OHSU doctor now head of American Academy of Pediatrics

Ben Hoffman is the first Oregon doctor to serve as president of the American Academy of Pediatrics in 84 years. A professor of pediatrics at Oregon Health & Science University, Hoffman has worked to promote injury prevention policies and advocacy training for pediatric residents. He joins us in studio to talk about his new role and what he sees as the biggest issues in children’s health care nationwide.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Ben Hoffman is the first Oregon doctor to serve as the president of the American Academy of Pediatrics in 84 years. He’s been a pediatrician at OHSU since 2011. For his career, he has combined his own clinical work with efforts to change policies at the state and national levels to promote children’s health. He joins me now to talk about his career and his current priorities as this new president of the American Academy of Pediatrics. Welcome to the show.

Ben Hoffman: Thanks. It’s amazing to be here.

Miller: How did you choose pediatrics as your specialty?

Hoffman: That was actually pretty easy. I went to college thinking I was going to be a pediatrician. I really focused on getting into medical school and then through that whole process, I had the opportunity as everybody does in medical school to spend time in different specialties.

Miller: Nothing else lured you.

Hoffman: There was nothing even close.

Miller: OK. Well then, you knew as a high schooler then that you want to be a pediatrician?

Hoffman: I thought that’s what I wanted to be.

Miller: Why?

Hoffman: I knew that I wanted to do good things for kids. I loved working with kids. I’d worked as a tutor and a soccer coach and I knew that I loved science and that was the perfect way to put them together.

Miller: So let’s zoom forward a bit. One of the first issues that you became focused on from a public health policy perspective was car seats. So what was the time frame? When was that?

Hoffman: That actually began in the winter of 1997.

Miller: What prompted that?

Hoffman: I was a pediatrician working in a hospital with the Indian Health Service on the Navajo Nation. And over the course of several consecutive call nights was called to the ER to take care of kids who’d been critically injured in car crashes, none of whom were restrained. And I remember after the fifth one standing in the ER just angry as hell saying to myself, somebody has to do something about this.

Miller: What did you do?

Hoffman: I started out by learning everything I didn’t know about car seats and that included the law, it included American Academy pediatric policy and then going to the community and working with them to figure out what the problems were and how to craft the solutions.

Miller: Were they not required or the norm?

Hoffman: At that point, they were. New Mexico’s law at that point was not very good. It only required car seats up to age one. And then after age one, a seat belt was allowed by the law and that was something we knew needed to change. But we also knew that was going to be a long game.

Miller: You had been trained to be a doctor, right? I imagine you hadn’t been trained to be an advocate or a policy person. How much overlap was there?

Hoffman: There’s more overlap than you would think. I had some really good role models and mentors who had worked in that space, but I really didn’t receive the training. So I learned how to do it on my own and then became convinced that that was part of what my mission was going to be, helping to transform the training, to ensure that the pediatricians we were producing in the future would be the pediatricians that kids and families and communities really need.

Miller: What were the lessons you learned in terms of how to be an effective spokesperson or policy communicator or someone to actually change the way society is set up? Because it really does seem like different skills.

Hoffman: It really is. It’s something that again, I learned by doing. I learned very early it’s really important to identify what your North Star is and stick to that North Star to understand that you need to start small and fail small and that it’s gonna be a long game. That relationships are key and engaging the communities working with people who are in positions of power to build trust and then to be able to harness the passion,

the energy, the expertise, to be able to address that. And one of the things that I learned very early on is that while pediatricians and physicians in general may not be comfortable in the halls of power, there’s a place for us and our voice can be incredibly powerful.

Miller: Are there any ways in which advocacy works–and I’m thinking less about something like car seats, which are not particularly politicized, and more about say gun control, which you have spoken about, you’ve testified to say to the Oregon legislature and other places–that can make your clinical work more challenging?

Hoffman: Yes and no. I think the clinical work helps bring stories to the advocacy. And it’s really the stories and the personal experience for me, for the patients and families for whom I care, that drive the work, but also help change people’s hearts and minds.

