Two years ago, the RSV epidemic shocked children’s hospitals across the country, along with the pediatric residents therein. One of us, Faith, was a resident at the time, and she and her colleagues call it the Dark Ages: Whether they arrived for their morning shift or left their night shift, the number of patients they cared for would not increase. change for weeks at a time. Hospitals were completely filledand resources were limited. Although the media reported Given the challenges the hospital faced during this time, no one considered the impact this epidemic would have on the evolving pediatric workforce.
This experience led many pediatricians to decide not to specialize further in pediatrics. It has also likely deterred many rotating medical students from pursuing a career in pediatrics. These interactions left a lasting impression on their opinions of the specialty, as we now see in the outcome of this year’s National Residency Matchwith 30% of pediatric residency programs remaining unfilled.
The combination of political apathy, limited support, chronic underfunding, and limited self-advocacy among pediatricians over decades has made pediatrics one of the largest health care teams in the country. According to the Association of Children’s HospitalsAlthough all pediatric subspecialties are experiencing shortages, developmental behavioral sciences, neurology, genetics, and child and adolescent psychiatry are among the worst, with more than 40% of hospital vacancies. Without immediate intervention, child care in the United States will experience an unprecedented decline.
To truly understand the complexities of pediatric health care, it is critical to examine the broader political landscape.
Conservative politicians are less likely to support legislation that actively improves the lives of children. Fifteen Republican-controlled state legislatures have not supported Summer electronic transfer of benefits for children to feed children during the summer, blocked the expansion of the Child tax credit to reduce child poverty, supported the “zero tolerance” policy that separated children from their families at the southern border and supported abortion bans that did not include it exceptions for children who become pregnant after rape. Infant mortality in Texas has risen since the state passed one of the strictest anti-abortion laws in the country.
In addition to the pain this policy causes families, especially children, it also creates more work for those of us who work in pediatrics.
Forty-seven percent of the Medicaid and Children Health Insurance Program enrollees are infants, children and adolescents. Although the Medicaid spending was there $800 billion by 2022only about 17% of Medicaid dollars were spent on pediatric health care. As a result, children’s hospitals largely have fewer resources 40 million children on Medicaid across the country, which are at the mercy of federal-state funding.
Free-standing children’s hospitals, where teaching takes place half of all general pediatricians and pediatric subspecialty trainees nationwide are unable to receive funding through Medicaid general medical education funding. In 1999, Congress established the Children’s hospitals have medical training program to address this problem, but Congressional funding for this program has always been half the amount given to GME until now. The 59 children’s hospitals under this program 33% of children’s hospitals across the country are left to teach future pediatricians with limited funding, which has led to bed shortages and closures within children’s hospitals.
The most notable closure of children’s hospitals, Tufts Children’s Hospital in 2022showed how both closure and bed shortages are a chronic problem in pediatrics, as inpatient beds were converted to adult ICU beds. Research has shown that inpatient pediatric units have decreased across the country almost 20% leaving few options for children, especially those in rural areas. With less access to children’s hospitals, 1 in 4 children across the country are forced to travel greater distances to receive care.
Medical students are well aware that children’s hospitals are experiencing bed shortages and even closures. Meanwhile, education funding remains scarce and pediatricians, especially subspecialists, do not receive sufficient compensation. As a result, fewer and fewer people are choosing to consider pediatrics as a career choice. This year, applications for pediatrics have fallen by 6%. This is a clear sign of things to come, as medical students look to choose a career that simply presents fewer headaches.
With a new administration in place, it is time for pediatricians to be proactive, not reactive, in funding pediatric education to expand their workforce. Failure to take immediate action could have detrimental consequences for the future of our workforce.
Jared E. Boyce, ScM, is an MD-Ph.D. candidate for the Medical Scientist Training Program at the University of Wisconsin School of Medicine and Public Health. Faith Crittenden, MD, MPH, is a pediatric endocrinology fellow at Yale New Haven Children’s Hospital and a 2023 public voice fellow at the OpEd Project and the National Black Child Developmental Institute.