Disinterest in pediatric care raises concerns about the future of child health

The path to a career in pediatrics is becoming increasingly deserted these days and the decline in interest in subspecialties has led to great concern about the ability of health care professionals to meet the growing demands of our pediatric population. The lack of adequate staffing is a concern and young physicians saying “no, not interested” is a warning sign for the future of children’s health care.

Katherine Jordan, MD, and Priyanka Rao, MD, of the UNC Division of General Pediatrics at the University of North Carolina School of Medicine, are the authors of a new perspective titled, “Where are all the pediatricians?” Published in JAMAThe article provides an analysis and in-depth look at the reasons why pediatric careers are declining.

“We are concerned that the recent pediatric match results, where programs struggled to fill their spots, mean that the shortage in certain pediatric subspecialties will become even greater,” Jordan said.

“What this tells us is that there will be a widening gap in the number of pediatricians completing their training programs, with a decline of nearly 10 percent across the country,” Rao said. “We will not have enough pediatricians to care for children, and this will disproportionately impact already vulnerable children and communities.”

The JAMA Analysis shows that the percentage of pediatric candidates in 2017 was approximately 98% and that this percentage has decreased to 91.8% in 2024, even after the additional phase of the match, which helps unmatched medical students find a place in training programs.

Jordan and Rao also say that enrollment in pediatric allopathic (MD) programs has been steadily declining over the past five years. These results leave a significant number of pediatric positions unfilled, and there are reasons for this, financial pressure being one of them.

“The cost of medical school and therefore the debt burden can be very high for many graduates, and it can be difficult to get into a low-paying specialty if you have a lot of debt to pay off,” Jordan said. “Pediatrics has traditionally been one of the lowest-paying specialties, in part because pediatricians are reimbursed less for similar services, since a large portion of our patients are insured through Medicaid.”

The challenge of high debt is compounded by the increased complexity of caring for children, especially when a child presents with a chronic condition. Additionally, pediatricians are also seeing a dramatic increase in mental health issues in pediatric patients, which places a burden on families and caregivers.

As staffing levels become increasingly limited, pediatricians often see themselves as a combination of physician, psychologist, and social worker.

As a child grows, there are physical changes, but there are also emotional and psychological changes. Without a substantial workforce to support the growing well-being of children across the country, this population will continue to experience negative effects, Jordan and Rao say.

The authors also point out that the administrative burden surrounding an electronic medical record-based system can make the workload challenging for physicians. Rao and Jordan state that there is already pressure to increase the number of patient visits, and once the patient arrives, the physician has limited time to provide care. Adding to the workload is this electronic medical record-based system that requires more of the patient’s time.

“In many specialties, including pediatrics, a large portion of the day is spent in front of a computer, which takes away from the reason many of us went to medical school,” Jordan said. “Efforts to reduce physicians’ time in electronic medical records, including efforts already underway at UNC, could allow us to spend more time in person with families.”

The article argues that some states’ laws restrict physicians’ ability to provide confidential care to adolescents, provide reproductive care, or provide care to transgender patients.

The authors note how these laws have affected medical school candidates who want to practice pediatrics in specific states. As a result, some patient populations are more at risk for poor geographic access to health care.

Drs. Rao and Jordan recognize that while there are many complex challenges facing the pediatric workforce, there are strategies to strengthen the pool of pediatric applicants.

They propose investing more money in fair compensation for children’s hospitals, higher wages for pediatric medical specialties, reduced administrative burdens, and efforts to lift restrictions on specific confidential medical care.

The article highlights how childcare should be addressed and how advocating for change to support sustainability is an important starting point.

Rao and Jordan believe that these efforts to address the physical and mental health needs of individual children could turn the tide and reduce the number of pediatricians in our country, while helping patients, families and their caregivers.