Current State of Pediatric Specialty ROI
Is There a Case for Pediatricians in your Neighborhood Providing Care to all Children in a Medical Home Model?
Compounding the challenges in care for children is the lack of incentive for physicians who could choose to specialize in pediatrics. The average starting salary for a pediatrician is $145,000.1 The median student debt in the USA for a graduating physician is more than $200,000.2 From our guests on our podcast, we have heard so many fantastic answers to our starting question, "Why did you want to become a pediatrician?" one answer we have never heard "It is for the money I can make." Pediatricians are drawn to this specialty because of their limitless commitment to the health and well-being of our communities. At our core, we also know that healthy children lead to stronger communities that contribute to generational fortitude. Like primary education that is not means tested, it is the investment we make in the future of our Democracy and Nation.
The cost of the median home in Northern Virginia is more than $600,000,3 according to Long and Foster. With that level of debt, a young woman starting her career after 11 years of education could afford a $180,000 home 4 or rent a room for $1,200 a month. This is not sustainable. We could argue that Pediatricians be replaced by Nurse Practitioners who demand $100,000 annually and can make much more money as specialty NPs. So there is little savings in dollars, they will go to higher paying jobs and we will endure losses in experience and skill. For reference, a two-year community college ultrasound technician starts at $80,000.(Private Communication )
Many counties in the USA don’t have access to a pediatricaian, and with the expected shortage of all primary care physicians, the need becomes more significant. All children are experiencing shortages and long waits. Although policymakers discuss the looming shortage by 2032,5 that shortage is here and will exponentially worsen. Mid-career physicians are leaving the workforce, as we will discuss later.
Functional shortages in the pediatric workforce have been described by the Children’s Hospital Association, in which data reveal long wait times for subspecialty services. Almost 50% of children’s hospitals reported vacancies in developmental and behavioral pediatrics and adolescent and child psychiatry, and >30% of children’s hospitals reported vacancies in child neurology and genetics.6
Data bears this out. The supply of key primary care physicians in the U.S. has not kept up with increasing demand.
The structural problems within our primary care system extend to financial incentives. The appealing aspects of primary care – developing long-term relationships with patients and families, focusing on prevention and wellness rather than disease management, working with a diverse patient population – hold less sway with new medical school grads saddled with hundreds of thousands of dollars of debt. It makes sense that aspiring doctors may choose to pursue more financially lucrative medical specialties, like surgery or dermatology.7
A possible area for improvement is the cost of medical school or the programs available for loan forgiveness. Currently, loan forgiveness is only available through 10 years of work at a mega health system, most of which don't value pediatric care, as the margins are thin and volume is low. In an in-depth piece, Drs. Rogu and Wania propose addressing loan forgiveness to all primary care physicians. In my mind, this is an insufficient remedy for the poor public policy, ineffective communication about workforce well-being by the American Academy of Pediatrics Chicago, consolidation of health systems, and the influx of Private Equity into health care.
If you have not listned to Morgan’s podcast, you can listen below. As a community we can’t afford to loose any more passionate persons.
Payscale.com
AAMC.org
Northern Virginia Housing Market Long and Foster
Wells Fargo Home Affordability Calculator
AAMC Report Reinforces Mounting Physician Shortage June 11, 2021
Children’s Hospital Association. Pediatric workforce shortages persist. 2018. Available at: www.childrenshospitals.org/Issues-and-Advocacy/Graduate-Medical-Education/Fact-Sheets/2018/Pediatric-Workforce-Shortages-Persist. Accessed May 15, 2020
The Hidden Crisis in Primary CareMore must be done to ease the burdens of primary care practitioners and encourage medical students to enter the field. By Jeffrey D. ShahidullahJan. 4, 2023