November 23, 2024 • 24 mins
Dr. Robyn Riseberg, founder of Boston Community Pediatrics, the first nonprofit pediatric private practice in Massachusetts, discusses the challenges of bringing equity to all children regardless of their insurance or family's ability to pay and addressing the substantial impact of social determinants of health.
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Speaker 1 (00:02):
This is What's at Risk with Mike Christian on WBZ,
Boston's news radio.
Speaker 2 (00:09):
Hi, Mike Christian, Hero What's at Risk? First up on
tonight's show, we welcome doctor Robin Reisberg, founder of Boston
Community Pediatrics, the first nonprofit pediatric private practice in Massachusetts.
She discusses the challenges of bringing equity to all children,
regardless of their insurance or family's ability to pay, and
(00:31):
addressing the substantial impact of social determinants of health. And
in our second segment, we speak with doctor John Shears,
co author of the new national geographic book and film Endurance,
The Discovery of Shackleton's legendary Ship. John talks passionately about
Ernest Shackleton's caroling survival story and the incredible rescue of
(00:55):
all twenty seven crew members. He also discusses his mission
to low cape, film and survey the wreck of Shackleton's
loss ship The Endurance. Doctor Robin Reisberg founded Boston Community
Pediatrics as a nonprofit pediatric private practice, the first of
(01:15):
its kind in Massachusetts. Its mission is to bring equity
to pediatric health care by giving all patients, including those
on mass health, direct access to their primary care provider
and access to comprehensive, prevention oriented medical care and integrated
behavioral health services. Boston Community Pediatrics leverages an asset based,
(01:39):
relationship driven approach to improve health outcomes and lower health
care costs for all pediatric patients, regardless of socioeconomic status
or background. What is the higher Our guest today is
(02:01):
doctor Robin Reisberg, pediatrician and founder of Boston Community Pediatrics. Robin,
how you doing great? How are you great to have
you on the show.
Speaker 1 (02:11):
Thank you so much for having me. I'm happy. Yeah.
Speaker 2 (02:15):
Maybe a good place to start would be for you
to tell our listeners a little bit about your background.
Speaker 1 (02:21):
I am a pediatrician, as you said, and I started
Boston Community Pediatrics in November of twenty twenty, and it
is the first nonprofit pediatric private practice in Massachusetts and
one of the first in the country. And our mission
is really to bring equity to pediatric healthcare. So we
have on site pediatric services, primary care pediatric services, and
(02:44):
then we also have on site integrated mental health services
that where we really deliver the care together, and then
also a whole team that works with families around the
social determines of health. We call it our care navigation
and wellness team. Prior to that, I was working at
the South End Community Health Center for about fifteen years,
where I was the head of pediatrics and the head
(03:04):
of a school based health center at the Blackstone School
which was at their satellite health center, the Doctor Gerald
House Center, and I had started out my career there
as a part time pediatrician. I actually enjoyed creating new
programs and bringing new and innovative ideas into the department
of pediatric Over time, became frustrated with the bureaucracy of
(03:26):
medicine and things taking so long to get done and
really not being able to be as innovative as I
wanted to be, and so spent a couple of years
thinking about lots of different ways to become more innovative
and pediatrics, lots of different models, for profit models, not
for profit models, and ultimately said what actually works in
(03:49):
Massachusetts and pediatrics, and it's really these small private practices.
They often really get to know the families who come there,
but those are primarily for patients who have private insurance.
And so if you have of Medicaid and you are
a blacker, brown family with low income, you actually don't
have access to many of those private practices. If I
really wanted to partner with families, I needed to create
(04:10):
a model that worked for families and wouldn't necessarily work
for on a business level. So I thought, if I
created as a private practice that's a nonprofit, I can
use philanthropy to make up the difference in reimbursements. I
established the organization in twenty nineteen and thought I would
get ready to launch it in twenty twenty, And in
(04:32):
March of twenty twenty had a small fundraiser where I
was hoping to raise some of the seed money I
needed to get the program off the ground. And that
was in March of twenty twenty. I think we all
remember what happened then, and that was that the whole
world shut down, and so I was still working full
time at the South End Health Center, and then we
had all of the racial reckoning that happened in that
(04:54):
year in the spring of that year, and it was
at that moment that I said, my tagline is bringing
equity to pediatric health care. So I went back to
some of the people I had met, fundraised a little bit,
and so in August of twenty twenty, I signed the
lease and we opened in November of twenty twenty, and
that's how it all started.
Speaker 2 (05:14):
Yeah, that's great. You mentioned mental health. I've had many
conversations about mental health over the last few years, and
of course it's a big topic, and you're focused on
some to a great degree, on mental health, especially for youth.
I see stats all over the place, but just get
say a range for youth in Massachusetts of twenty to
(05:35):
forty percent youth having some reporting some mental health issue,
and Massachusetts surprisingly is fairly high in that percentage compared
to other states in the country, and it's getting worse.
What do you think is that attributed to I know
COVID was a big, big driver of it for a while,
but now it doesn't seem to be getting better as
(05:57):
COVID has waned. What are your thoughts around that.
