand shifts or doses expire. 11% of surveyed clinicians said vaccines had expired on their shelves due to reduced uptake since January. 22% said they're uncertain how much vaccine to buy for the season.
The brief recommends moving that inventory risk off small and independent practices. Right now, the small practice carries it.
Then Medicaid Gets Cut
KFF Health News reports that Medicaid covers 4 in 10 children in the US. The federal budget law is expected to reduce Medicaid spending by about $1 trillion over the next decade.
Less federal money means states have to make choices. KFF's Jennifer Tolbert said states may cut eligibility for optional populations, cut optional services or reduce payments to providers.
That last one lands directly on pediatricians. A pediatric billing industry report says Colorado cut Medicaid rates 2% across the board for providers who care for children, and that two pediatric clinics near Commerce City, Colorado, shut down due to insufficient revenue.
The Middleman Decides What Counts
Look at who sets the price in all of this. It isn't the pediatrician.
Insurers and Medicaid managed care companies decide what's covered, what's paid and what's denied. State budgets decide the fee schedule. The practice does the visit, the counseling and the paperwork, and then waits to find out what someone else decided it was worth.
The Milbank brief says payers should treat vaccine counseling, including counseling that doesn't end in a shot, as a reimbursable clinical service. That recommendation exists because, for now, they mostly don't.
Coverage itself now depends on the middlemen too. The brief notes that AHIP, the insurance industry trade group, has said its members' plans will cover vaccines recommended as of September 1, 2025, through the end of 2027. Practices that follow the pediatricians' own schedule are left watching insurer decisions before they place seasonal orders. The insurers set the terms. The practice carries the risk.
Who Pays
Families pay first. When a pediatric practice can't make the numbers work, it stops taking new patients or closes, and parents lose the doctor who knows their child.
You pay too. Premiums and taxes keep flowing into a system that pays the people doing the work less and less. The money doesn't disappear. It goes to the layers in between.
A Simpler Way to Price Care
There's another way to run health care: a posted price, set by the people providing the care, that you can see before you pay. No middleman deciding after the fact what the work was worth.
That's how we run Forest Park Pharmacy. We don't take insurance. Every drug is priced at actual acquisition cost plus a transparent fee. We have no reason to pretend the price is higher than it is. We compete on price.
Head to forestparkpharmacy.com to look at our price checker and transfer today to save. See ya.
