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