Who’s Your Daddy?: Part 1 of 3

Written by David R. Sprayberry, MD

You have undoubtedly heard this question used as a taunt of another, but let’s take the question seriously.

What do you know about your dad? Do you know him or do you know of him? I grew up in a two-parent home with my birth parents.

Things were not always perfect. I can tell you the positive things about my dad and some negatives.

The reason, though, that I can tell you the negatives is that I know my father and I know him well because he was there.

He was there at the dinner table. He was there at my baseball practices. He was there at my basketball games. He was at all the school functions and awards nights.

He was there.

During my pediatric residency, one of my classmates was posed this question by one of the kids he was seeing in the clinic: Are you my daddy? Sadly, this was not a joke.

The child had no idea who his father was. More and more American kids are growing up not knowing their fathers at all or having minimal relationships with them. Their dads are just not there, either partially or fully.

The absence of a father from a child’s life can do immense harm and the presence of a father can do immense good.

Scope of the problem

In discussing this issue, it is important to define what an absent father is. In general, when we use the term absent father, we are speaking of fathers who are physically absent from the child’s primary home. This includes fathers who have only joint custody of their children.

The degree of this issue is immense. Over one-third of all U.S. children live absent from their biological fathers. Nearly half of all children from disrupted families have not seen their fathers in the past year.

Nearly 20% of kids in female headed households have not seen their fathers in 5 years.

From 1960 to 2000, the proportion of children living with just one parent increased from 9% to 28% over that 40 year span. When the statistics are broken down by race, results become even more alarming.

As of the year 2000, 20.9% of all white children lived in single-parent homes. At the same time, 31.8% of all Hispanic children and 57.7% of all black children were living in single-parent homes.

The reasons for the racial differences are debatable, but what is clear is that this is a problem that is not limited to a single race.

Reasons for father absence

Why do we have so many absent fathers? There are many factors that contribute to this problem, but a large proportion of absent fathers are absent for one of the following reasons.

One of the largest reasons that fathers are absent from the homes of their children is divorce. The number of currently divorced adults has nearly sextupled from 4.3 million in 1970 to 23.7 million in 2010.

The number of divorces per year has increased from 390,000 in 1960 to 1.2 million in 2009.

There are recent reports of decreasing divorce rates, but these decreases are generally looking at divorces as a proportion of the general population, not as a proportion of marriages. Additionally, the marriage rate has declined considerably, likely leading to an increase in the second factor contributing to absent fathers.

A second significant reason that fathers are absent is births out-of-wedlock. Forty-one percent of all newborns in the U.S. were born out-of-wedlock in 2009, up from 33% in 2000.

About 75% of all teen births are out-of wedlock. In many of these cases, the father never lives in the child’s home, even at the beginning.

A smaller, but still significant, reason for father absence is incarceration. As of 1991, there were an estimated 423,000 fathers in prison with children under the age of 18. That number has increased to 744,200 as of 2007.

To be fair, many men may not be able to control the amount of time they are with their children. They may want to be involved, but are prevented by factors beyond their control.

As a pediatrician, I understand how difficult it is to balance a demanding work schedule and family life, and I don’t always do a great job at maintaining that balance.

I point these issues out not for the sake of being critical, but in order to spur men on to take a larger role in the lives of their children and to become more physically and emotionally present for them. We have a relatively short time to raise our children. Let’s make the most of it.

My next post (the second in a three-part series) will discuss the consequences of father absence and the benefits of father presence.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


Photo credit:  Chin.Musik

Doctor, Back Slowly Away From That Sandwich!

Written by John Moore MD

In American health care, the era of the free drug-company sponsored lunch is definitely over. Gifts from companies to physicians and hospitals have essentially vanished. Samples have disappeared from our offices. Corporate-sponsored CME budgets have dried up. Next year, as a part of the Affordable Care Act, companies will be forced to disclose any gifts to physicians that cost more that $10. Physicians who accept those small gifts will be listed on a searchable database. No more sandwiches for us!

I am not an apologist for drug companies by any means. The negative impact they have on health care cannot be ignored. There is a lot of scientific data that support the claim that even small items may influence prescribing practices. Our journals are unfortunately full of bogus scientific studies claiming to “prove” one product is better than another with poor scientific support. We have all heard prepared lectures from paid physician spokespeople which provide no educational value beyond brand recognition for the sponsor. Transparency in any industry is good; patients should be able to know whom their physicians are taking money from.

However, we need to bring some balance back into this discussion. First, the headaches of maintaining such a database for small gifts seem far out of proportion to any benefit that patients can receive. Second, we need to remember that pharmaceutical companies can provide useful information to doctors. I know that it is out-of-style to mention anything positive that can come from talking to the local drug rep, but let’s think about it. I learn from my reps what vaccination strategies have worked in other practices in my area. I learn how disease-specific recall notes have worked for the group across town. I am not naïve enough to believe the slick brochures left on my desk (and in fact I throw most of them directly in the trash), but I do use them as a starting point to my own research.