Speaker 1 (06:00):
I think it's it's like multifactorial. So I would agree
with those numbers, those of the numbers we're seeing, And
I think one people are talking about it more, which
is good, but there are still not enough resources and
we're not addressing it. You know, from a very very
early age, like we need to be this is something
(06:22):
that we need to be addressing from when kids are born,
frankly in terms of learning even in the preschool ages,
coping mechanisms, how to talk about your feelings, how to
get along with other children, how to be ready for preschool,
ready for school, ready for kindergarten. All of those things
(06:45):
make people more likely to have less mental health problems
later in life. And I think our whole medical system
is not set up for prevention, right, It's set up
for a crisis, and so we really need to be
putting a lot more emphasis on that prevention.
Speaker 2 (07:02):
Do you think the causes of mental health have changed
or it's just there's a greater awareness of it, and
as you mentioned, people are talking about it more. But
do you think the underlying causes are different now than
say they were ten years ago.
Speaker 1 (07:16):
The amount of exposure to violence, to even just like
inappropriate content, is everywhere, and that does affect people's mental health.
So it does make it harder to go about your
day as an eight year old when you have all
these things coming in on your iPhone feed of violence
(07:39):
in the world, violence in your neighborhoods. Exposure to that
does affect people.
Speaker 2 (07:44):
What are some of the practices or the approaches that
your practice embraces to address some of these issues.
Speaker 1 (07:51):
Yeah, So the first thing that we do is we
really think of a very holistic field of health. Mental
health is integrated in everything that we do, and so
I think of health is having many different sassets. But
really the things that we focus on here are your
physical health, your mental health, and the social determents that
affect your health, and all of those affect each other
and are totally integrated. So if you're homeless, that's going
(08:15):
to affect your mental health, it's actually also going to
affect your physical health. So every day, people, all of
the staff working in all three of those departments, almost
the entire staff in our office, meets together and talks
about the patients who are coming in that day. So
once we know who's coming in and who's going to
need what, we sort of divvy up who's going to
(08:35):
address what with everyone and who's going to need to
do that work together, and then our pediatricians and pediatric
providers go into mental health clinicians with mental health visits
with the mental health clinditionans and they come into our visit.
So patient just this morning, we were seeing a teenage
patient one of our mental health clinicians was for depression.
(08:57):
I came into the therapy visit and anticipated in the
therapy and talked about the medications that she was on,
talked about how we were making changes because she was
still depressed, and we did that all together. We're doing
it all together, which really breaks down silos, makes us
much more available to patients. Patients know one of our
(09:20):
mental health clinicians was on vacation a few weeks ago.
This same patient had a visit with me to talk
about her mental health because we didn't want her to
go too long without seeing someone to check in. That's
the work we're able to do because we're doing it together,
and it just it makes it so. It takes the
burden off of the families too. So if you're a
(09:41):
single mom with kids and you're working one or two jobs,
trying to go to those three different appointments is almost impossible.
They may not have a job that gives them any
sick leave there. If you're an hourly worker, you may not.
So you have to make the decision do I take
my kid to their appointment or do I put food
on the table. The other thing that we do here
(10:02):
to address it the social determines of health, which again
will affect mental health. Is we really support families around
food and security, housing, childcare, and so we have a
whole team working with families around helping them get what
resources they need and deserve. And then at every visit
we're giving out food and hygiene products and feminine hygiene
(10:23):
products and underwear and clothing and meals, and so we're
really saying, here's what families need, and we're going to
deliver that to you at this visit in a really
dignified way. So again we're not asking you to three
different places to get all those things. We also we
have individual therapy, we have group therapy. We have a
parent support group that's over Zoom so parents can join,
(10:47):
run by one of our mental health clinicians. We run
a whole host of after school programs, which is also
protective of people's mental health. So we have a Girls
on the Run program that has a whole mental health
component to it. In fact, tomorrow is our five K culmination,
so I'm taking a whole group of kids and we're
going to run their five K together. And that's a
huge sense of accomplishment for kids who have never done
(11:09):
something like that we have a cooking class where we
send food to families ahead of time and kids get
to cook with fruits and vetels for their families each
and every week and serve a meal. I mean that
gives kids such a sense of pride. And then we
also have a consulting child and adolescent psychiatrist who helps
us manage more complicated patients. So we're really trying to
(11:30):
bring everything into the pediatric practice, which is where we
know families are going to come.
Speaker 2 (11:37):
Nonprofit physician practices can often provide better access and affordability
for low income patients compared to for profit practices. This
is due to several factors. These practices often have a
mission to serve their communities, which frequently includes addressing the
needs of underserved populations. Many nonprofits aim to reduce health
(11:58):
disparities and all for services regardless of a patient's ability
to pay. Nonprofits are eligible for grants and subsidies from
philanthropy and federal and state governments, which can enable them
to offer lower cost services. Nonprofit practices often prioritize preventative
and holistic care, which includes services like nutrition, counseling, mental
(12:22):
health care, and chronic disease management. Many of these practices
are involved in community outreach and patient education programs. These
initiatives help ensure patients are informed about health resources and
know how to navigate the health care system, which can
be particularly helpful for low income patients. Nonprofits are not
(12:43):
driven by profit motives, so they may have more flexibility
to allocate resources to patient care. This can result in
a more patient centered approach. Now back to our discussion
with doctor Reisberg, and then on the other side of
it is, can you talk just a little bit about
how the traditional model of pediatric care really deepens the
(13:05):
socioeconomic inequity for families.
