2024: Lessons From the Front Lines of Pediatric Primary Care

In 2024, I’ve had the unique opportunity to practice pediatric primary care in two very different settings: an independent practice in the United States and a larger clinic at a U.S. military base in Germany. These experiences have reinforced my love for the core of primary care—building relationships, supporting families, and helping children grow into healthy adults.

But this year has also shined a glaring light on the challenges that pediatricians face every single day. These challenges are not about a lack of skill, dedication, or even technology. They stem from a foundational issue: the inability to access accurate, complete, and timely information about the patients we serve.

In a healthcare system that boasts AI breakthroughs, precision medicine, and predictive analytics, it’s almost unbelievable that pediatricians still struggle to know when their patients are born, track vaccine histories, and confirm whether a child has been seen by a specialist. The problem isn’t that pediatric primary care lacks ambition—it’s that the foundation of healthcare data is so fractured that even basic tasks can feel like scavenger hunts.

2024 has been a wake-up call for how much better pediatric care could be if we addressed these foundational issues. At the heart of the solution is something simple yet transformative: a universal medical record number (UMRN).

The Fragility of Foundational Data

For pediatricians, accurate and accessible information is not a luxury—it’s a necessity. Without foundational data, care becomes fragmented, decisions are delayed, and opportunities for prevention and early intervention are missed.

Unfortunately, the current healthcare system doesn’t prioritize this foundational data. Instead, pediatricians are often left piecing together incomplete information, chasing down records, and making decisions without the full picture. Let’s look at some of the most common—and frustrating—scenarios that highlight this systemic failure.

When a Baby Is Born

A newborn’s first weeks are some of the most critical in their life. Pediatricians play a vital role during this time, providing care that can impact the baby’s health for years to come.

But here’s the problem: pediatricians often don’t know when their patients are born.

In an ideal system, pediatricians would automatically receive notifications when a baby is delivered. These notifications would include key details: the baby’s birth weight, Apgar scores, results of newborn screenings, any complications during delivery, and whether the baby received the hepatitis B vaccine.

In reality, this information is rarely shared proactively. Pediatricians only learn about the birth if the parents reach out to schedule the baby’s first visit. From there, it becomes the pediatrician’s responsibility to track down the hospital’s birth records—a process that often involves faxes and long waits. And at the military clinic in Germany, these records are brought in a “yellow book” provided by the family—and, of course, they’re written in German.

When the records finally arrive (if they arrive at all), they are often incomplete. Critical details may be missing, forcing pediatricians to rely on parents to fill in the gaps. This guesswork creates unnecessary delays in care and puts newborns at risk.

The Immunization Scavenger Hunt

Vaccines are a cornerstone of pediatric care, but tracking immunization histories is a frustratingly inefficient process.

Take this common scenario: a toddler comes in for a well-child visit, and the parents hand over a partially filled-out paper vaccine card. The information is incomplete or unclear. Maybe the child received some vaccines at a public health clinic, others at an urgent care center, and a few more at a previous pediatrician’s office.

The pediatrician is now left with a detective’s task: calling clinics, requesting faxes, and trying to piece together a timeline of vaccines. This takes time and resources—neither of which are unlimited in a busy primary care setting.

Without a clear record, the pediatrician faces a difficult choice: administer vaccines to fill in the gaps, even if it means potential duplication, or hold off and risk leaving the child unprotected against preventable diseases. Either choice is less than ideal and could easily be avoided if there were a centralized way to track immunizations.

Referrals Without Follow-Up

Pediatricians are often the first to identify potential health concerns that require specialist care. A child with developmental delays might be referred to a neurologist, or a concerning heart murmur might lead to a cardiology referral. But once the referral is made, the communication often stops there.

In a perfect world, specialists would provide feedback—sending notes, test results, and treatment recommendations back to the pediatrician. In reality, this feedback loop is broken more often than not.

If the specialist doesn’t send a report, the pediatrician is left in the dark. Did the family make it to the appointment? Did the specialist confirm the diagnosis? Were further tests ordered or a treatment plan started? The answers are often unclear, and the pediatrician has to rely on parents to relay the information.

This lack of communication undermines the ability to provide coordinated care. It leaves families to navigate the healthcare system on their own, often without the expertise or resources to do so effectively.

Military Families and Medicaid Challenges

For military families and Medicaid patients, the challenges of foundational data are even greater.

Military families move frequently, often across state or international borders. Each move brings new providers and a new healthcare system, but the family’s medical records rarely follow them. Pediatricians at the new location are forced to start from scratch, with little to no information about the child’s previous care.

Medicaid patients face similar issues. Families can switch primary care providers at any time, but there’s no system in place to ensure that records are transferred. A pediatrician who has spent months managing a child’s asthma or ADHD might suddenly lose track of that patient when they switch to a new provider. The new pediatrician, meanwhile, has no way of knowing the child’s history, medication regimen, or prior interventions.

For these children, the lack of continuity leads to gaps in care, missed opportunities for intervention, and poorer health outcomes.

The Big Questions Pediatricians Face

These struggles raise some pressing questions that can no longer be ignored:

• Why don’t we have a universal medical record number? A UMRN would ensure that every child has a unique identifier linked to a centralized, comprehensive health record. This record would follow them across all providers, from birth hospitals to public health clinics, pediatricians, specialists, urgent care centers, and ERs. It would eliminate the scavenger hunts for birth records, immunization histories, and specialist notes.
• Why don’t pediatricians know where their patients have been seen? If a child visits an urgent care clinic, the ER, or a public health department, why doesn’t their pediatrician know? The lack of communication between providers leads to fragmentation and duplication of care.
• Why does Medicaid allow patients to switch primary care providers without ensuring continuity of care? While flexibility is important, it shouldn’t come at the cost of consistent care. There must be a system to ensure that medical records transfer seamlessly when families switch providers.

These aren’t questions of technology—they’re questions of priorities. If we truly value pediatric primary care, we must address these foundational issues.

A Path Forward

Fixing these problems doesn’t require futuristic AI or expensive new tools. It starts with basic solutions: better communication, coordinated care, and systems that prioritize foundational data. At the heart of this effort should be a universal medical record number—a simple, transformative solution that would allow pediatricians to know their patients’ full health history.

Imagine a system where pediatricians no longer have to chase records or guess at critical details. Imagine a system where every child’s health journey is documented and accessible, no matter where they’ve been or who they’ve seen. That’s not just a dream—it’s a basic expectation that healthcare should meet.

In 2024 and into 2025, as we marvel at the potential of AI and technological innovation, let’s not forget the basics. Pediatric primary care is the foundation of lifelong health. It’s time we gave it the strong foundation it needs to thrive.