Uncategorized Archives - Joyful Pediatrics

How Do I Get One of Those IEPs?

I am sitting in a meeting with a frustrated parent, desperate for her child to get the academic help that everyone in the room knew he needed. The child was in 5th grade, and for the past five years, it has become increasingly clear that this child is academically behind his peers. In fact, this year the gap is wider than ever before, and we all knew it was only going to get worse.

As we discussed the strategies we are using to provide support, differentiation, and interventions, the parent interrupts and says, “How do I get one of those IEPs for my son?”

An IEP, or Individualized Education Plan, is a customized plan for a student with special needs that outlines their educational goals and the services, accommodations, and support they will receive from the school to meet those goals. Many parents have heard about them through friends, teachers, or social media, but how exactly does a child receive an IEP?

The truth is, an IEP isn’t something you simply get. It’s something that is earned through a very specific process set by federal law. And while that process exists to protect students and ensure they receive the right services, it can feel confusing and slow for families who just want their child to succeed.

I explained to the parent that before a school can consider an IEP, the child must go through a formal evaluation to determine if they qualify for special education services under one of the recognized disability categories. This evaluation is not based on a single test, a teacher’s opinion, or even a bad year academically. It’s a comprehensive look at the whole child: strengths, weaknesses, classroom performance, assessment data, behavior, and how all of these factors impact the child’s ability to learn in the general education environment.

And here’s the part most parents don’t realize: schools are required to try a variety of interventions before referring a child for special education testing. That means targeted small-group instruction, progress monitoring, classroom accommodations, behavior supports—whatever is appropriate for the child’s specific needs. These steps aren’t delays; they’re attempts to support the student without immediately jumping to a label.

I could see the parent processing this, weighing the years of struggle her child had already experienced. She wasn’t wrong for wanting an IEP. She was advocating for her son, just like any parent would. But understanding the pathway to get there, and the reasons behind it, is the first step in making sure children get the help they truly need.

If you relate to this experience, or know someone who can, here are three tips to help move through what can sometimes be a confusing and lengthy process:

1. Document everything—consistently and clearly.
Keep a running record of your child’s struggles, strengths, work samples, test scores, and any communication with teachers. The more concrete data you have, the easier it is for the school team to see patterns over time and determine whether additional evaluation is warranted. Documentation doesn’t need to be fancy—just consistent.

2. Ask for an evaluation in writing.
If you believe your child needs to be formally evaluated for an IEP, submit a written request to the school. This triggers a legal timeline for the school to respond. Be specific in your concerns and share examples of what you’re seeing at home. A written request ensures that the process is formalized and tracked.

3. Stay collaborative, not combative.
It’s natural to feel emotional or frustrated, but approaching the school as a partner rather than an adversary almost always leads to better outcomes. Ask questions, seek clarification, and remember that you and the school both want the same thing: a plan that supports your child’s success. Collaboration sets the tone for a stronger, more productive IEP process.

By: Dr. Adam Dovico

What kind of pediatrician do parents want?

One of my goals in opening Joyful Pediatrics was to make sure I could practice and be the kind of doctor that parents wanted and one that I knew I could be. I commonly ask parents, “What are you looking for in a pediatrician?” By far the most frequent answer is a pediatrician who actually listens to them, and doesn’t make them “feel dumb” for asking questions or not understanding.

I thought a lot about this and wondered why so many families had this experience. I know it’s not the goal of a pediatrician to make a parent feel that way – so why does this happen?

I think it’s multifaceted. The system in which most physicians operate carries the most blame. Reimbursement in the fee-for-service model continues to decline as costs keep rising. This means physicians, even private practice ones, need to see more and more patients each day just to stay afloat. It’s commonly touted that a primary care physician has 1500-2500 patients on their panel and sees 30 (or more) patients per day. While those numbers are slightly higher than my personal private practice experience, most physicians agree those are relatively accurate.

This makes it difficult to spend a great deal of time with any one patient or family. Anytime that we do, it means that other patients and families get shortchanged. That’s not a good feeling. Limited time per family forces doctors to breeze through diagnoses and plans because we understand them completely and know why we are recommending them.

That’s not the type of pediatrician I wanted to be. I think a huge part of being a pediatrician is educating families – breaking down medically complex topics into understandable guidance. I love being a teacher and explaining the “why” behind my decisions and recommendations. Families appreciate it too. No one wants the “because I said so” reasoning, because it creates an adversarial rather than collaborative relationship.

I love the parent and patient experience that direct pediatric care offers. My default is to spend an hour with families, possibly longer with new patients. I really get to know the parents and the children, which improves my ability to provide medical care. If parents have a question about something I said after a visit, they’re always welcome to call or text me directly. This allows me to provide what I consider the highest level of care for children and their families. Kids deserve that.

Do Pediatricians Profit from Vaccines? A Doctor Explains the Facts

If I had to pick the piece of misinformation circulating around social media that drives me nuts, it’s that pediatricians are making “big bucks” from giving vaccines. That could not be further from the truth.

Like most misinformation, it starts with a kernel of fact that then grows, and becomes exaggerated and twisted to imply something completely different than that small truth. There are a few (not many) insurance companies that will reimburse slightly higher if physicians meet certain metrics. Those metrics can include patients coming in on time for their yearly visits, blood tests improving, and yes, even vaccines.

This stems from the fact that the current insurance-based system does not really reward great medical care over mediocre medical care. Seeing 50 patients per day quickly, and providing average care reimburses much more than seeing 25 patients per day, and providing extraordinary care – even if the physician is spending the exact same amount of time working. This is opposite of most industries, where a higher performing product or service generally has higher financial reward. If a company makes a really good widget, they will sell more and can charge a higher price than a company that makes an average widget.

People are not widgets though, so it’s difficult to quantify “better” care. These metrics related to reimbursement are an attempt to reward better care in a quantifiable way, knowing it’s difficult to quantify patients’ health.

Pediatricians give the most vaccines and we are the lowest paid medical specialty. That right there should tell you that vaccines are not highly profitable for pediatricians. We have to purchase vaccine refrigerators and freezers (much more expensive than home models) and high-tech thermometers to make sure the temperatures are always in range. Most practices pay a staff to give them and record them in the medical record and the immunization registry. We have to purchase different sized needles, alcohol wipes, bandaids and pay to dispose of sharps in a special container. Immunizations range from ~$20 a piece to almost $500 for one dose. Practices often have a large up-front investment and hope that insurance will reimburse enough to break even.

The riskiest part is mistakes or waste. If a vaccine is drawn up and not used, it must be disposed of properly, and the practice is responsible for the cost. If there are too many vaccines that have expired, often companies will only let a certain percentage be returned. Recently, I made just ONE mistake – thinking the company I use for vaccines was contracted with ONE patient’s insurance and it wasn’t – and I lost $150.

While it’s impossible for me to look at every pediatric practice’s financial records, I firmly believe that most pediatric practices would save money (and time) by not carrying vaccines. Most do though, despite the financial risk, because we care about your child and their health.