Speaker 1 (13:08):
Private practices are really, you know, much more focused on
families who have private insurance. And then we have the
community health centers and some of the larger hospitals who
are more likely to take mass health or medicaid to
serve kids who have low income. And although those places
are doing, you know, amazing work, and they're serving so
(13:31):
many kids, and they're such big institutions that there's so
much bureaucracy that it can even sometimes be hard to
get through on the phone if you have a sick child.
That's not acceptable. But these systems are so overwhelmed that
they're not able to address what families need addressed.
Speaker 2 (13:47):
In that moment, So maybe we can. We'll shift a
little bit and just talk about your recent event, Voices
from the front Lines. That was a fundraising event that
you had at the John F. Kennedy Presidential Library. What
was that all about and how to go and how
many people did you have and what were the big
topics that you talked about?
Speaker 1 (14:07):
It was amazing, you know, this event sort of came
out of some discussions that we were having this year
that we tomorrow is actually our fourth anniversary of you know,
since we opened, so we are a very new organization
who is you know, trying to establish ourselves in our community.
And we had one gala about a year and a
(14:27):
half after we opened in twenty twenty two, and then
last year we had a smaller event at our own
office because we doubled our space, so we wanted people
to come in and see our space. And this year
we thought, well, gala isn't exactly like, we have a
lot to say and a lot that we want to accomplish.
We kind of started out thinking we would have a
fireside chat and then all of a sudden, we realized
(14:49):
what we were putting together was so important that we
wanted to really make it a larger event. We had
almost four hundred people there, which was incredible, and we
had the Attorney General who kind of opened our evening,
which was amazing. I said in my speech, I feel
like we've made it because the Attorney General is speaking
at our event. And then we had a piano discussion
(15:12):
with doctor Kevin Simon, who's the chief Behavioral Health Officer
for the city, and doctor Stacey Drury, who is the
chair of Psychiatry at Boston Children's Hospital. Both of them
are psychiatrists. Kevin Simon also works at children They have
like very unique perspectives on what is the mental health crisis.
(15:32):
People keep acting like it happened today, you know this
has been going on for years and years, and doctor
Drury talked about that. Doctor Simon was really interesting. He
asked people to raise their hand. People could raise their
hand if they knew of someone who'd had a cardiac issue.
He asked people in the room to raise their hand
and say if they knew of anyone who had a
mental health issue, and so many more people raise their
(15:53):
hand around mental health, and yet the disparity in what
we spend on mental health versus cardiac health is is
so unbelievable. So we really talked around a lot about
how there isn't enough investment in mental health, even in Boston,
even in Massachusetts, which invests the most in mental health
probably in the country. We had doctor Jose Maso the
(16:15):
third who was the moderator for that panel, who did
an amazing job helping kind of narrate and move that
conversation along, and I did a sort of ted talk
type talk about why I started Boston Community Pediatrics and
why we need more of this type of healthcare and
why our healthcare system is broken, and it was really
(16:38):
important to me that we are hopeful in this moment
because I wanted people to know there is another way.
You know, it's interesting people, I think in healthcare, everyone's
always like, this is the way we've always done it,
this is what we're doing, And I thought everyone should
have the access to the care that my own true
daughters have. And that's really where this came from. When
people say how do you do this or how do
you do that? We uber kids do appointments and we
(17:01):
make sure that kids are you have jobs, are going
to college? We help them with their college applications. I
would say, it's just the work that I would do
with my own two kids. Like, it's no different, that's it.
It's very basic. But obviously there aren't that many people
doing it right.
Speaker 2 (17:16):
The nonprofit model is really intriguing to me. I mean,
if you think about in Boston in particular, there's been
a lot of coverage about Stuart Health, right, the big
hospital chain and the financial collapse and the just sort
of extreme excess and greed around that. And now that's
an extreme example. Of course private equity, everything that you
(17:37):
can imagine that could be negative about ownership of a
health organization, and so not all examples are that extreme.
But how does the nonprofit model differ from the for
profit model? And certainly the for profit model is a
lot more prevalent than the nonprofit model. Do you think
it's realistic to think that that can be replicated in
a more meaningful way in other areas?
Speaker 1 (18:00):
The million dollar question you just asked, So, I believe
that health and health care should be done in a
way that is prioritizing patients over profits, right, So we
center the patient and all we do, and that to
me is the most critical piece of this work. So
if a patient needs an hour long visit because they
are failings out of school, they are homeless, like to
(18:24):
ask them to come back three times or to not
address those things, to me, we are failing our children.
