Why This Nebraska Clinic Prioritizes Vaccines Over Profits

One pediatrician explains why vaccines are her biggest expense—not her cash cow

We’re working on a larger piece examining the economics of vaccine delivery in pediatric practices across America. As we talk to providers and look at the financial realities they face, we’re finding a story that contradicts the common claim that vaccines are profit centers for doctors. While we’re still gathering perspectives and data for our comprehensive report, we wanted to share one conversation that captures what we’re hearing from pediatricians.

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Dr. Sian Jones works in a pediatric practice in Nebraska. She has heard people claim that vaccines are among the biggest revenue streams for clinics. She has a different story to tell. “If you really look at the balance,” she says, “it’s a wash.”

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Ordering Months Ahead, Getting Paid Months Later

Here is how it actually works. The practice orders commercial vaccines weeks in advance so they are ready when patients walk through the door. Those vaccines sit in the refrigerator or freezer, waiting. Then a patient comes in, gets vaccinated, and the practice submits the bill to insurance. Now the real waiting begins. Thirty days. Sixty days. Meanwhile, the practice has already paid for that vaccine.

Do the math: the clinic buys the vaccine, stores it for a month, administers it, and then waits another two months for the insurance check. That’s roughly 90 days of the practice’s money sitting in someone else’s hands. This creates a significant cash flow problem for a small business.

Some vaccine suppliers offer extended payment terms. But it doesn’t solve the fundamental problem. The practice still writes checks before insurance pays them for the service. “We’re still paying for it before we get paid,” Dr. Jones explains. It’s money the practice doesn’t have yet.

The Refrigerator Problem

You can’t store vaccines in a kitchen fridge. That won’t work. Vaccines need to be refrigerated at specific temperatures that can NOT fluctuate. Practices need to purchase specialized medical-grade refrigerators for vaccines. These machines cost real money. But wait, there’s more! The real drain is running them. Because these refrigerators maintain precise temperatures constantly, they require significant electrical power. The electricity bill alone is substantial. “It’s very expensive,” Dr. Jones says. “It takes a lot of power.”

Beyond the equipment itself, the practice maintains monitoring systems to ensure vaccines stay at the right temperature. Regulatory compliance requires they document this. Another system, another cost.

Weather, Waste, and 2 AM Phone Calls

Tornadoes. Ice storms. Windstorms. When weather happens in Nebraska, the power can go out. If a refrigerator loses power in the middle of the night... an entire inventory of expensive vaccines can be ruined. That’s why practices install alarm systems. When an alarm does sound at 2 AM, staff get called in. They put vaccines in coolers and drive them to another location. Dr. Jones’ practice has done this before. “We’ve had to do that,” she says. That’s paid staff time in the middle of the night.

Inevitably, other common situations arise in which vaccines become unusable. Sometimes the needle hub separates from the syringe before injection—that dose goes in the trash. Families change their minds after staff thaw a vaccine and prepare the syringe. A vaccine that is prepared can’t go back in the freezer, so it goes in the trash. Equipment fails. Accidents happen. These things occur regularly enough that practices must budget for the loss of wasted vaccines as an unavoidable cost of doing business.

The Math Doesn’t Work

When insurance companies finally pay providers for administering the vaccines, it doesn’t add up. Nursing time alone often exceeds what insurance pays. Add in supplies, and the practice is operating at a loss. “Depending on the insurance, it may be more or less than the supplies required to give it or the nursing time that we’re paying our nurses,” Dr. Jones notes.

“I have heard certain HHS officials say that it’s one of the biggest revenue generators for practices,” Dr. Jones says. “What I would tell you is it is also our biggest expense.”

Money goes out for refrigerators, electricity, alarm systems, monitoring equipment, staff time for emergency calls, vaccine waste, and the vaccines themselves. Money comes in from insurance. When you add it all up, Dr. Jones says, “the money comes in, and the money goes out. It is a wash.”

Why Keep Doing It?

The obvious business answer would be to stop offering vaccines and refer patients elsewhere. Eliminate the costs and the headaches. “If we didn’t have to do it,” Dr. Jones says, “it would be, I mean, so much less expensive for us.”

But Dr. Jones’s practice absorbs these costs anyway. Not because it’s profitable. Not because it’s easy. But because the consequence would mean fewer vaccinated kids. As Dr. Jones says, “If all kids had to go somewhere else, a lot of kids wouldn’t get vaccinated. That’s a reality.”

So pediatricians across the country continue to administer vaccines because Dr. Jones explained, “it’s the right thing to do.”

That commitment to doing ‘the right thing’ keeps the vaccines coming, refrigerators running, alarms ringing, and staff putting shots into arms. Because for this practice—and thousands like it across America—a child’s health matters more than the balance sheet.

What Dr. Jones describes isn’t unique to Nebraska. As we continue talking to pediatricians across the country, we’re hearing similar stories from practices large and small, urban and rural. The claim that vaccines are profit centers is crumbling when you look at the actual costs and reimbursements. The real story is one of medical practices absorbing costs to protect public health—a fragile system that depends on providers who believe protecting children is worth the financial strain. How long can that last?

Stay Curious,

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