Program Represents Most Significant Investment in Pediatric Workforce

Recently, the House Committee on Energy and Commerce met to consider advancing a bipartisan bill for children’s health — the Children’s Hospital GME Support Reauthorization Act of 2018, introduced by Reps. Gene Green (D-Texas) and Michael Burgess (R-Texas).

As one of two expert witnesses who testified at the committee hearing, I emphasized how its support for the Children’s Hospitals Graduate Medical Education program helps ensure access to pediatric care for children nationwide. Trained pediatricians and pediatric specialists are essential to helping all children reach their full health potential.

The CHGME program represents our nation’s most significant investment in strengthening the pediatric workforce, and the Children’s Hospital GME Support Reauthorization Act of 2018 would increase its authorization level by 10 percent, to $330 million annually. Congress created CHGME in 1999 with bipartisan support because children’s hospitals were effectively being left out of the federal GME system of support provided through Medicare, as children’s hospitals treat children, not the elderly.

Since then, dedicated CHGME funding has enabled children’s hospitals to dramatically increase training overall to 7,000 residents per year, and in particular grow the supply of pediatric specialists — the area of greatest shortage in children’s health care. Today, the 58 children’s hospitals that receive CHGME funding — which represent a mere 1 percent of all hospitals — train approximately half of the nation’s pediatricians — including 44 percent of all general pediatricians and 57 percent of all pediatric subspecialists.

This would be impossible without CHGME. Furthermore, there are no adequate substitutes for CHGME to support training at eligible children’s hospitals like my own – Texas Children’s Hospital in Houston, which utilizes CHGME to subsidize 25 percent of our training. Other potential sources of support, such as Medicaid GME or grant funding, are not available to many children’s hospitals and cannot support training on the scale necessary to meet current and future workforce needs.

Pediatric workforce shortages persist in large part because of these gaps in support, which occur most acutely among pediatric subspecialties, such as developmental pediatrics, child and adolescent psychiatry, and pediatric genetics and genomics. Many children’s hospitals struggle to fill vacancies for these types of providers, and in other areas, wait times can exceed two or three months. CHA survey data show, for example, average wait times of 18 weeks for developmental pediatrics and nearly 10 weeks for child and adolescent psychiatry. As we are all aware, access to mental health services is especially critical as studies reveal the increasing toll adverse events are taking on our children’s lives.

Thanks to CHGME, children’s hospitals developed training programs in highly specialized disciplines that target the unique needs of a growing population of kids – children with complex medical conditions. Examples include pediatric surgical oncology, radiation oncology, pediatric pathology and bone marrow transplantation. For some of these disciplines, only a small number of institutions provide this training.

The CHGME program is critical to protecting important gains in pediatric health. We must act to ensure all children have access to high-quality medical care. Reauthorizing the CHGME program is a big step toward helping children’s hospitals continue our work to better align the supply of pediatric providers to growing demand. It is my hope that Congress will recognize this when considering The Children’s Hospital GME Support Reauthorization Act of 2018.

Gordon E. Schutze, M.D., F.A.A.P., is the executive vice chairman of the Department of Pediatrics at the Baylor College of Medicine.

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