Pediatrics Needs a Game Plan

Football season is starting. Across the country, teams are buried in film study, practice reps, scouting reports, and game plans. The truth is, games are not won on Sunday. They are won in the hours nobody sees: the preparation, the line drills, the endless rehearsals.

In pediatrics, we do the opposite. Every day is game day. We show up, take whoever walks in, give our best in the moment, and move on. We do not review the film. We do not study the roster. We do not build a plan. We measure ourselves by how many snaps we played, not whether we moved the ball down the field for the kids we serve.

It is an odd contrast. We plan every detail of a football game that lasts a few hours, but we improvise our way through the health of children whose lives depend on us.

The Wrong Scoreboard

In most pediatric clinics, success is defined by a full schedule. Ten well checks, two ADHD follow-ups, three coughs. Rooms filled, RVUs billed. On paper, that appears to be a victory.

But what about the kids who never walked through the door? The teenager who dropped out of follow-up after her asthma admission. The toddler whose family cannot get time off work. The baby who went to the ER last night. None of them count on the scoreboard we keep.

We still measure throughput instead of outcomes. We still reward volume instead of prevention. We still grade the team on how fast it moves down the list, not whether the ball ever drives down the field.

The Wrong Film Study

Ironically, pediatrics has more “data” than ever. Faxes, PDFs, portals, dashboards. We are even talking about recording visits — not to learn from them, but to prove what we did, to bill, to score points.

That is like replaying the television broadcast on Monday just to confirm the announcer’s stats and work so they then get paid. It is not a film study. It does not change how you play.

Real film study in pediatrics would mean knowing before a child walks in:

• They were in the ER last night
• Their ADHD prescription has not been refilled
• Their asthma score dropped at school
• Their mother screened positive for depression at WIC

That kind of insight changes the game plan. It changes how we use our fifteen minutes. It helps us win. But most of the time, that film never makes it to our hands.

The Line of Scrimmage

Football fans love the highlight reels of the long passes, the breakaway runs, the touchdowns. But coaches will tell you the truth: games are won at the line of scrimmage. Without the offensive line, the skill players never shine. Without the defensive line, nothing else works. Championships are built in the trenches.

Pediatrics is no different. Our line of scrimmage is not a glossy new app or the heroics of the ER. It is the unglamorous blocking and tackling of primary care:

• Nurses making morning calls
• Care coordinators tracking high-risk kids
• Clean data feeds that arrive the next morning
• Simple, reliable communication across hospitals, schools, and pharmacies

When we fail to invest in this line, everything else breaks down. Specialists burn out. ERs overflow. Families lose trust. We admire the highlight plays, but the team loses the game.

Building the Pediatric Game Plan

So what would it look like if pediatrics were prepared to win? What if we had a true game plan?

It would start with the basics every good coach demands:

• Know your roster. Not just who is scheduled, but who is on the team. Who has not been seen? Who is at risk? Who is bouncing between urgent cares and ERs?
• Review the film. Clean, timely data about ER visits, admissions, refills, and missed appointments. Delivered in time to matter, not weeks later as a PDF nobody can sort.
• Practice the plays. Protected time in the clinic day is not just for visits, but for outreach: calls, coordination, follow-up. Practice is not extra; it is part of the game.
• Engage the fans. Families need simple, two-way communication. A short text check-in. A trusted call. Not just portals, they never open.
• Measure the right things. Not just visits and RVUs, but avoided admissions, school days saved, symptoms controlled, trust earned.

And here is the other truth: NFL teams never bring the same plan to every game. They prepare differently depending on the strengths and weaknesses of the opponent. Pediatrics must do the same. We cannot plug every patient into the same 15-minute template and expect to win. One family may need education. Another needs social support. Another needs close follow-up. Our playbook should flex with the opponent, because every child and every circumstance is different.

The Tools That Belong in the Playbook

A modern pediatric game plan would not mean piling on more dashboards. It would mean using tools that actually move the ball:

• Care coordination built into the schedule, not pushed to lunch breaks
• Patient engagement that makes it easy for families to respond, not overwhelming portals
• Outcome tracking that highlights who improved, not just who showed up
• Data integration that brings ER visits, pharmacy fills, and hospital discharges into the clinic’s hands by the next morning
• Remote patient monitoring, where it makes sense — asthma scores, weight checks, blood pressures — simple signals that can trigger action before a flare

These are not moonshots. They are the building blocks of a team that plays to win.

Why We Are Still Losing Yardage

If this sounds obvious, why are we not already doing it? Because the system still pays us to play a different game.

• It rewards encounters, not outcomes
• It hides data behind portals instead of sending it clean
• It uses HIPAA as a wall, even though sharing for treatment is allowed
• It counts RVUs and calls it a value

We should not be surprised when the ball does not move down the field. We designed the game that way.

What Winning Would Look Like

Winning in pediatrics would look like:

• A Friday huddle where the team reviews the roster and knows which kids are at risk next week
• A Monday morning list of who went to the ER over the weekend, ready for outreach
• A clinic where “who needs us” matters as much as “who is scheduled”
• Families who feel watched over, not just processed
• Teams who leave Friday knowing they played for something that mattered

That is what moving the ball looks like. That is what winning feels like.

The Real Scoreboard

We say we want value, equity, and trust. But our scoreboard still counts speed and volume.

The real scoreboard would count:

• Children kept out of the ER
• Families who trusted enough to call early
• Crises were prevented before they spiraled
• Teams that stayed intact because their work had meaning

That scoreboard would tell us whether we are moving the ball — not just whether we played the downs.

Calling the Question

The NFL does not win because it hopes Sunday goes well. They win because they prepare.

Children deserve more than a system that reacts to whoever shows up. They deserve clinics that know their roster, study the film, and prepare a game plan. They deserve investment at the line of scrimmage, where nurses, coordinators, and simple data make everything else possible.

And just like football, they deserve a team that adjusts the plan to the opponent. Every family brings different strengths and struggles. Every child faces different risks. There is no single script that wins every game. A clinic that prepares to win knows its roster, knows the opponent, and tailors the plan.

If we truly believe children deserve better, we need to stop playing pick-up ball and start preparing like a team that plans to win.

The question is not whether we can do it. The question is whether we will.