Why aren’t doctors choosing pediatrics?

Screenshot from the New York Times; Picture by Lucas Burtin

"Approximately 30 percent of pediatric training programs failed to fill their available residency slots, leaving 252 positions vacant — a notable increase from just 88 vacant spots last year. This isn’t a minor hiccup; it’s a warning for the future of pediatric care in the United States."

-Dr. Aaron E. Carroll, NYT Opinion
https://www.nytimes.com/2024/07/01/opinion/pediatrician-shortage.html

Some key issues raised from this guest essay, along with my proposed solutions:
🏥 >37 million children are covered through Medicaid or the Children’s Health Insurance Program. This means pediatric reimbursement rates are much lower than those in other areas of medicine.
✅ Improve Medicaid and CHIP reimbursement rates and tie them to value based on long-term health outcomes.

💰Pediatricians attend the same medical schools as those who enter other specialties... Almost half of those who graduated with over $150,000 in debt 20 years ago have still not paid it off completely. In 2020 the average debt of those completing pediatrics residencies was $264,000.
✅ PAY PEDIATRICIANS MORE. "JUST DO IT" - Nike. "Or like give us scholarships or loan forgiveness or something." -Zhen the Wise. "Throw me a frickin' bone here." - Dr. Evil.

🏃‍♂️Pediatric subspecialists often need to train longer than their adult counterparts, with most fellowships being 3 years after a 3-year pediatric residency as opposed to 1-2 years after a 3-year internal medicine residency. So they're training more to earn less...
✅ Reduce required training time. Revisit what's necessary and cut out the fat. My tinfoil hat theory - pediatric fellowships are longer to prolong the underpaying of much-needed labor because reimbursement rates are so low. Someone explain to me why pediatric hospitalist fellowships are 2 years of training on top of mostly inpatient residencies. To pump research, to learn QI methodologies, to teach care coordination and case management?

🦄 There aren’t enough pediatricians right now... I see patients in urgent care because families can't get same-day appointments with their primary pediatrician. In New Jersey, children who need a developmental pediatrician wait a minimum of three months. In Philadelphia, kids can wait three to six months for a pulmonologist and four months to see an allergist, and many can’t see a developmental pediatrician at all.
✅ On top of improving the supply by incentivizing more med students to enter pediatrics, optimize the supply that is already present. Invest in improved recruitment strategies like Grapevyne that are physician-first, driving transparency, reliability, and trustworthiness for doctors, by doctors. Invest in retention strategies, wellness committees, and the mental and physical health of all your physicians.

Link to referenced report on the future of the pediatric workforce by the National Academies of Sciences, Engineering and Medicine: https://nap.nationalacademies.org/read/27207/chapter/2