And so in order to be able to do that, though,
you can't be worried about all of the revenue. And
obviously it's a business. Everything's a business. I run this
nonprofit like a for profit business, but I use philanthropy
as my venture capital investment. I believe there is enough
(18:47):
money in the system. If you think about all the
money that we spend in healthcare in this state, in
this country. To me, we're just not spending in the
right place. It's that the hand raising of the cardiac
versus the mental health. Everyone's got that. Everyone knows someone
if not you know that is struggling with mental health.
Not everyone knows someone who has a heart problem. Right now,
if we teach kids to be ready or to eat
(19:11):
foods and vegetables at a young age, there's going to
be less diabetes. But we're not. No one wants to
invest in that, but they're willing to invest in all
the people have diabetes like we to me, we've got
it backwards, you know. I actually believe there should be
like a multi kind of funding stream that goes into healthcare.
So it should be some insurance reinforsement, potentially some government investment,
(19:34):
and we're potentially philanthropy. But I think we need to
push the healthcare system and push our greater like public
health system, our greater government systems to invest in that more.
Speaker 2 (19:45):
And so on the philanthropy side of funding, that's not
always guaranteed. Obviously, it's a lot of work. You just
put a big galea on and you now know how
much work doing that is. Yeah, that's doing that myself.
How do you think if you can sort of strike
a balance between funding government funding and insurance company funding,
(20:07):
and you know it, maybe even partial patient funding and
philanthropic funding, what would be the right balance and how
could you attain that in a way that doesn't detract
from the care that you're giving to your patients.
Speaker 1 (20:23):
I don't think this is going to happen overnight, but
there's a couple of things in healthcare funding. So right
now we spend about five to six percent on primary
care in this country. If we spend fifteen percent on
primary care, which is what most people think is needed,
that's three times what we're spending now. That is a
lot more revenue. There's also something called Medicaid and Medicare purity.
(20:47):
So Medicare, which is health care for older adults, reimburses
much at a much higher rate than Medicaid, which is
reimbursement for kids and families. So again that doesn't make
any sense, right, There's a lot of people pushing for
Medicaid purity to Medicare, so that would be helpful. And
then I think, you know. The last thing is it
(21:11):
is almost impossible to explain to people not in healthcare
how insurance reimbursements work because it sounds so unbelievable. So basically,
as a pediatrician, I can charge whatever I want for
a visit, believe it or not. I can charge two
hundred and fifty dollars. I can charge three hundred dollars,
and the insurance companies can pay me whatever they want,
(21:33):
which is also unbelievable. Right Like, so I charge everyone
the same and Blue Cross can pay me one hundred
and twenty dollars, Medicaid can pay me one hundred and
nine dollars. United Healthcare can pay me one hundred and
thirty dollars and I have no say in the matter.
They pay me what they want to pay me.
Speaker 2 (21:50):
Yeah, And it's evolved over decades and decades, and it's
it's you know, it's definitely a very intricate and complex web.
Do you see any hope on the horizon? Do you
see momentum with other physicians like yourself that are thinking
about I know the's frustration with physicians, just that you
(22:11):
just expressed and did it in a pretty articulate way
with a little emotion, But I've heard that from many
many other physicians are just tired of it. They just
want to treat their patients, They want to do their job,
they want to make a fair amount of money. But
do you see any positive movement? And we have some
political changes now, but I'm not going.
Speaker 1 (22:31):
To talk about those that because I don't think that
there's going to be any positive movement there for kids
and healthcare, to be honest. But what I do think,
what I do think is really positive, is that this
model that we've created is what doctors want. I have
had no medical staff, no physicians leave since opening and
(22:52):
only people clamoring to get in. Literally, you know, I
receive lots of emails all the time from physicians who
are like, Hey, how do I get in on this,
or how can you help me figure out how to
do this in family medicine, in women's health, And so
I think, you know, my one of one of the
things that I want to do is inspire other people
to do this. You know, it is It's a lot
(23:15):
of work. It's more work than I've ever done, and
I love it so much because we all get to
practice medicine the way it should be practiced. We get
to actually take care of patients the way patients should
be taking care of with respect and dignity, and we
get to create community. And so so I think if
we can all say, like, let's reimagine healthcare that's what
(23:36):
I did, then we would be in a much better place.
And so I am very hopeful about that, and I
believe that there's plenty of people who would want to
work in this type of a system.
Speaker 2 (23:49):
I think you're absolutely right. Our guest today has been
doctor Robin Reisberg. She's a pediatrician and she's a founder
of Boston Community Pediatrics a firm that does a lot
different than many other practices. Robert, thank you so much.
That was really an enlightening and energizing conversation. So I
appreciate it. How can how can our listeners find out
(24:10):
a little bit more about what you're doing and the
work you're doing.
Speaker 1 (24:12):
Yeah, so follow us on Instagram, come to our you know,
we have a website. We're also on LinkedIn and Facebook,
but you know, we'd love to, you know, hear from people.
Were our Instagram, I would say, is our you know,
we are a lot of up to date information goes
and our and our website has a ton of information
(24:34):
about the work that we're doing.
Speaker 2 (24:36):
That's great. Well, thanks again, I really appreciate it.