Miller: What comes to mind is, for example, when you’ve testified to say I had a young patient who died by suicide because they accessed an unlocked loaded rifle in their family’s possession. That’s part of your testimony you’ve given. That’s an example of one of your patients that you can tell lawmakers about.

Hoffman: Absolutely.

Miller: But I guess I’m wondering if any of your patients or their families see you as someone who is speaking out, say, about gun laws and if they disagree with your position, if that makes it less likely for them to then listen to you when you talk about other aspects of their health?

Hoffman: So I think it’s incumbent on us to meet the patients and families that we work with where they are. And you know, if we talk about firearms in specific, I’m not gonna push a position that is anti-gun because I’m not. I’m going to start with where we all can get to, that no child should ever be injured by a firearm and acknowledge a family’s absolute right to own a firearm. But then to identify what the specific risks may be within their family and how we can mitigate those in a way that’s gonna protect the kids.

Miller: What are some of the public health risks to young people in American society right now that you think are not getting enough attention?

Hoffman: I think we hear a lot about the mental and behavioral health crisis that exists, but we are nowhere close to being able to address it in the way that we need to. The American Academy of Pediatrics, two years ago, issued a notification of a national emergency around child and adolescent behavioral health. We just reissued it in November.

Miller: Can you give us a sense for what you and colleagues have seen with your patients that led to that call?

Hoffman: The personal experience of working with families, children and adolescents who are suffering from behavioral health issues, anxiety, depression, and eating disorders have just absolutely ballooned in the last couple of decades to the point where even in my training…In the mid-nineties, we really didn’t learn much about psychiatric meds and anti anxiety meds and those sorts of things. And now that’s part of our bread and butter. 20% of children in this country currently have a diagnosable behavioral health issue. The landscape has just completely changed. Training is changing, but we need to acknowledge that behavioral health, mental health, is health and the way that the system and society tends to deal with it is separating it out. We also need to start thinking about it in terms of how we build systems and support for families and kids so that we can buffer them from the issues that lead to anxiety, depression and those sorts of things.

Miller: I’m glad you brought that up because, I mean, the analogy isn’t perfect, but in a sense, having three- and four-year olds in car seats or having guns locked up, those are prevention efforts. So, what is the prevention that you think is not happening nearly enough that could lead to lower rates of youth mental illness?

Hoffman: So, I think we have to go far upstream for that. And this gets back to maternal and child health - ensuring that maternal health during pre pregnancy and pregnancy is optimized, that deliveries go well and that we’re supporting young children and their parents and caregivers with the resources that they need to help provide a stable, nurturing, safe, loving environment.

Miller: What role do you think pediatricians can or should play in the fentanyl crisis?

Hoffman: I think the biggest impact, at least from my experience in the area around fentanyl, is parents and friends and relatives, more on the adult side. We are seeing horrible unfortunate ingestions of fentanyl among youth and the fact that it’s out on the streets, that’s really the problem. I think a lot of this gets back to behavioral health issues and need for self medication. So I think that’s a huge question that would require hours to be able to unpack but we’re definitely feeling the impact.

Miller: Do you think that pediatricians should be telling their 13-year old patients, these pills are out there, you could encounter them at a party. Don’t take any pill that doesn’t come from a doctor or a parent. Is that something that pediatricians are now in the habit of saying?

Hoffman: I’m afraid it is. Yeah, I mean, because we see the impacts. We hear [and] we live the stories and so we know what the issues are. We have to be talking about that with kids in the same way we talk about dealing with alcohol and tobacco and liquid nicotine and all those sorts of other sorts of things. This is just another threat that has emerged that we need to stay on top of and work with families and kids to be able to mitigate the risks.

Miller: What are some of the other ways, do you think, that the practice of pediatrics has changed since you entered the profession?

Hoffman: So I think it has become more specialized. As a general pediatrician when I started in my career, I did a little bit of everything. I attended deliveries, C-sections and when there were complications, I attended in the newborn nursery. I took care of kids in an inpatient unit. And we’ve seen the rise of subspecialties within general pediatrics. So, hospitalists who only care for hospitalized kids.

