MILWAUKEE (5/20/2011) -
Opinion by Peggy Troy, MSN, RN, president and CEO of Children's Hospital of Wisconsin
When President Obama's budget was rolled out, we heard much talk about the sacrifices that need to be made so that our generation does not pass along to our children a painful, unsustainable deficit. We therefore see great irony in one particular provision in the Administration's budget that would burden the children of tomorrow in another profound way.
As part of the effort to rein in spending, President Obama's administration eliminated funding for a program that trains the nation's future pediatricians and pediatric specialists. This cut threatens the health care of every child in the U.S. since it will inevitably erode the number of physicians trained to care for children today and for years to come.
Why does this program exist? Hospitals that train physicians to care for adults receive federal support through Medicare. Since children's teaching hospitals treat children, not seniors, they receive virtually no support through Medicare. Recognizing this unintended inequity, Congress established the Children's Hospitals Graduate Medical Education (CHGME) program more than 10 years ago.
Training pediatricians and pediatric specialists matters. Congress rightly recognized when they enacted CHGME that treating children is vastly different than treating adults. Children are not just small adults, and providing the care they need is not simply a matter of providing kid-sized equipment or scaling down medication doses. Ask any cardiac surgeon about the complexities of operating on a child's heart that's the size of a thumb and you will hear that specialized pediatric training makes all the difference to the outcome of that child.
The CHGME program has demonstrated tremendous success. Before it was enacted, the number of residents being trained to treat children had started to dwindle, declining 13 percent in the 1990s. CHGME turned the tide, increasing training in children's teaching hospitals by 35 percent. Annually, the program supports the training of 5,400 pediatricians and pediatric specialists.
Children's Hospital of Wisconsin has a three-year pediatric residency program and a two-year pediatric dental program. In 2009, 97 residents completed the three-year pediatric program and 13 completed the two-year dental program. That same year, more than 75 family practice residents rotated through the hospital, as required by the pediatric training component of their program. Sixty percent of the residents who receive training at Children's Hospital remain in Wisconsin to care for children, providing primary, specialty care and emergency care to infants, children and adolescents.
With this number being trained, CHGME has helped stave off a full-blown crisis in the supply of pediatricians and pediatric specialists. While our country faces regional shortages of pediatricians, demand for specialty care still outstrips supply. In 2010, the National Association of Children's Hospitals and Related Institutions reported a national shortage among such pediatric specialties as neurology and developmental behavioral pediatrics.
The impact of the shortage is well known to many families who have already sought care for children who need evaluations for attention deficit disorder or autism, for example. A wait time of more than three months is too long for any child in need to wait. Without CHGME, the shortage crisis will only intensify, care will be delayed and wait times will increase.
Few people can fathom a time when we won't have enough pediatricians and pediatric specialists to care for our kids. Most figure that surely another program or effort will be able to protect the workforce that cares for children.
Don't be so sure.
There is great peril in eliminating the very program that has helped boost the number of providers - primary care and specialists - available to provide much-needed medical care for children. Even though free-standing children's teaching hospitals represent just 1 percent of all hospitals, they train more than 40 percent of general pediatricians, 43 percent of all pediatric specialists and the majority of pediatric researchers. More than 60 percent of all pediatric emergency physicians and all pediatric surgeons are trained in children's teaching hospitals receiving CHGME support. In FY 2008, children's hospitals and their affiliated pediatric departments conducted 20 percent of all NIH-sponsored pediatric research.
CHGME is a program that is working. It is accomplishing exactly what it was designed to accomplish, has not created unintended consequences and, unlike many programs facing elimination, it's not redundant with existing programs. If CHGME goes away, we will still care for our children and we will seen an increase in the already long wait times that parents face in gaining access to care for their children.
There are truly difficult fiscal choices to be made right now and there are many worthy programs on the chopping block. The return on investment in CHGME has been great. It isn't fair to ask children, who are 24 percent of the nation's population, to sacrifice for the sake of a federal budget that only devotes 10 percent of its outlays to their needs. Surely there are other ways to tighten the nation's fiscal belt. Surely there are other ways to tighten the nation's fiscal belt.
Peggy Troy is president and CEO of Children's Hospital of Wisconsin, located in Milwaukee. The 296-bed hospital is a Level I Trauma Center.
Troy currently serves on the board of the National Association of Children's Hospital and Related Institutions and on an advisory council for Child Health Corporation of America. She frequently has been invited to Washington, DC, to meet with public and elected officials regarding pediatric health care policy.
Previous roles include executive vice president and COO of Methodist Le Bonheur Healthcare in Memphis, Tenn., president and CEO of Le Bonheur Children's Medical Center, also in Memphis, and president of Cook Children's Medical Center in Ft. Worth, Texas.
Photo caption: Peggy Troy, President and CEO of Wisconsin's Children's Hospital and Health System, testified in 2010 in Washington D.C. in front of Chairman David Obey and the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies on the topic of Children's Hospitals Graduate Medical Education. She has spoken on numerous occasions on behalf of the National Association of Children's Hospitals and the 60 independent children's teaching hospitals that qualify for this program. Photo courtesy of National Association of Children's Hospitals and Related Institutions.