Editor’s Note: Eli is the editor of the SOPT Feature in Pediatrics. He is also a resident at the Boston Combined Residency Program, which rotates at Boston Children’s Hospital, where the authors hold affiliations. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
When MetroWest Framingham Hospital in Massachusetts closed its pediatric unit, local clinicians were unhappy, if not terribly surprised.
Decades of medical innovations were keeping children out of the hospital more and more, which is a good thing! Those same innovations were keeping children with graver illnesses healthier longer—and driving those children to increasingly more specialized centers.
Which is why, when nearby Tufts University closed its pediatric unit months later, doctors were taken aback.
The Tufts closure is a microcosm of larger national trends. Recent studies have found that pediatric beds are down some 20% across the country over the past decade. In some states—like Illinois—almost 30% of beds disappeared. And in recent years, following COVID-19 pandemic-era losses on the order of millions of dollars, closure rates in some places are much higher.
Dr. Catherine Coughlin and colleagues from Boston Children’s Hospital and Children’s National Hospital explain in a Feature being early released this week in Pediatrics, entitled, “Federal Funding for Children's Hospitals: Challenges and Critical Shortages for Pediatric Care,” that a congressional funding program called the Children’s Hospital Graduate Medical Education (CHGME) may be part of the problem (10.1542/peds.2023-061714).
“Unlike Medicare [Graduate Medical Education funding], CHGME is not an entitlement program, but rather subject to annual appropriations from the Congress,” the authors write, adding that “this different funding mechanism results in less predictability in funding year-to-year, and an overall gap in funding levels which has persisted and increased over time.”
But this Section on Pediatric Trainees Feature is more than just policy analysis; Coughlin et al weave in their intimate experience of caring for patients to humanize the real-world impact of this policy.
The authors also provide strategies for advocating for the health of children served by hospitals dependent on CHGME funding. “As more pediatric beds at hospitals close nationally, CHGME funding is vital to ensure children’s hospitals are able to continue providing high-quality care to increasingly large volumes of patients,” the authors write. In other words, this is not merely a yesterday or a today problem, but increasingly, a tomorrow problem, too.
Trainees and senior clinicians alike interested in understanding the landscape of funding that supports childrens hospitals—or, increasingly, fails to do so—would be well-served to review this article in depth. The same is true for those interested in learning what an important role they can play in the advocacy sphere.