National shortage of pediatric specialists pose challenge to children's access to care

The Children's Medical Center of Dayton participated in a December 2009 survey of children's hospitals on the supply of pediatric specialists. Released today by the National Association of Children's Hospitals and Related Institutions (NACHRI), the survey findings document significant nationwide physician shortages in a multitude of pediatric specialties, posing challenges to children's access to timely care. 

Children's hospital respondents to the survey report the top pediatric specialist shortages that most affect their ability to deliver care in:

1. neurology
2. developmental-behavioral pediatrics
3. gastroenterology, general surgery and pulmonology (three-way tie)

"The shortages that we see here at Dayton Children's closely mimic this national picture," said Thomas Murphy, MD, vice president for medical affairs at Dayton Children's. "This region feels the shortages because when the demand for highly trained pediatric specialists outpaces the number available, the result is often a delay in the length of time children and families here and across the country have to wait to be seen." 

According to the survey findings, pediatric specialist shortages result in:

• delayed or lost clinic visits (90 percent of hospitals report this result)
• lost referrals to other providers, frequently adults clinicians (86 percent)
• delayed and lost surgeries (64 percent)
• reduced level of services (60 percent)

"We have established service excellence benchmarks here at Dayton Children's for providing new appointments to children needing to see a pediatric specialist, and these shortages can cause us to exceed those standards. This is not acceptable to us," said Vicki Giambrone, vice president of marketing and external relations. "We don't want any child who needs to see a pediatric expert to wait, yet we have to face the realities these shortages create." 

Children's hospitals identify several reasons for the specialty vacancies including a national shortage of experienced candidates; competition among hospitals; shortage of recent graduates; and low Medicaid reimbursement for pediatric specialty services. Children's hospitals, on average, devote half their patient care to children reliant on Medicaid. At Dayton Children's, 50 percent of the patients rely on Medicaid for their care. Medicaid reimburses pediatric specialists 20 percent to 30 percent below what Medicare reimburses adult specialists for similar procedures. 

Giambrone commented, "The financing of pediatric health care relies heavily on Medicaid and this federal-state program pays far below the cost of care. Any medical professional who chooses a pediatric specialty does so knowing they will get paid far less over the lifetime of their career than does their colleague down the street who cares for adults. It is a huge disincentive to go into pediatrics, especially when you consider the magnitude of the school loans and the cost of malpractice insurance a new physician faces. It is just not acceptable that health care reform didn't even address this issue for children and those of us who care for them." 

"Specialist shortages pose a significant challenge to families seeking access to timely specialized care for their children," said Lawrence McAndrews, president and CEO of NACHRI. "The national survey findings raise the immediate questions of what actions we can take now to improve children's access to specialty care and how can we address the shortages more systematically." 

Dayton Children's continues to work with state and federal elected officials to stress the importance and correlation of adequate reimbursement through Medicaid and a strong supply of pediatric specialists, said Giambrone. "We hope that the political will exits to improve access to specialty care for kids through the current reform efforts. To me it is about who is really for kids and who is just kidding." 

"Yet, as we work on reform, we continually work on ways to promote the opportunities here at Dayton Children's and find ways to improve access through providing services in a more effective and efficient manner and innovating," said Giambrone. 

"Nurse Practitioners are an integral part of our mission and health care team at Dayton Children's," said Dr. Murphy. "Our nurse practitioners work collaboratively with our specialists to provide high-quality, patient care. They are instrumental in maintaining timely patient access." 

According to Dr. Murphy, "Dayton Children's has recently hired an additional nurse practitioner in neurology, resulting in increased access for patients. In addition, we are currently looking at adding nurse practitioners in other key areas where access has been a challenge, especially those areas with specialist shortages." 

During the few past years, Dayton Children's has opened community testing centers in Beavercreek, Springboro, Vandalia, Warren County and Kettering for closer access to pediatric lab and medical imaging services. Dayton Children's Outpatient Care Center in Springboro also offers outpatient rehabilitative and urgent care services. The Specialty Care Center in Warren County offers 11 different specialties in services such as gastroenterology, neurology, pulmonology, urology, cardiology, endocrinology, genetics counseling, hematology, nephrology, ear nose and throat (ENT), infectious disease and child abuse and review evaluation. 

"The NACHRI survey findings illustrate once again how pediatric care differs from adult care. Physician shortages on the adult side are in primary care. Children, on the other hand, experience barriers to pediatric specialty care because of specialist shortages. We must specifically address the needs of children, our most vulnerable population, when examining options to improve access to care," added McAndrews. 

For more information, contact: 
Marketing Communications Department 
Phone: 937-641-3666 
marketing@childrensdayton.org