Speaker 1 (24:38):
Thank you so much. It's been a pleasure. I really
appreciate you having me on.
Speaker 2 (24:47):
We'll be right back after the news at the bottom
of the hour.
This is What's at Risk with Mike Christian on WBZ,
Boston's news radio.
Speaker 2 (00:09):
Hi, Mike Christian, Hero What's at Risk? First up on
tonight's show, we welcome doctor Robin Reisberg, founder of Boston
Community Pediatrics, the first nonprofit pediatric private practice in Massachusetts.
She discusses the challenges of bringing equity to all children,
regardless of their insurance or family's ability to pay, and
(00:31):
addressing the substantial impact of social determinants of health. And
in our second segment, we speak with doctor John Shears,
co author of the new national geographic book and film Endurance,
The Discovery of Shackleton's legendary Ship. John talks passionately about
Ernest Shackleton's caroling survival story and the incredible rescue of
(00:55):
all twenty seven crew members. He also discusses his mission
to low cape, film and survey the wreck of Shackleton's
loss ship The Endurance. Doctor Robin Reisberg founded Boston Community
Pediatrics as a nonprofit pediatric private practice, the first of
(01:15):
its kind in Massachusetts. Its mission is to bring equity
to pediatric health care by giving all patients, including those
on mass health, direct access to their primary care provider
and access to comprehensive, prevention oriented medical care and integrated
behavioral health services. Boston Community Pediatrics leverages an asset based,
(01:39):
relationship driven approach to improve health outcomes and lower health
care costs for all pediatric patients, regardless of socioeconomic status
or background. What is the higher Our guest today is
(02:01):
doctor Robin Reisberg, pediatrician and founder of Boston Community Pediatrics. Robin,
how you doing great? How are you great to have
you on the show.
Speaker 1 (02:11):
Thank you so much for having me. I'm happy. Yeah.
Speaker 2 (02:15):
Maybe a good place to start would be for you
to tell our listeners a little bit about your background.
Speaker 1 (02:21):
I am a pediatrician, as you said, and I started
Boston Community Pediatrics in November of twenty twenty, and it
is the first nonprofit pediatric private practice in Massachusetts and
one of the first in the country. And our mission
is really to bring equity to pediatric healthcare. So we
have on site pediatric services, primary care pediatric services, and
(02:44):
then we also have on site integrated mental health services
that where we really deliver the care together, and then
also a whole team that works with families around the
social determines of health. We call it our care navigation
and wellness team. Prior to that, I was working at
the South End Community Health Center for about fifteen years,
where I was the head of pediatrics and the head
(03:04):
of a school based health center at the Blackstone School
which was at their satellite health center, the Doctor Gerald
House Center, and I had started out my career there
as a part time pediatrician. I actually enjoyed creating new
programs and bringing new and innovative ideas into the department
of pediatric Over time, became frustrated with the bureaucracy of
(03:26):
medicine and things taking so long to get done and
really not being able to be as innovative as I
wanted to be, and so spent a couple of years
thinking about lots of different ways to become more innovative
and pediatrics, lots of different models, for profit models, not
for profit models, and ultimately said what actually works in
(03:49):
Massachusetts and pediatrics, and it's really these small private practices.
They often really get to know the families who come there,
but those are primarily for patients who have private insurance.
And so if you have of Medicaid and you are
a blacker, brown family with low income, you actually don't
have access to many of those private practices. If I
really wanted to partner with families, I needed to create
(04:10):
a model that worked for families and wouldn't necessarily work
for on a business level. So I thought, if I
created as a private practice that's a nonprofit, I can
use philanthropy to make up the difference in reimbursements. I
established the organization in twenty nineteen and thought I would
get ready to launch it in twenty twenty, And in
(04:32):
March of twenty twenty had a small fundraiser where I
was hoping to raise some of the seed money I
needed to get the program off the ground. And that
was in March of twenty twenty. I think we all
remember what happened then, and that was that the whole
world shut down, and so I was still working full
time at the South End Health Center, and then we
had all of the racial reckoning that happened in that
(04:54):
year in the spring of that year, and it was
at that moment that I said, my tagline is bringing
equity to pediatric health care. So I went back to
some of the people I had met, fundraised a little bit,
and so in August of twenty twenty, I signed the
lease and we opened in November of twenty twenty, and
that's how it all started.
Speaker 2 (05:14):
Yeah, that's great. You mentioned mental health. I've had many
conversations about mental health over the last few years, and
of course it's a big topic, and you're focused on
some to a great degree, on mental health, especially for youth.
I see stats all over the place, but just get
say a range for youth in Massachusetts of twenty to
(05:35):
forty percent youth having some reporting some mental health issue,
and Massachusetts surprisingly is fairly high in that percentage compared
to other states in the country, and it's getting worse.
What do you think is that attributed to I know
COVID was a big, big driver of it for a while,
but now it doesn't seem to be getting better as
(05:57):
COVID has waned. What are your thoughts around that.
