The Academy is calling for increased public funding of graduate medical education (GME) to address a shortage of pediatric subspecialists.
“The AAP maintains that increasing the number of fully funded residency training positions directed toward pediatric surgical specialties, child psychiatry, pediatric medical subspecialties, and general pediatrics … could improve access to care and enhance pediatric health,” authors said in the policy Financing Graduate Medical Education to Meet the Needs of Children and the Future Pediatrician Workforce (Rimsza ME, et al. Pediatrics. March 28, 2016, http://pediatrics.aappublications.org/content/early/2016/03/25/peds.2016-0211).GME training gives pediatricians hands-on opportunities after medical school.
GME training gives pediatricians hands-on opportunities after medical school and is an “essential public investment in the future physician workforce,” according to the policy from the AAP Committee on Pediatric Workforce. However, it receives less than 1% of federal and state spending on health care.
General pediatricians need three years of such training to qualify for board certification and additional fellowship training for subspecialty certification.
On average, hospitals spend about $100,000 a year to train a resident. For teaching hospitals, most of the funding comes from the Centers for Medicare & Medicaid Services, while children’s hospitals receive most of their resident training funding from the Children’s Hospital GME (CHGME) Payment Program and Medicaid.
However, funding sources aren’t all reliable. For instance, the CHGME program relies on Congress to appropriate funds each year. Alternative funding sources like patient care revenues and grants tend to go to adult medicine.
In the meantime, the growing number of children with chronic health problems likely will increase the demand for pediatric medical subspecialists and surgical specialists, according to the policy. There also must be enough funding to maintain the current workforce of general pediatricians.
The Academy recommends that GME funding:
- covers the full length of training;
- comes from all entities that gain from a well-trained pediatrician workforce without influencing curriculum;
- be provided at similar levels and stability at freestanding children’s hospitals and other teaching hospitals;
- be allocated in a way that is transparent, addresses current and future workforce needs, and covers time trainees spend in scholarly, didactic and clinical activities;
- be available in full for combined specialty programs; and
- supports education of trainees in all settings and flows to the training sites.