AES Sign-on Letter of Support for Reauthorization of the Pediatric Subspecialty Loan Repayment Program

February 1, 2019

Dear Chairmen Pallone and Alexander and Ranking Members Walden and Murray:

On behalf of organizations dedicated to improving the health and well-being of children and adolescents, we write to urge you to reauthorize the Pediatric Subspecialty Loan Repayment program (Section 775 of the Public Health Service Act) as part of the effort to reauthorize the Title VII health professions workforce programs. Support for pediatric subspecialists is a needed step toward curbing today’s demonstrated critical shortage of pediatric medical subspecialists, pediatric surgical specialists, and child and adolescent psychiatrists to help provide children with timely access to the vital health services they need.

Currently, there is not only a shortage but also a significant disparity in the geographic distribution of pediatric subspecialists trained to treat children in need of specialty care, resulting in many children in underserved areas not receiving timely or appropriate health care. Children and their families often face long waiting lists to see subspecialists or must travel long distances to find needed care. According to a recent survey conducted by the Children’s Hospital Association, appointment wait times for certain pediatric subspecialty care far exceed the prevailing benchmark of two-weeks in children’s hospitals. The survey showed that the average time for a pediatric genetics specialist is 20.8 weeks, 18.7 weeks for a developmental pediatric specialist, and 12.1 weeks for a pediatric pain management palliative care specialist, citing just a few examples.¹

Shortages threaten to become more severe as fewer medical students choose careers in pediatric mental health care and pediatric subspecialties. There are three primary economic disincentives that discourage medical students from pursuing careers in pediatric subspecialties: (1) additional training beyond their primary residency training of 2-3 years on average, (2) high loan debt due to longer training;² and (3) average Medicaid reimbursement that is 30 percent less than Medicare. In addition, the shortage of pediatric subspecialists is compounded both by an aging physician workforce, where the mean age of pediatric subspecialists exceeds 50 years,³ and by the growing number of children in the United States. In 2016, there were 73.6 million children in the United States under the age of 18. According to the Census Bureau, that number is expected to grow by approximately 5 million by 2050, increasing demand for pediatric health care services.⁴

Timely access to pediatric subspecialists is essential. Longer lag times between symptom onset and treatment may not only result in poorer outcomes but also in greater costs to patients and the health care system. Support for pediatric subspecialty loan repayment will help ameliorate shortages by providing a financial incentive for trainees to choose careers in pediatric subspecialties.

We understand that there is interest in advancing a reauthorization of the Title VII health professions workforce programs in the new Congress. Given the dire shortages of pediatric subspecialists, we urge you to take this opportunity to strengthen the pediatric workforce and improve access to specialized care for children by reauthorizing the pediatric subspecialty loan repayment program in any bill to reauthorize the Title VII programs. Thank you for your dedication to the health and well-being of children. We look forward to working with you to improve child access to pediatric subspecialists.

Sincerely,

1 Children’s Hospital Association. ”Pediatric Workforce Shortages Persist.” https://www.childrenshospitals.org/Issues-and-Advocacy/GraduateMedical-Education/Fact-Sheets/2018/Pediatric-Workforce-Shortages-Persist. January 19, 2018. Accessed January 4, 2019. 2Frintner MP, Mulvey HJ, Pletcher BA, Olson LM. "Pediatric Resident Debt and Career Intentions." Pediatrics. 2013. Rochlin JM, Simon HK. "Does Fellowship Pay: What is the Long-Term Financial Impact of Subspecialty Training in Pediatrics?" Pediatrics. 2011 Feb;127(2):254-60. 3 Werner RM, Polsky D. “Comparing the Supply of Pediatric Subspecialists and Child Neurologists.” Journal of Pediatrics. 2005 Jan; 146(1):20-5. 4 United States Census Bureau. 2017 National Population Projections Tables. “Table 2. Projected age and sex composition of the population.” https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. Accessed January 4, 2019.