Speaker 1 (06:00):
I think it's it's like multifactorial. So I would agree
with those numbers, those of the numbers we're seeing, And
I think one people are talking about it more, which
is good, but there are still not enough resources and
we're not addressing it. You know, from a very very
early age, like we need to be this is something
(06:22):
that we need to be addressing from when kids are born,
frankly in terms of learning even in the preschool ages,
coping mechanisms, how to talk about your feelings, how to
get along with other children, how to be ready for preschool,
ready for school, ready for kindergarten. All of those things
(06:45):
make people more likely to have less mental health problems
later in life. And I think our whole medical system
is not set up for prevention, right, It's set up
for a crisis, and so we really need to be
putting a lot more emphasis on that prevention.
Speaker 2 (07:02):
Do you think the causes of mental health have changed
or it's just there's a greater awareness of it, and
as you mentioned, people are talking about it more. But
do you think the underlying causes are different now than
say they were ten years ago.
Speaker 1 (07:16):
The amount of exposure to violence, to even just like
inappropriate content, is everywhere, and that does affect people's mental health.
So it does make it harder to go about your
day as an eight year old when you have all
these things coming in on your iPhone feed of violence
(07:39):
in the world, violence in your neighborhoods. Exposure to that
does affect people.
Speaker 2 (07:44):
What are some of the practices or the approaches that
your practice embraces to address some of these issues.
Speaker 1 (07:51):
Yeah, So the first thing that we do is we
really think of a very holistic field of health. Mental
health is integrated in everything that we do, and so
I think of health is having many different sassets. But
really the things that we focus on here are your
physical health, your mental health, and the social determents that
affect your health, and all of those affect each other
and are totally integrated. So if you're homeless, that's going
(08:15):
to affect your mental health, it's actually also going to
affect your physical health. So every day, people, all of
the staff working in all three of those departments, almost
the entire staff in our office, meets together and talks
about the patients who are coming in that day. So
once we know who's coming in and who's going to
need what, we sort of divvy up who's going to
(08:35):
address what with everyone and who's going to need to
do that work together, and then our pediatricians and pediatric
providers go into mental health clinicians with mental health visits
with the mental health clinditionans and they come into our visit.
So patient just this morning, we were seeing a teenage
patient one of our mental health clinicians was for depression.
(08:57):
I came into the therapy visit and anticipated in the
therapy and talked about the medications that she was on,
talked about how we were making changes because she was
still depressed, and we did that all together. We're doing
it all together, which really breaks down silos, makes us
much more available to patients. Patients know one of our
(09:20):
mental health clinicians was on vacation a few weeks ago.
This same patient had a visit with me to talk
about her mental health because we didn't want her to
go too long without seeing someone to check in. That's
the work we're able to do because we're doing it together,
and it just it makes it so. It takes the
burden off of the families too. So if you're a
(09:41):
single mom with kids and you're working one or two jobs,
trying to go to those three different appointments is almost impossible.
They may not have a job that gives them any
sick leave there. If you're an hourly worker, you may not.
So you have to make the decision do I take
my kid to their appointment or do I put food
on the table. The other thing that we do here
(10:02):
to address it the social determines of health, which again
will affect mental health. Is we really support families around
food and security, housing, childcare, and so we have a
whole team working with families around helping them get what
resources they need and deserve. And then at every visit
we're giving out food and hygiene products and feminine hygiene
(10:23):
products and underwear and clothing and meals, and so we're
really saying, here's what families need, and we're going to
deliver that to you at this visit in a really
dignified way. So again we're not asking you to three
different places to get all those things. We also we
have individual therapy, we have group therapy. We have a
parent support group that's over Zoom so parents can join,
(10:47):
run by one of our mental health clinicians. We run
a whole host of after school programs, which is also
protective of people's mental health. So we have a Girls
on the Run program that has a whole mental health
component to it. In fact, tomorrow is our five K culmination,
so I'm taking a whole group of kids and we're
going to run their five K together. And that's a
huge sense of accomplishment for kids who have never done
(11:09):
something like that we have a cooking class where we
send food to families ahead of time and kids get
to cook with fruits and vetels for their families each
and every week and serve a meal. I mean that
gives kids such a sense of pride. And then we
also have a consulting child and adolescent psychiatrist who helps
us manage more complicated patients. So we're really trying to
(11:30):
bring everything into the pediatric practice, which is where we
know families are going to come.
Speaker 2 (11:37):
Nonprofit physician practices can often provide better access and affordability
for low income patients compared to for profit practices. This
is due to several factors. These practices often have a
mission to serve their communities, which frequently includes addressing the
needs of underserved populations. Many nonprofits aim to reduce health
(11:58):
disparities and all for services regardless of a patient's ability
to pay. Nonprofits are eligible for grants and subsidies from
philanthropy and federal and state governments, which can enable them
to offer lower cost services. Nonprofit practices often prioritize preventative
and holistic care, which includes services like nutrition, counseling, mental
(12:22):
health care, and chronic disease management. Many of these practices
are involved in community outreach and patient education programs. These
initiatives help ensure patients are informed about health resources and
know how to navigate the health care system, which can
be particularly helpful for low income patients. Nonprofits are not
(12:43):
driven by profit motives, so they may have more flexibility
to allocate resources to patient care. This can result in
a more patient centered approach. Now back to our discussion
with doctor Reisberg, and then on the other side of
it is, can you talk just a little bit about
how the traditional model of pediatric care really deepens the
(13:05):
socioeconomic inequity for families.