Miller: Are you talking about the changes that are more obvious in bigger cities with academic hospitals?

Hoffman: It’s happening even in community hospitals. And I think the other things that we have seen has been that there is an acknowledgment that the social impacts of health are something that we need to be addressing as a health care system, which becomes the pediatrician’s role. The things that kill kids or make kids sick have changed, just in the three decades that I’ve been a pediatrician.

Miller: How well is training keeping up with those changes?

Hoffman: I think training’s keeping up pretty well with those changes. I was in charge of the residency training program for pediatrics at the University of New Mexico for almost nine years before I came to Oregon. I think things are adapting and the recognition of the behavioral health crisis, the need for advocacy and the ability to be able to address the social drivers of health is definitely built into the training programs.

Miller: What did you look for in a pediatrician for your own kids when you became a parent?

Hoffman: Somebody who I could trust, somebody who I could talk to. I think, for me, it was a slightly different process than I think it is for most families. My wife is a pediatrician as well. And we wanted somebody who would be able to talk to us as parents and not treat us necessarily as colleagues. You would think that two pediatricians having a kid is as close to informed consent as you get. And my wife and I were blindsided in the beginning by how clueless and scared we felt having a newborn at home.

Miller: It’s a well known phrase that doctors make the worst patients. And I hadn’t thought about pediatricians as parents and what that is like, but when you say you felt unprepared, that’s a classic feeling. I remember when I got in the car with my wife and we took our first kid home, there was a feeling of, “wait, you’re letting us just go home with this thing.” But we don’t know what we’re doing. But it is surprising to imagine that pediatricians, two of them, would feel anything like that.

Hoffman: Because we’d never taken one home before, to be honest with you.

Miller: You don’t get to take them home when they are your patients.

Hoffman: We had our first right after we’d finished residency. We’d spent three years doing 48-hour shifts every third or fourth night, but we got to go home and there was respite. Having a baby who is 24/7 changes everything. And it’s also that you think differently, which is why it’s really important for pediatricians not to be the doctors for their kids.

Miller: What was it like to become a parent when you were acutely aware, I imagine, of the beauty and profundity of birth and of young life but also - more so than most of us, I imagine - you were much more acutely aware of the million ways that things can go wrong?

Hoffman: I think we tried really hard just to be parents in that scenario and to not overthink it and to have resources. We listen to our moms the same way that I think everybody listens to their moms.

Miller: As adult children of parents as opposed to pediatricians.

Hoffman: Yeah, I think we tried not to be pediatricians.

Miller: Would you go into pediatrics today given the economic realities - which we don’t have time to get into now - and the ways that your profession has changed over the last couple of decades? Would you still want to go into pediatrics?

Hoffman: To be 100% honest, I can’t imagine anything I would rather do.

Miller: Why? What do you love about this job?

Hoffman: I love, as a general pediatrician and a clinician, the opportunity, the privilege of having deep, significant meaningful relationships with kids and families and working with them to help ensure their well being. To watch the growth of the child, but also of the parents and the family and to be able to fight for what’s right for justice. Kids get screwed left and right. And the system really is not built to support kids and working to be able to mitigate that is a privilege and it’s something that gets me out of bed every single day.

Miller: You have three years in this current position. Is that right?

Hoffman: Yeah, there’s a year of the president-elect, president and then past president.

Miller: What do you hope to be able to say when this is done that you’ve accomplished, that we did during my tenure?

Hoffman: We continued to do the amazingly good work that the Academy has done for almost 100 years. That we kept to our North Star, which is to do what’s best for kids. And that we will have tangible outcomes, whether it’s legislation, the policy that we create with it, that we draft within the academy, that we will have tangible products and outcomes to show for it.

Miller: Ben Hoffman, thank you very much for coming in. I really appreciate it.

Hoffman: This has been a blast. Thank you,

Miller: Ben Hoffman is a professor of pediatrics at OHSU. He is also the president of the American Academy of Pediatrics.

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