We also should examine the effects of industry sponsorship on organized continuing medical education in America. While the potential biases are real, the positive impact of pharmaceutical industry money on CME is huge! From the most prestigious national conferences all the way down to local community hospitals, budgets for CME have been slashed, in part due to the lack of industry funding. Fees for participants have increased, and not surprisingly attendance has decreased at live CME events around the country.

The bottom line is that pharmaceutical companies and physicians have a complicated relationship, one that is not inherently good or bad. Like any business relationship, the association between pharmaceutical companies and physicians relies on real people on both sides doing what is right. No amount of oversight can force someone with questionable ethics to follow the rules. No amount of bribery can sway an honest doctor to prescribe a medication not in the best interests of their patients. The vast majority of pediatricians are caring advocates for their patients whose loyalty cannot be purchased by a pen or a sandwich.


Dr Moore is a pediatrician in Roanoke, VA. He schedules drug rep visits only one time per week and always ignores lunches, preferring to meet his family instead!

Crossing State Lines: Crossing the Line?

In the search for reducing healthcare costs, some public policymakers have suggested allowing consumers to purchase health insurance across state lines. Theoretically, this would allow families to shop around for the best insurance deal, even if they aren’t a resident of the state in which the insurance is sold or regulated.

In general, increased access to choices drives down prices and increases competition; given the proliferation of online shopping for all kinds of other products, you might indeed find a great deal in another state. Even some state-based financial products, like 529 college savings plans, are marketed across state lines, allowing flexibility and consumer choice.

However, I’m opposed to selling health insurance plans across state lines: out-of-state insurance plans (including ERISA plans) can thumb their noses at a state’s consumer protection laws.

Here’s an example: Tennessee mandates that newborns be covered from the moment of birth to 30 days of age without any special action required on the part of the baby’s family (TCA 56-7-2301.) This is a good idea: moms shouldn’t have to call their insurance company’s 800 number in between contractions to ensure her baby gets added to her policy. The thirty-day rule gives families a short grace period to get their paperwork in order.

However, Tennessee law doesn’t apply to all infants born in Tennessee. Families who are employed by a big-box corporation headquartered in another state often have an insurance plan domiciled in that state. If mom and dad have, say, Blue Cross Blue Shield of Alabama — the company does not have to follow the 30-day rule of newborn care. They’re shocked to find out after their child is born (and too late to make other arrangements) that they owe hundreds or thousands of dollars to doctors and hospitals. It’s even more depressing when you realize these costs are incurred during a period when moms are taking time off work and family incomes are tight as a result.

Tennessee law also requires insurance companies to be transparent in their dealings with doctors: to pay clean claims promptly (56-32-126); to credential doctors fairly (56-7-1001), and to be up front about what doctors will be paid for their services ahead of time (56-7-1013). These laws protect employers, patients, and doctors from unfair insurance company tactics – but again, only as long as the company is an in-state company.

Our practice already spends a lot of resources policing our own state’s insurance companies. If they violate regulations, we can appeal to our state’s Department of Commerce and Insurance, our state’s legislature, and our state’s judiciary, all of whom are accountable to voters for their actions. Yet insurance companies in other states can blissfully ignore directives from our state, even though they’re insuring our state’s citizens. At last count, there were over 1300 out-of-state insurers during business in Tennessee; until consumer protections are more consistent, we need less of this, not more.


The Nurse Will See You Now

Written by David Sprayberry M.D.

Something has got to change.

In recent years, the practice of medicine has been under attack from a variety of sources. Insurance companies continue to squeeze both physicians and patients in order to increase their already enormous profits. Our federal and state governments have decided to target physicians when an error is made in the exceedingly complex billing process in order to levy fines and recoup some of what they spend on Medicare and Medicaid.

Our federal government purposes to replace physicians with cheaper, lesser trained individuals who have not received nearly the level of education that physicians have. Even other healthcare professionals who have traditionally been a part of the physician’s team are seeking to take on the role of a physician and become your “provider.”

I fear that the best and brightest students will increasingly choose careers other than medicine if we as a nation continue to demean the work that physicians do and continue to attack the physicians who entered the field with altruistic intentions. It is also quite possible that the U.S. will lose practicing physicians to other nations that value their services more highly or at least do not make it as painful to do their jobs.

The American public needs to spend some time thinking about what they want from our medical system. Do they want their primary physician to be merely a coordinator of care or do they want him or her to be the provider of care? Do they want nearly all their office visits to be performed by a nurse who only calls in the physician if something is complicated or do they want a physician who is capable of detecting serious problems based on subtle findings or symptoms? Do they want to see a nurse when they go to a specialist? Do they want the person who is deciding whether they may have cancer to be someone who has never spent sleepless hours at the bedside of someone dying of cancer? Do they want the person who is deciding whether their child should be admitted to the hospital to be someone who has never seen a patient progress from simple wheezing to respiratory failure and death in a matter of hours? Do they want the person counseling them on whether to get that new vaccine to be someone who has never taken care of a child who died from a vaccine-preventable disease?

Our current system continues to march toward having nurses provide medical care and physicians only supervising and taking care of “complicated things”. Is this really what we want?

Dr. Sprayberry is a practicing pediatrician in Watkinsville, GA and blogs at Pediatrics Gone to the Dawgs