The Buzz This Week
More than 50,000 medical school students applied to residency programs this year—the highest number on record, reflecting a 5% increase from last year. And nearly 40,000 students were placed in residency programs through the annual Match process. This influx of physicians entering the field could presumably help mitigate the future shortage of physicians projected by the Association of American Medical Colleges (AAMC), which is estimated to be up to 86,000 physicians by 2036.
Those who didn’t match (roughly 10,000 this year) likely applied to highly competitive specialties. For example, only about 80% of US students from allopathic schools and 35% of US students from osteopathic schools who applied to dermatology matched in recent years. Data shows non-US students experience even lower match rates, and there were nearly 2,000 more non-US applicants this year than in previous years.
Pediatrics was a notable outlier in this year’s Match process, showing a substantial decline instead of growth. Medical students seeking pediatric residencies dropped by over 6% since last year, representing the largest decrease in a decade, after a steady pattern of decline. In contrast to the overall growth in residency applications and successful matches for other medical specialties, nearly one-third of pediatric residency programs did not fill their positions this year.
Several factors are likely driving this trend and the shift away from pediatrics including:
- Lower pay: Pediatricians are consistently reimbursed at lower rates than physicians who provide similar services to adults. More than 50% of children in the US are covered under the Medicaid program, which typically provides reimbursement below the actual cost of care. Two pediatricians who work in academic medicine said, “Pediatricians make approximately 25% less than doctors who treat adults; all train for the same number of years.”
- Lack of exposure: Pediatrics is not a large focus of medical school education, and while students learn about many complex and interesting adult diseases, they are not typically introduced to the more complex pediatric diseases during their education.
- Increased case complexity: Childhood mental health has experienced a substantial decline—one the American Psychological Association calls a crisis—especially since the pandemic. And yet, with a shortage of pediatric psychologists and psychiatrists, most children and their families still turn to their pediatrician. Current pediatric residencies do not provide extensive mental health training, making it difficult for a pediatrician to navigate through the complex needs of his or her patients.
- Need to care for the family, not just the child: Providing appropriate and effective care for a child or adolescent patient necessitates building a strong connection with the patient’s family and/or caregivers. This can be incredibly rewarding but can also involve complicated family dynamics that take time and effort to address—all of which is not reimbursed.
- Added scrutiny from outside parties: Pediatric providers have landed in the center of several thorny political issues, including vaccination, gender affirmation treatments, and birth control, among others.
While rewarding, the pediatric specialty it is not compensated at the same level as other medical specialties, and often involves more complex dynamics than working in adult medicine. When asked why they chose this specialty, one pediatrician interviewed by NPR said, “I think there’s nothing better than being able to help a child and their family,” but with the growing shortages, “…unfortunately the care of children and the access to care is really what’s going to suffer.”
Why It Matters
A shortage in pediatricians and pediatric specialists could cause long-term catastrophic impacts to the health and economy of the US population and healthcare system.
While it is essential to care for the increasingly older age groups, our healthcare system cannot deprioritize the health and care of younger generations. If access to pediatricians and pediatric services is reduced, childhood health will inevitably decline, and “chronic diseases that take hold in childhood [will] thrive, leaving prospects for future population health and the costs of providing health care even more bleak than they are now.” Future healthcare costs could skyrocket as younger generations age.
In addition, because children are the poorest age group of the US population, they already face multiple challenges, including access to healthcare. Any additional hurdles resulting from a further shortage of pediatricians and pediatric specialists will only exacerbate health disparities.
While the drop in interest in pediatrics is multifactorial, the first step to right the ship is to amend the economic imbalance. This can be addressed with additional federal funding for Medicaid and the Children’s Health Insurance Program (CHIP) and correcting the salary imbalance within large physician groups (e.g., physicians employed by a health system). Greater exposure to pediatrics in medical school, and bolstered training for the complexities of providing pediatric care, might reverse this negative trend, help boost childhood health, and prevent astronomical healthcare costs down the road.
RELATED LINKS
STAT:
A nation with too few pediatricians could see health care costs soar
NPR:
Fewer doctors are going into pediatrics. That’s leaving a huge gap in hospitals
Editorial advisor: Roger Ray, MD, Chief Physician Executive.