Speaker 1 (13:08):
Private practices are really, you know, much more focused on
families who have private insurance. And then we have the
community health centers and some of the larger hospitals who
are more likely to take mass health or medicaid to
serve kids who have low income. And although those places
are doing, you know, amazing work, and they're serving so
(13:31):
many kids, and they're such big institutions that there's so
much bureaucracy that it can even sometimes be hard to
get through on the phone if you have a sick child.
That's not acceptable. But these systems are so overwhelmed that
they're not able to address what families need addressed.
Speaker 2 (13:47):
In that moment, So maybe we can. We'll shift a
little bit and just talk about your recent event, Voices
from the front Lines. That was a fundraising event that
you had at the John F. Kennedy Presidential Library. What
was that all about and how to go and how
many people did you have and what were the big
topics that you talked about?
Speaker 1 (14:07):
It was amazing, you know, this event sort of came
out of some discussions that we were having this year
that we tomorrow is actually our fourth anniversary of you know,
since we opened, so we are a very new organization
who is you know, trying to establish ourselves in our community.
And we had one gala about a year and a
(14:27):
half after we opened in twenty twenty two, and then
last year we had a smaller event at our own
office because we doubled our space, so we wanted people
to come in and see our space. And this year
we thought, well, gala isn't exactly like, we have a
lot to say and a lot that we want to accomplish.
We kind of started out thinking we would have a
fireside chat and then all of a sudden, we realized
(14:49):
what we were putting together was so important that we
wanted to really make it a larger event. We had
almost four hundred people there, which was incredible, and we
had the Attorney General who kind of opened our evening,
which was amazing. I said in my speech, I feel
like we've made it because the Attorney General is speaking
at our event. And then we had a piano discussion
(15:12):
with doctor Kevin Simon, who's the chief Behavioral Health Officer
for the city, and doctor Stacey Drury, who is the
chair of Psychiatry at Boston Children's Hospital. Both of them
are psychiatrists. Kevin Simon also works at children They have
like very unique perspectives on what is the mental health crisis.
(15:32):
People keep acting like it happened today, you know this
has been going on for years and years, and doctor
Drury talked about that. Doctor Simon was really interesting. He
asked people to raise their hand. People could raise their
hand if they knew of someone who'd had a cardiac issue.
He asked people in the room to raise their hand
and say if they knew of anyone who had a
mental health issue, and so many more people raise their
(15:53):
hand around mental health, and yet the disparity in what
we spend on mental health versus cardiac health is is
so unbelievable. So we really talked around a lot about
how there isn't enough investment in mental health, even in Boston,
even in Massachusetts, which invests the most in mental health
probably in the country. We had doctor Jose Maso the
(16:15):
third who was the moderator for that panel, who did
an amazing job helping kind of narrate and move that
conversation along, and I did a sort of ted talk
type talk about why I started Boston Community Pediatrics and
why we need more of this type of healthcare and
why our healthcare system is broken, and it was really
(16:38):
important to me that we are hopeful in this moment
because I wanted people to know there is another way.
You know, it's interesting people, I think in healthcare, everyone's
always like, this is the way we've always done it,
this is what we're doing, And I thought everyone should
have the access to the care that my own true
daughters have. And that's really where this came from. When
people say how do you do this or how do
you do that? We uber kids do appointments and we
(17:01):
make sure that kids are you have jobs, are going
to college? We help them with their college applications. I
would say, it's just the work that I would do
with my own two kids. Like, it's no different, that's it.
It's very basic. But obviously there aren't that many people
doing it right.
Speaker 2 (17:16):
The nonprofit model is really intriguing to me. I mean,
if you think about in Boston in particular, there's been
a lot of coverage about Stuart Health, right, the big
hospital chain and the financial collapse and the just sort
of extreme excess and greed around that. And now that's
an extreme example. Of course private equity, everything that you
(17:37):
can imagine that could be negative about ownership of a
health organization, and so not all examples are that extreme.
But how does the nonprofit model differ from the for
profit model? And certainly the for profit model is a
lot more prevalent than the nonprofit model. Do you think
it's realistic to think that that can be replicated in
a more meaningful way in other areas?
Speaker 1 (18:00):
The million dollar question you just asked, So, I believe
that health and health care should be done in a
way that is prioritizing patients over profits, right, So we
center the patient and all we do, and that to
me is the most critical piece of this work. So
if a patient needs an hour long visit because they
are failings out of school, they are homeless, like to
(18:24):
ask them to come back three times or to not
address those things, to me, we are failing our children.
And so in order to be able to do that, though,
you can't be worried about all of the revenue. And
obviously it's a business. Everything's a business. I run this
nonprofit like a for profit business, but I use philanthropy
as my venture capital investment. I believe there is enough
(18:47):
money in the system. If you think about all the
money that we spend in healthcare in this state, in
this country. To me, we're just not spending in the
right place. It's that the hand raising of the cardiac
versus the mental health. Everyone's got that. Everyone knows someone
if not you know that is struggling with mental health.
