Q&A: Why sub-specialty pediatricians are in short supply

Researcher Daphna Gans.

California’s kids experience more problems obtaining subspecialized pediatric care than children in any other state, a new UCLA Center for Health Policy Research study has found.

The California Health Report spoke with Daphna Gans, a research scientist at the UCLA Center for Health Policy Research and assistant adjunct professor at the university’s Fielding School of Public Health, about why California has so few pediatric subspecialists.

Gans, a lead author of the report, will participate in a webinar April 25 to discuss the findings. The excerpts below have been edited for space and clarity.

Why is the issue more acute in California?

One of the possible explanations is that California has a very high cost of living. When you have physicians whose training is already extended, have a lot of debt to pay coming out of their program and are looking for a place to start their practice, it can be harder for them to be living in California than other states. They’ll take that into account when they accept a position.

Also, Medi-Cal – California’s Medicaid program—payments are also lower in California than in other states. So you have a combination of those two things that can lead to some sub-specialists to decide to practice elsewhere.

What access issues will we see in the coming years when Latinos become the largest racial group in the most populous state? What will that mean for these children?

We have found in the literature that access barriers are found across racial and lower socioeconomic status. Some of the disparities are not so much by race, but by language. If we see a large population of children of color having difficulty access sub-specialty pediatric care, it’s important to target that population because they are already at a disadvantage. The majority of the children with special health care needs are already children of color.

Some residency programs are considering reducing the availability of sub-specialty rotations to save money. What will the impact be and what are some alternatives?

I think that some programs are trying to reduce the cost. There’s also a debate within the schools on whether these pediatricians should have such an intensive training—if they can reduce some of the training and still have the practice and knowledge that would allow them to practice. The consensus is that intensive training is needed.

However, there are issues related to budgets. We recommend that Congress reinstate the $22 million in funding that was cut from the 2013 budget from the Children’s Hospital Graduate Medical Education funds. The funds support 43 percent of the nation’s pediatric sub-specialty training. Those cuts could result in 465 fewer pediatric subspecialty residency positions annually, which is a huge reduction.

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