How the pediatric workforce shortage places rural kids at risk in a changing healthcare landscape

My young patient sadly accepted that she couldn’t watch her favorite show because her family had to cancel their streaming subscriptions. Her mother confided that money was tight. For this family who traveled to our medical center from a small town more than 250 miles away, they had high expenses — not only for their child’s medical bills, but for gas and hotels for frequent visits to see specialists. This was compounded by the fact that their income was recently cut in half, as the patient’s mother had to give up her job to be in the hospital with her daughter for weeks at a time. My patient brushed it off and moved on to play with toys. She had known disappointment before. The previous day, she told me how she missed playing with her brother and father, who were back home for work and to attend school. They sent their love over video calls every day and wished they could hug their girl every night.

The extra burdens this family faces are common. Since I grew up in a small town, this patient’s story reminds me of so many stories from home. In Texas, 75% of children live over an hour from the closest facility that provides pediatric emergency services or specialty care.  Unfortunately, this lack of access to critical care for children in rural areas is a problem that has been getting worse, due in part to the shrinking pediatric workforce.

While there is a growing shortage of pediatricians nationwide, the supply and demand mismatch is particularly large in rural areas and in medical subspecialties. One recent study found that average driving times to pediatric endocrinologists for children with diabetes on Medicaid were 72 minutes for rural families compared to 18 minutes for urban families. Another study revealed that 58.7% of rural counties and an overwhelming 90.4% of completely rural counties had no general pediatricians at all.

Such disparities are only worsening, as few medical school graduates are pursuing pediatrics, leading to even fewer pediatricians and pediatric subspecialists. One major driver of this is lower compensation of pediatric physicians compared to their adult medicine counterparts, related in part to reimbursements from Medicaid and CHIP (which cover about half of Texas children) being lower than those from Medicare. With rising medical school tuition rates, the reimbursement gap has made attracting new pediatricians harder than ever.

The workforce shortage also has major consequences for hospital care. In recent years, many rural hospitals have had to make tough decisions about what to cut to stay afloat. Since pediatric care brings in less money and it is difficult to find providers, closure rates for inpatient pediatric units have been much higher than those for adults. This has consequences. Rural children with medical complexity experience a much higher risk of in-hospital mortality than their urban counterparts.

So, what can be done to help? We can all advocate for programs that support the recruitment and training of pediatric providers. The Children’s Hospital Graduate Medical Education (CHGME) program funds the training of more than half of all pediatric residents and fellows. Its funding is not guaranteed, and a proposal recently suggested its elimination. You can contact your congresspeople to support robust funding for CHGME. At the state level, Texas helps with loan repayment for physicians in underserved areas.  Its funding depends on the state budget, so you can voice your support to your state representatives. If you live in a rural area, you can advocate for your local hospital’s funding. If you work at or have connections to a major hospital with pediatric services, you can support outreach that brings services from your hospital to rural patients.

Finally, as I learned from my small hometown community, we can come together to help the kids and families that we know, whether by connecting them to resources, supporting nonprofits that help them, or by being a good neighbor in their times of need.

By Dr. Caraline Sepich-Poore, Resident Physician in Pediatrics and Medical Genetics at Baylor College of Medicine

Any opinions, conclusions, and recommendations expressed in this article are those of the author and do not represent the views of Baylor College of Medicine.