Subspecialty pediatrics: An unmet opportunity to address unmet social risks

While strengthening the medical home remains an important priority for CMC, relationships with subspecialists offer opportunities to mitigate challenges at the intersection of health and socioeconomic adversity that are often faced by families caring for CMC. Frequent interactions mean CMC and their families build deep, trusting, and longitudinal relationships with subspecialists that exist in parallel with primary care provider relationships. Indeed, some patients are in contact with their subspecialists even more frequently than with their primary care clinicians, with one study finding that roughly 40% of CMC with Medicaid insurance did not see a primary care physician in the past year. Moreover, primary care pediatricians report varying levels of comfort caring for CMC, with 60% reporting in one study that they would not want to add additional children and youth with special health care needs into their practice. Subspecialists also often have critical experience navigating disease-specific social hurdles that pose barriers to navigating care for CMC. Together, these factors highlight the important role subspecialists could play in addressing families’ social risks (eg, food insecurity) in ways that supplement primary care-based social care activities.