Last year, vaccines became a hot button issue with the Disneyland measles outbreak in the winter. After the outbreak occurred, more people began looking at vaccines, and this led to the question of whether or not there was a trend of doctors refusing to treat patients who refused vaccinations.
For pediatricians, the practice of “firing” a family for not allowing their child to get vaccinated is still controversial, but it has become more relevant over the last year and has now been addressed at the American Academy of Pediatrics (AAP) Annual Conference. Pediatricians will now be able to legally protect themselves after dismissing a family from their practice on the basis of the family refusing vaccines, even after the AAP discouraged the practice.
A recent study published in Pediatrics Today looked at the doctors who have ended their working relationships with families over vaccine refusal. The study asked 534 pediatricians and physicians and had about a 66% response rate.
Of the responses they received, the study found that 83% of doctors say at least one family in their practice has denied vaccines each month, and 63% say that 1% to 4% refused any vaccinations. One in five of those surveyed also said that a total of 5% of parents are now refusing any vaccinations.
When asked how those numbers compare to previous years, 11% of the doctors reported that the number of parents refusing has gone up, while most agreed it stayed the same. About 23% of the respondents said their number has actually decreased.
The study also highlighted that the rate at which pediatricians turned away families was higher in states like California, where there are stricter vaccination laws. In fact, as many as twice the amount of doctors said they had no one refusing in a typical month, bar those who have a philosophical exemption for school vaccinations.
In addition, the rate at which doctors dismissed families was four times higher in states that don’t have philosophical exemption laws. In states that do have those laws in place, only 9% of doctors dismissed families based on vaccination refusal.
So what do these pediatricians have in common when they dismiss families? They are most likely to live in the South, where there are stricter vaccination laws; they also live in states that do not have philosophical exemptions, and they likely have a private practice.
The study found that private practices were five times more likely to dismiss a family for refusing vaccines compared to practices in HMO, university or public settings.
Back in the midst of the Disneyland outbreaks, Forbes touched on this subject, asking doctors their opinion and how they would be choosing their policy.
“I think the AAP’s policy statement asking me not to ‘eject’ vaccine-refusing parents from my practice is valid when your practice area has good vaccination rates — that is, at or above herd immunity levels — and you aren’t having vaccine-preventable disease outbreaks,” said Chris Hickie, a Tucson-based pediatrician.
However, Hickie also acknowledged that vaccines are essential in keeping other patients, especially infants, safe. Research shows that vaccines are responsible for preventing more than 2.5 million deaths per year globally.
“I think it becomes a dangerous policy to patients when you live in a practice area where you do not have herd immunity levels of vaccination because then the odds become much greater that a child will come into your office with a vaccine-preventable disease like pertussis, measles or chickenpox and expose a vulnerable patient too young to be vaccinated or with a medical reason for a weakened immune system that either won’t respond to vaccines or cannot receive vaccines,” Hickie added.
Many do acknowledge that there simply is not enough research for informed decisions on this practice. No studies have been done to see how areas where doctors are dismissing families are faring in preventable diseases.