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

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View all May 2013 news releases in the Children's Hospital and Health System News Section.

NATIONAL SHORTAGE OF PEDIATRIC SPECIALISTS POSES CHALLENGE TO CHILDREN'S ACCESS TO CARE

MILWAUKEE (1/13/2010) - Children's Hospital of Wisconsin innovates services to address local shortages

Children's Hospital of Wisconsin 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:

Neurology.

Developmental-behavioral pediatrics.

Gastroenterology, general surgery and pulmonology (three-way tie).

The shortages that Children's Hospital is seeing correspond to this national picture. "Unfortunately, when the demand for specialists outstrips the supply, the result at our hospital is longer than anticipated waits to schedule non-urgent appointments," said Peggy Troy, president and CEO of Children's Hospital and Health System, parent organization of Children's Hospital. "We absolutely will provide access to care for all children in the state of Wisconsin – regardless of their ability to pay – but we can't always provide that care as quickly as we'd like."

According to the national 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 adult clinicians (86 percent).

Delayed and lost surgeries (64 percent).

Reduced level of services (60 percent).

National shortages contribute to vacancies in children's hospitals that commonly last 12 months or longer. "Though we have been successful in recruiting specialists to Milwaukee and optimizing our clinical teams with advanced practice nurses and physician assistants, the inadequate Medicaid reimbursement for these services will continue to limit our ability to recruit and retain the depth and scope of services required," said Joseph Kerschner, MD, president and CEO of Children's Specialty Group, a physician specialty group practice of Children's Hospital and The Medical College of Wisconsin, in Milwaukee. "If we are able to pay pediatric specialists more, then more bright, talented medical students will go into the field. That gives us a better supply of pediatric specialists. We work very closely with the Medical College to ensure we will have the right number of specialist today – and into the future – to care for Wisconsin's children."

While two weeks is the prevailing national benchmark to schedule specialty appointments, half of children's hospital respondents to the survey report wait times longer than the benchmark for those specialties experiencing the most severe shortages of specialists. Nationally, developmental-behavioral pediatrics claims the longest wait time for an appointment at 66 days or 13 weeks. Endocrinology claims the second longest wait time at 52 days or just over 10 weeks.

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. Medicaid reimburses pediatric specialists 20 percent to 30 percent below what Medicare reimburses adult specialists for similar procedures.

"The financing of pediatric health care relies heavily on the federal-state program Medicaid," said Troy. "As long as Medicaid continues to reimburse far below the cost of care, medical residents will face disincentives to pursue a pediatric specialty. The pediatric specialists at Children's Hospital serve kids from all over the state. We are the largest Medicaid provider group."

"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."

"Children's Hospital is working with state officials and our federal delegation to stress the importance and correlation of adequate Medicaid reimbursement and a strong supply of pediatric specialists," said Troy. "These are challenging fiscal times but access and quality care for kids must be a priority. Our state officials and federal delegation in Washington, DC, understand that. They've been working with us on efforts to bring more federal money to Wisconsin's Medicaid program.

"However, we know that because public policy implementation takes time, Children's Hospital continually works on more immediate ways to improve access to and to innovate delivery of specialty care throughout Wisconsin," said Troy.

Children's Hospital is implementing innovative scheduling systems to improve efficiency of the clinics, seeing more patients each day and improving patient satisfaction along the way. In addition, the hospital integrates advanced practice nurse and physician assistant teams into the clinical care delivery system. Also, telemedicine services are available to provide care closer to a family's home.

"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.