National Shortages of Pediatric Subspecialists Impede Children’s Access to Care

Access more resources on the survey findings.
For Immediate Release
January 13, 2010
Norida Torriente, 703/797-6059
Gillian Ray, 703/797-6027

(Washington, DC) – Today, the National Association of Children’s Hospitals and Related Institutions (NACHRI) presents findings of a December 2009 national survey of children’s hospitals at a Congressional Children’s Health Care Caucus briefing on Capitol Hill. The survey finds significant shortages in a multitude of pediatric subspecialties that pose challenges to children’s access to timely care.

“With Congress in the final stage of passing legislation that promises to provide coverage to millions more Americans, we are concerned that coverage is being equated with access to care. In our current health system, children’s access to care is impeded by nationwide subspecialist shortages in high-demand specialties,” says NACHRI’s President and CEO Lawrence McAndrews.”The time is now to take action to address children’s significant access problem through sensible health reform strategies.”

Children’s hospital respondents to the survey report the top pediatric subspecialist shortages that most affect their ability to deliver care are:

  • pediatric neurologists
  • developmental-behavioral pediatricians
  • pediatric gastroenterologists
  • pediatric general surgeons
  • pediatric pulmonologists

“Demand for pediatric subspecialists is simply outstripping supply,” says McAndrews. For example, the national physician-to-child population ratio for developmental-behavioral pediatrics is 0.6 per 100,000 children, according to the American Board of Pediatrics. Twenty-seven states are below that ratio. “Especially with the increase in diagnosis of autism-spectrum conditions among children, the ratio of developmental pediatricians to children is alarming,” adds McAndrews.

National shortages contribute to vacancies in children’s hospitals that commonly last 12 months or longer. The subspecialties with the most frequently reported vacancies (12 months or longer) in children’s hospitals are:

  • pediatric neurology
  • developmental-behavioral pediatrics
  • pediatric endocrinology
  • pediatric pulmonology
  • pediatric gastroenterology

Children’s hospitals identify several reasons for the subspecialty vacancies including a national shortage of experienced candidates; shortage of recent graduates; and low Medicaid reimbursement for pediatric subspecialty services. Children’s hospitals, on average, devote half their patient care to children reliant on Medicaid yet Medicaid reimburses pediatric subspecialists 20% to 30% below what Medicare reimburses adult subspecialists for similar procedures.

Shortages combined with long-term vacancies result in wait times for scheduling subspecialist appointments that often exceed the prevailing national benchmark to schedule subspecialty appointments. While two weeks is the benchmark, half of children’s hospital respondents to the survey report wait times longer than two weeks for the pediatric subspecialties experiencing the most severe shortages of subspecialists.

  • 68% of children’s hospitals experience difficulty scheduling endocrinology visits; the average wait time is over 10 weeks
  • 61% report difficult scheduling neurology visits; the average wait time is 9 weeks
  • 50% report difficulty scheduling developmental pediatrics visits; the average wait time is over 13 weeks – one of the subspecialties with the longest wait times

Not only are families burdened by long wait times, but many also travel significant distances to see a subspecialist. A recent study using data from the American Board of Pediatrics found children travel an average of:

  • 73 miles to see a subspecialist in neurodevelopmental disabilities
  • 60 miles to see a pediatric rheumatologist
  • 44 miles to see a developmental pediatrician

"Significant pediatric subspecialty work force shortages began to appear in the late 1990's, as a result of declining interest in subspecialty careers,” says James A. Stockman III, MD, president and CEO, American Board of Pediatrics. “Although the pipeline of trainees is increasing in some areas, the net effect is that large gaps still exist with respect to supply and demand in many specialty areas. This situation is likely to continue given the disparities in reimbursement of pediatric providers, the uncertainty of sustained financial support for training programs and the absence of targeted incentives for entering certain specialty fields and practice locales.”


About the NACHRI Survey

The NACHRI Pediatric Subspecialty Physician Survey of Children’s Hospitals was fielded in December 2009 by NACHRI Child Health Policy Research & Analytics. In total, 44 children’s hospitals responded to the survey. Of all freestanding acute care children’s hospitals which train the majority of all pediatric subspecialists, 38% participated in the survey.


Founded in 1968, NACHRI is an association of more than 200 children’s hospitals and related institutions devoted to improving the health and well-being of children and families through support of children’s hospitals’ four-fold mission of clinical care, pediatric training, research and child advocacy. All children need children’s hospitals.