An ongoing shortage of pediatric specialists in areas like neurology and pulmonology has meant long waits or long drives for specialized care. Experts warn that missing early treatment and prevention of diseases can mean more problems and higher costs down the road. John Yang speaks with Dr. Sallie Permar to learn more.
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John Yang: This year, the number of medical school graduates applying for residency programs set our record high, but the number of those choosing pediatrics went down. Already, there's a shortage of pediatric specialists in areas like neurology or pulmonology. That means long waits or long drives for specialized care. We asked you to tell us about your experiences.
Melissa Busse: Every year you have to take your child for health physical if they want to participate in sports and activities and things like that at school. And so what we started noticing was that we had to schedule that well child check earlier and earlier.
Tania Arias: The receptionist said, I just want to let you know there's a waiting list and it hasn't moved in a year. Considering that one of my children is special needs. There's things that I have to get going and me just having a wait that timeframe. It doesn't work out for me at all.
Merrill Curtis: We had an emergency happened with my daughter, it was January 2023. I found her having a full seizure in her sleep. We showed up at the emergency room minutes later, everything went according to plan exactly as you would want it to an emergency. The trouble came when we called the next morning when we got home to get that neurologist and we were told this was January we were told the next available appointment was in April.
Kimberly Tiedeken: My younger child has autism and cognitive delays. We needed a neuro psych evaluation that has an 18 month waitlist.
Melissa Busse: I called eight different practices, different providers, and they all say oh, we're not taking new patients. I finally got one on the ninth try and that would take new patients and the first available appointment was June 2025. Isn't that terrible you have to hope for somebody else to cancel an appointment to get your child the care that they need.
Kimberly Tiedeken: Some of the other options that they've given us were to drive, you know, an hour and a half to another town. But what that also means is that once you're in that doctor, every time you go to see them, you have to make that same drive.
Merrill Curtis: How did we get here? How did we get to the point where there isn't a neurosurgeon to see somebody that's been through the emergency room and is a candidate for surgery and surgery, that should happen sooner rather than later. She was able to get a neurologist. She did have successful brain surgery, but it sort of opened Pandora's box to ask questions.
Tania Arias: Maybe I can get a therapist, someone that is certified and just, you know, pay out of pocket until I'm able to actually get an appointment. But then you know, as a parent, that's another expense. So it's not the ideal situation, but I guess we're forced to think outside the box.
John Yang: The number of pediatric residents has been on a steady decline for the past 10 years or so. But this year's drop was much steeper. Dr. Sallie Permar is head of the Pediatrics Department at Weill Cornell Medicine, and the pediatrician in chief at New York Presbyterian Children's Hospital. Doctor, why this decline in pediatric residents, why are they doctors reluctant to go into that field? Dr. Sallie Permar, Head of Pediatrics, Weill Cornell Medicine: This is a really important issue that's facing a lot of American families and their children is access to a pediatrician is becoming harder. And in fact, pediatricians have to think about when they come out of medical school with significant debt is how they're going to think about the economics of both paying off that debt while setting up their practice. And it's been well established that pediatricians are paid at a lower level than that of adult doctors despite the same number of years of training and debt after medical school. And so that's really facing them when they make their decision.
John Yang: Explain that. Why are pediatricians paid at a lower level?Sallie Permar: So in pediatrics, children are generally supported by either commercial insurance, or government insurance, which is Medicaid. But Medicaid insurance pays at a lower level for doctors for reimbursement compared to Medicare in most states. And that leads to a lower level of reimbursement for pediatric services. And that translated into lower salaries.
John Yang: Obviously, there are short term consequences of not being able to see a doctor as quickly as possible. But are there long term consequences, health consequences?
Sallie Permar: Absolutely. Investment and health and well-being and prevention of disease, from the earliest times in life is going to pay off the most in the end. And so, treating early things like mental health disease, preventing obesity, getting vaccines to prevent those vaccine preventable illnesses that can impact you lifelong. Those are things that pediatricians do and do well. And so if we don't have access to those preventative care measures from early in life, we're going to all pay the price as a society later, in our adult population.
John Yang: Are there areas, either communities or specialty fields that are more affected by this than others?
Sallie Permar: There absolutely are. So there are areas of the country that have fewer, a pediatrician, there's some counties in many states that don't have a single pediatric provider and definitely don't have specialists. So those rural areas lead to families having to drive for longer, or even have to go without specialty care. And then high cost of living districts. Like I'm here in New York City, it is hard for us to convince those that are going into the pediatrics field to move to New York City and take on pediatric specialty care with the salaries that we have available. And then for specialties, it's the specialties that have the lowest ability to generate reimbursement that have traditionally had by national benchmarks, the lowest salaries, things that are really chronic, lifelong diseases that children need doctors for when they have those issues. Those are the specialties that we're having a hard time filling now for many years.
John Yang: What drew you to this field? And did you consider this question of the lower pay when you chose pediatrics?
Sallie Permar: I was really drawn into pediatrics because of that opportunity to prevent disease from the earliest points in life. I was really excited to go into pediatrics as a pediatric infectious disease doctor and actually one of the lowest paying medical specialties because of the opportunity to vaccinate to create new vaccines to prevent infectious diseases and really generate immunity that would last lifelong. Also children have charm. We know that. But what we're finding is that's not enough anymore to draw people into the field.
John Yang: Are there other things other than getting rid of the the lower Medicaid reimbursement rate that could help this?
Sallie Permar: Yeah, so the Center for Medicare Services also should reconsider how we value our services. We value a surgical procedure are much higher than that of a preventative care visit. They may take a similar amount of time, but we are funding them at a at a different level that that does not take advantage of the opportunity to prevent disease rather than treating it when it becomes severe.