Not everyone knows someone who has a heart problem. Right now,
if we teach kids to be ready or to eat
(19:11):
foods and vegetables at a young age, there's going to
be less diabetes. But we're not. No one wants to
invest in that, but they're willing to invest in all
the people have diabetes like we to me, we've got
it backwards, you know. I actually believe there should be
like a multi kind of funding stream that goes into healthcare.
So it should be some insurance reinforsement, potentially some government investment,
(19:34):
and we're potentially philanthropy. But I think we need to
push the healthcare system and push our greater like public
health system, our greater government systems to invest in that more.
Speaker 2 (19:45):
And so on the philanthropy side of funding, that's not
always guaranteed. Obviously, it's a lot of work. You just
put a big galea on and you now know how
much work doing that is. Yeah, that's doing that myself.
How do you think if you can sort of strike
a balance between funding government funding and insurance company funding,
(20:07):
and you know it, maybe even partial patient funding and
philanthropic funding, what would be the right balance and how
could you attain that in a way that doesn't detract
from the care that you're giving to your patients.
Speaker 1 (20:23):
I don't think this is going to happen overnight, but
there's a couple of things in healthcare funding. So right
now we spend about five to six percent on primary
care in this country. If we spend fifteen percent on
primary care, which is what most people think is needed,
that's three times what we're spending now. That is a
lot more revenue. There's also something called Medicaid and Medicare purity.
(20:47):
So Medicare, which is health care for older adults, reimburses
much at a much higher rate than Medicaid, which is
reimbursement for kids and families. So again that doesn't make
any sense, right, There's a lot of people pushing for
Medicaid purity to Medicare, so that would be helpful. And
then I think, you know. The last thing is it
(21:11):
is almost impossible to explain to people not in healthcare
how insurance reimbursements work because it sounds so unbelievable. So basically,
as a pediatrician, I can charge whatever I want for
a visit, believe it or not. I can charge two
hundred and fifty dollars. I can charge three hundred dollars,
and the insurance companies can pay me whatever they want,
(21:33):
which is also unbelievable. Right Like, so I charge everyone
the same and Blue Cross can pay me one hundred
and twenty dollars, Medicaid can pay me one hundred and
nine dollars. United Healthcare can pay me one hundred and
thirty dollars and I have no say in the matter.
They pay me what they want to pay me.
Speaker 2 (21:50):
Yeah, And it's evolved over decades and decades, and it's
it's you know, it's definitely a very intricate and complex web.
Do you see any hope on the horizon? Do you
see momentum with other physicians like yourself that are thinking
about I know the's frustration with physicians, just that you
(22:11):
just expressed and did it in a pretty articulate way
with a little emotion, But I've heard that from many
many other physicians are just tired of it. They just
want to treat their patients, They want to do their job,
they want to make a fair amount of money. But
do you see any positive movement? And we have some
political changes now, but I'm not going.
Speaker 1 (22:31):
To talk about those that because I don't think that
there's going to be any positive movement there for kids
and healthcare, to be honest. But what I do think,
what I do think is really positive, is that this
model that we've created is what doctors want. I have
had no medical staff, no physicians leave since opening and
(22:52):
only people clamoring to get in. Literally, you know, I
receive lots of emails all the time from physicians who
are like, Hey, how do I get in on this,
or how can you help me figure out how to
do this in family medicine, in women's health, And so
I think, you know, my one of one of the
things that I want to do is inspire other people
to do this. You know, it is It's a lot
(23:15):
of work. It's more work than I've ever done, and
I love it so much because we all get to
practice medicine the way it should be practiced. We get
to actually take care of patients the way patients should
be taking care of with respect and dignity, and we
get to create community. And so so I think if
we can all say, like, let's reimagine healthcare that's what
(23:36):
I did, then we would be in a much better place.
And so I am very hopeful about that, and I
believe that there's plenty of people who would want to
work in this type of a system.
Speaker 2 (23:49):
I think you're absolutely right. Our guest today has been
doctor Robin Reisberg. She's a pediatrician and she's a founder
of Boston Community Pediatrics a firm that does a lot
different than many other practices. Robert, thank you so much.
That was really an enlightening and energizing conversation. So I
appreciate it. How can how can our listeners find out
(24:10):
a little bit more about what you're doing and the
work you're doing.
Speaker 1 (24:12):
Yeah, so follow us on Instagram, come to our you know,
we have a website. We're also on LinkedIn and Facebook,
but you know, we'd love to, you know, hear from people.
Were our Instagram, I would say, is our you know,
we are a lot of up to date information goes
and our and our website has a ton of information
(24:34):
about the work that we're doing.
Speaker 2 (24:36):
That's great. Well, thanks again, I really appreciate it.
Speaker 1 (24:38):
Thank you so much. It's been a pleasure. I really
appreciate you having me on.
Speaker 2 (24:47):
We'll be right back after the news at the bottom
of the hour.
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