Speak up for pediatric specialty care and training–we need your help!

Claire McCarthy, MD

Living in Boston, we take it for granted that if something happens to one of our children, we can find just the right doctor to take care of them. We can find someone with expertise, someone who will know the latest treatments, who will know exactly what to do.

Here in Boston, we have lots of pediatric specialists. These are doctors who have trained in pediatrics, so fully understand all the ways that children are different from adults, and have additional training in a particular area of medicine, like heart defects or hormone problems or cancer. Here in Boston, children can get the health care they need.

That’s not the case in other parts of the country. According to an article in this month’s Archives of Pediatric and Adolescent Medicine by Dr. Dennis Rosen of Children’s Hospital Boston, there is a national shortage of pediatric subspecialists. In Alaska, Idaho, Montana and Wyoming, for example, there are no pediatric pulmonologists. These doctors treat lung problems, like cystic fibrosis or asthma; they can make a tremendous difference in improving the lives of children with these diseases.

There are lots of reasons why this is happening. Financial reasons loom large: most young doctors have lots of debt from paying for medical school, and specialists are often paid less than general pediatricians. It’s also easier to have a flexible schedule as a general pediatrician, something that appeals to mothers—and most pediatricians are women.

Most of the funding for training doctors comes from Medicare, but here’s the glitch: independent hospitals for children, like Children’s Hospital Boston, don’t have a lot of Medicare patients. So they don’t qualify for the funding.

There’s another threat to the training of pediatric specialists, and this one hits home here in Boston: the funding of the training is under threat. It costs a lot of money to train doctors. I’m talking about the training that happens after medical school, the on-the-job training called residency and, for specialists, fellowship. These doctors are paid a salary (pretty low for the work they do), and there are other costs, like paying the doctors who teach them. We’re talking millions and millions of dollars.

Most of the funding for training doctors comes from Medicare, the government insurance program that gives health insurance coverage to people 65 and older (and people with certain health conditions). But here’s the glitch: independent hospitals for children, like Children’s Hospital Boston, don’t exactly have a lot of Medicare patients. So they don’t qualify for the funding.

That’s where the Children’s Hospitals Graduate Medical Education (CHGME) program comes in. This government program doesn’t pay as much as Medicare does, but it helps—a lot. Problem is, the recently passed budget cut the program significantly, and a pending proposal for next year would eliminate it entirely.

There are certainly hospitals that see patients of all ages (and so get Medicare funding) that train pediatricians and pediatric subspecialists. Less than 1% of hospitals in the US are independent children’s hospitals. But those few hospitals, it turns out, train a third of all pediatricians—and half of all pediatric specialists.

Those hospitals, too, take care of the most severely ill children. They take care of more poor children than other hospitals. And, perhaps most importantly, they are the places where research and innovation happen: not only do they train specialists to take care of children now, but they are where people come together to find cures, and build hope for the future. Without CHGME funding, everything they do is threatened.

Here in the US, we are used to getting what we need. We figure that if something is important, like good health care, the people in charge will make it happen—and find a way to pay for it. So we don’t speak up or get involved.

Luckily for us, that usually works out. But sometimes it doesn’t. Sometimes the people in charge don’t make important things happen—often because they don’t understand just how important they are.

Our Massachusetts congressmen do understand. They are working hard to help. But to get CHGME funding restored, we’re going to need more on board.

So if you have a child who sees a specialist, speak up. If you know someone who has been made better by the latest pediatric research, speak up. If you are a specialist, or work in pediatric health care, speak up. Help legislators understand—and give them the stories they need to help other legislators understand.

This, really, affects all of us. It is about the future of our children, and they are the future of our world.

For more information on how to get involved, click here.