| INSURANCE COVERAGE REFORM | | | | DOCTOR DEFICIT |
| The never ending saga of health reform having an | | | | This rising demand is on top of the fact that |
| impact on all medical disciplines. Until it becomes | | | | hospitals report that jobs for the uppermost |
| unmistakable precisely what is being altered and | | | | Pediatric specialties are remaining vacant; reporting |
| how that will shape each party the market will be | | | | vacancies in pediatric-rehabilitation medicine, |
| constrained. Indecisiveness affects spending on | | | | hematology and oncology, and cardiology. For |
| expansion and hiring at all areas of health services. | | | | families, that often means waiting for months to |
| Some characteristics of the bill are trying to deal | | | | see a specialist and incurring severe travel and |
| with shortages in primary care. The Senate bill | | | | accommodation costs to find appropriate care. |
| contains a measure that would fund a | | | | DEMOGRAPHICS |
| loan-forgiveness program for pediatric | | | | An overbearing issue is the socioeconomic |
| sub-specialists, easing the financial burden of | | | | demographics of the US. The main bulk of the |
| medical-school costs. The federal Medicare | | | | populace in the US is the baby boom generation |
| program funds instructional programs for adult | | | | which is now reaching retirement age. The |
| medicine. Five years ago, Congress endorsed | | | | "boomers" cause several problems; 1) this means |
| funding for pediatric specialty training, but the | | | | the bulk of physicians are retiring just when they |
| funds must be re-approved every year. | | | | will be of the most value, 2) as we age we |
| Pediatric groups continue to press for to more | | | | require more health care services. Higher demand |
| funding for residents. The cost of pediatric | | | | for services will cause an even greater financial |
| residency is rising (see California!) and yet the | | | | pressure on the government through increased |
| earnings for primary care is not competetive with | | | | dependence on Medicare. Finally, a "good news |
| many other specializations. There may be a need | | | | bad news" is they may live longer then any |
| to get reimbursement for post-graduate | | | | generation before but this will further burden the |
| education or higher reimbursement for residents | | | | budget with burden on Social Security and |
| specializing in pediatrics, in the hope of encouraging | | | | Medicare. Even though the boomer problem does |
| more doctors-in-training to enter the field. | | | | not directly impact pediatrics, it does indirectly in |
| Specialization generally requires up to 3 years of | | | | that their increased want will mean higher salaries |
| training beyond a general pediatrics residency | | | | for those specialized fields that care for them and |
| programs and historically can pay salaries half or | | | | less for pediatrics. To further confuse the issue |
| less than the rate of adult specialty medicine. | | | | there is a mini baby boom going on now that will |
| BIGGER DEMAND | | | | directly increase demand for all pediatric |
| The demand for additional pediatric sub-specialists | | | | specialties. |
| is continuing to swell for the following reasons: | | | | ALTERNATIVES: |
| * More Educated parents requesting sub-specialists | | | | To cope with the dilemma, many hospitals are |
| for treatment | | | | turning to telemedicine : remote consultations |
| * Alarming obesity rates among children | | | | using two-way video systems-and mobile vans |
| * Fellowship programs not meeting the current | | | | that may drive hundreds of miles to set up |
| mini boom in number of children | | | | temporary care centers in under-served areas. |
| Many general pediatric residents are pursuing | | | | Hospitals are also more often resorting to adult |
| pediatric subspecialty training. The number of | | | | specialists instead of pediatricians to treat children, |
| subspecialization training opportunities has not | | | | though not all are willing to do so since their |
| adequately opened during this last decade. | | | | post-doctoral education is for adult physiology |
| GROWING NEED LEADS TO GROWING | | | | rather than childrens. |
| For a certain time now there have been guesses | | | | Even with the health reform at last signed into |
| of deficits of physicians of many specialties in the | | | | law its effect on our health care is not known. By |
| US. For pediatrics the issue seems to be with the | | | | 2014 their will be an increase in the enrollment into |
| subspecialties like pediatric neurology, | | | | health care insurance programs. This increase |
| gastroenterology, and developmental and | | | | when, combined with the long term aging of the |
| behavioral medicine and pediatric surgeons. As a | | | | people, should push demand for services and |
| result of this deficit, remuneration rates have | | | | consequently cost higher. However, no one yet |
| outpaced other medical specialties. The shortage is | | | | knows what will happen to repayment rates from |
| big enough that the remunerations for a few of | | | | Medicare and this new program. The question is |
| these sub specialties is nearing that of adult | | | | will there be rate a cut of repayment rates for |
| specialties for the for the first time ever. | | | | different specialties by Medicare and this new |
| According to the MGMA Physician Compensation | | | | program that may conversely become a |
| Surveys pediatric sub-specialists pay have risen to | | | | decreasing factor of the income of all specialties |
| a great extent and for one of the first times, | | | | including Pediatrics, its related specialties, and |
| pediatric surgeons in fact do earn more than their | | | | subspecialties. |
| adult surgeon counterparts. | | | | |