By Evereth Woodruff 
My uncle looked exhausted as he told me one of his biggest challenges as a pediatrician — one that had nothing to do with medical issues. “I spend about half a million a year on vaccines,” he explained. “After all is said and done, I’m not even sure I break even on them.” After providing care to children in Virginia for 25 years, my uncle was describing a financial trap that is undermining our country’s pediatricians.
Vaccines consistently make big headlines these days. But this broken financial model, in which pediatricians front enormous costs and absorb incredible risk just to inoculate their patients, is a silent threat to childhood vaccination programs across the United States — and all the children, families and communities who benefit from them.
An impossible burden
Vaccines are incredibly costly. They represent the second-largest expense for pediatric practices after staff salaries. Let’s start at the beginning: buying the vaccine. Each vaccine has a price that isn’t transparent: It depends on many factors, such as manufacturer and distributor loyalty, your scale as a practice, your ability to get the right contracts in the first place, and the time of the year. Those prices change constantly, so you’re always adjusting.
Then, as a small independent practice you need to purchase between $50,000 to $100,000 in vaccine inventory per month. You must risk either having too much and taking too much cash flow and inventory risk, or having too little and having to turn patients away. As you maintain your inventory, you need to track manufacturer lots, expiration dates and temperature in real time to ensure that patients receive safe, high-quality immunizations.
All the while you must contend with the time-consuming process of documentation. Different vaccines go to different patients, and sometimes it’s not easy to determine who is who. In some cases, patients with the same exact insurance company will need a different vaccine depending on which plan they’re on. Once that’s sorted, you must document the whole process — including the inventory that was used — in your own records, while also reporting the information to the state. And these critical records that serve as proof of vaccination often don’t transfer between states, or even between cities in a single state. So if the patient recently moved, you have to find and enter it all from scratch.
Finally, you have to get the insurance companies to pay you back. Different insurance companies and different plans have different rules for how to submit claims. Any minor issue can get you a denial which at best delays the process a full three months, and at worst is a write-off for the vaccine you’ve already paid for. And that’s just the beginning. Hurdles are everywhere: newborns who don’t yet legally have insurance, families with multiple insurance plans, recent job changes that affect insurance status, you name it. Even if all goes well, insurance reimbursements can be lower than what you paid for the vaccine in the first place.
Rinse and repeat, 15+ times per day, per doctor.
What’s most eye-opening, though, is when you realize that no part of this unforgiving system has anything to do with medicine or science. It’s supply chain optimization, not pediatric medicine.
With that, it shouldn’t come as a surprise that 36% of pediatricians have stopped or are considering stopping offering vaccines altogether, according to Academic Pediatrics. That’s an especially alarming figure given the list of significant challenges already weighing pediatricians down. They make up one of the lowest-paid physician categories in the country. Their time is increasingly spent on administrative work — an average of 15 hours per week, up from nine hours weekly in 2012, according to Medscape’s annual physician compensation report. Pediatricians pour hundreds of hours a week into the foundation of care that keeps our healthcare system from collapsing under the weight of preventable diseases.
It’s absurd that we ask the physicians responsible for preventing measles outbreaks and polio resurgences to subsidize those efforts out of their own pockets. The Vaccines for Children Program was instituted in 1994 to help address this issue for Medicaid and uninsured patients — but there, the process is more complex and the margins are even thinner.
Dangerous ripple effects
This unsustainable model is particularly damaging given troubling national trends. Vaccination rates are decreasing, while vaccine hesitancy is on the rise. When I talk to pediatricians about how to address the increase in vaccine-hesitant parents, I hear the same thing across the board: They need more time for education, counseling and thoughtful check-ins with patients. Yet every additional minute spent with a concerned parent can drive a practice deeper into debt. It’s a vicious cycle where everyone loses.
It’s worth asking: Is the reason people have more questions now than ever about vaccines because there’s truly more uncertainty than before? Or because the experts they are asking simply don’t have the time to answer thoughtfully and carefully?
What I’ve learned from working every day with pediatricians across the country is that most people in medicine don’t naturally think about economic effects. And why should they? Pediatricians spend over a decade learning to provide exceptional medical care, not studying cash flow management or insurance reimbursement optimization.
A new way forward
It doesn’t have to be this way. I’ve seen what’s possible when we get this right. Pediatricians are less encumbered, parents get better counseling, children get better care and communities stay protected. The technology and expertise needed to solve this problem already exist — we just need the will to implement solutions that toss out the status quo and put children’s health first.
We can continue asking pediatricians to subsidize disease prevention out of their own pockets, and watch the numbers of physicians who specialize in caring for children continue to plummet while those who stay in practice suffer financially. Or we can build a system where doing the right thing for children’s health also makes financial sense for their health care providers. The choice is ours. I know which future I’m working toward.
Photo: Geber86, Getty Images
Pedro Sánchez de Lozada is the founder and CEO of Canid, a healthcare technology company that manages vaccine programs for over 150 independent pediatricians nationwide. Before launching Canid in 2021, Pedro spent more than 15 years building tools for small businesses, with key roles at Udemy, Rinse, and Merlin. His passion for healthcare began early — his mother and uncle are both pediatricians — and deepened when he managed their practices during the Covid-19 pandemic, gaining firsthand insight into the operational and administrative challenges facing doctors today. Under his leadership, Canid has raised nearly $13 million to streamline vaccine administration, reduce paperwork, and help physicians focus on patient care. Pedro brings a unique blend of startup expertise and clinical perspective to conversations about healthcare, AI, and the future of primary care. He holds a BA in Economics from the University of Chicago and is committed to building sustainable, patient-centered solutions.
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