The Future of Pediatric Subspecialty Physicians — New Report

A new report from the National Academies of Sciences, Engineering, and Medicine makes recommendations for improving access to pediatric subspecialty care. The Department of Pediatrics very own, Chris Stille, MD, MPH/PSPH, sat on the committee that authored the report.

Each year, approximately 10 percent to 20 percent of all U.S. children visit a pediatric subspecialist. Pediatric subspecialist physicians complete pediatric residency and receive additional fellowship training in a specific area, and augment pediatric primary care by caring for children who require technical procedures or have health conditions that occur infrequently. These physicians include pediatric oncologists or cardiologists, adolescent medicine subspecialists, and pediatric developmental and behavioral subspecialists, among others.

The report examines barriers to accessing pediatric subspecialty care, including cost, the number of physicians in these specialties, unnecessary referrals, and more. The report’s recommendations include:

• Pediatric professional societies should develop testing, management, and referral guidelines for health conditions commonly managed by subspecialists.
• Congress should provide federal funds to states to increase Medicaid payment rates for pediatric services, to an amount that meets or exceed Medicare payment rates within five years. Congress should also reform graduate medical education formulas and programs to ensure equitable and sufficient support for pediatric training programs.
• Health insurance payers should adequately reimburse evidence-based care delivery models — including e-consults and telehealth visits — to enhance access to pediatric subspecialty care.
• Pediatric boards and accreditors should develop, implement, and evaluate flexible training pathways, including a 2-year option focused on clinical care.
• Congress should increase funding for the Pediatric Specialty Loan Repayment Program to $30 million annually. The Health Resources and Services Administration should focus on loan repayment for high-priority pediatric medical subspecialties, as well as subspecialists from backgrounds underrepresented in medicine or who are economically disadvantaged.