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For some sick children, delays in care dim hope

Children’s hospitals nationwide struggle to address shortage of pediatricians.

Demand for local pediatric services has doubled

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By Ben Sutherly, Staff Writer Updated 12:32 AM Tuesday, March 2, 2010

A December survey of children’s hospitals nationwide laid bare what many in the pediatric community have known for years: access to care for children with complicated medical conditions often is delayed by high demand and a shortage of pediatric specialists.

Such delays can mean less hopeful outcomes for sick kids, said Lawrence McAndrews, president and CEO of the National Association of Children’s Hospitals and Related Institutions.

Among 44 children’s hospitals surveyed nationwide:

68 percent have difficulty scheduling endocrinology visits, with an average wait time of more than 10 weeks;

61 percent have difficulty scheduling neurology visits, with an average wait time of 9 weeks;

50 percent have difficulty scheduling developmental pediatrics visits, with an average wait time of more than 13 weeks.

Many factors have contributed to the shortage.

Medicaid, the government program that funds health care for the poor, probably is the largest payer for children’s health care services, said Jim Kaufman, vice president of public policy for the National Association of Children’s Hospitals. Yet reimbursement to pediatric specialists through Medicaid is about 30 percent of what adult specialists are reimbursed through Medicare, the government program that funds health care for senior citizens.

In Ohio, the gap is more than 40 percent, according to the Ohio Children’s Hospital Association.

At the same time, pediatric specialists in some instances train two to three years longer than do doctors who specialize in the same areas but who care for adults, Kaufman said.

“You’re creating some real economic disincentives for physicians to enter that field,” Kaufman said.

While direct comparisons are difficult, wait times also can be significant for those waiting to see adult specialists.

The average wait time nationwide ranges from 15.5 days for cardiologists to 27.5 days for obstetrician-gynecologists, according to Merritt Hawkins & Associates, a national health care search and consulting firm specializing in the recruitment of physicians.

Locally, the need for adult specialists is greatest in the areas of urology, radiology, the emergency department, critical care and cardiology, said Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association.

The lack of a university hospital puts the region at a competitive disadvantage in recruiting adult specialists and subspecialists because many of those professionals also want to do research, which typically happens in a university hospital setting, Bucklew said.

The difficulty filling specialist vacancies at children’s hospitals is not new. In the early 1990s, amid a push to develop more primary-care physicians, interest to pursue specialties dropped off considerably among graduates of medical training programs in general pediatrics, said Dr. Arthur Pickoff, chair of the pediatrics department at the Children’s Medical Center of Dayton.

Societal trends have compounded the shortage, McAndrews said. While there has been an increase in the number of women entering pediatrics, for example, women enter subspecialties less frequently than men, he said. Women also have sought out shorter hours, he said, likely in response to to the child-bearing and child-rearing expectations placed on them by society, he said.

Shifts in attitudes toward work-life balance have contributed to bottlenecks in access to pediatric specialty care, McAndrews said.

The result is longer wait times. While no Ohioan lives more than two hours from one of the state’s six children’s hospitals, many find the wait for even consultations “exorbitant,” said Nick Lashutka, president of the Ohio Children’s Hospital Association.

“It’s often weeks to months, depending on what the specialty is,” he said.

Dayton Children’s has tried to address the shortage by enhancing recruitment efforts. The hospital has offered its current resident group the opportunity to specialize in gastroenterology or neurology at hospitals with accredited training programs in those areas at Dayton Children’s expense, then return to the hospital.

So far, there have been no takers, Pickoff said.

The hospital has had more success in other areas, such as endocrinology, sleep medicine, pulmonology and critical care, according to Pickoff.

“Endocrinology is one of those specialties where nationally a significant shortage is seen,” Pickoff wrote.

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