Children’s Hospital Association CEO Matt Cook on shortages in pediatrics

Medicaid is the largest insurer of children’s health care in America, and Matt Cook says that’s a factor in shortages of physicians and longer waits for families to get care.

Cook, the CEO of the Children’s Hospital Association, says Medicaid doesn’t cover the full cost of care for pediatric hospitals. He says that’s one of a number of challenges leading to shortages in pediatric care, especially certain specialties where families often wait months for appointments.

In a conversation with Chief Healthcare Executive®, he talks about the shortages of physicians, the impact on patients, and steps that could alleviate the shortage of physicians.

Here are some excerpts from our conversation.

Q: Obviously, we need more clinicians. We need more physicians. How do we get there? What are the federal policies that need to change to get more physicians working in pediatrics?

A: “First, it is a complicated issue, and it's multi-factorial, and we didn't get here overnight. And so to think that we're going to figure out a way to get out of this sort of situation in the near future is also unlikely to happen.

“But in terms of Medicaid, for example, Medicaid is a really low reimburser for healthcare services, and the downstream impact that that has is not just on the hospital's financials. But it does also impact the compensation for physicians.

“When you have lower compensation, and in some cases, remember, we have pediatric specialists that train longer than their adult counterparts and then make less money. So from a rational argument perspective, that's kind of tough to entice people into a field where they're going to train longer and make less money. But having said that, I mean the low reimbursement of the Medicaid program is one issue.”

“The Children's Hospital Graduate Medical Education Program is an issue that you and I have talked about in the past. It came into being in 1999. Since it came into being, you know, over 80% of the increase in pediatric specialists can be tied to that program. But at the same time, compared to the Medicare GME program, it's highly underfunded.

“We used to think that the CHGME program, per capita, so per trainee paid out … hospitals received about 50% of the funding as compared to the Medicare GME program. We actually know from more recent analysis that the number is 38%. And so it puts this incredible burden on children's hospitals to bear the financial brunt of training the workforce of the future. And that's just not sustainable.”

Q: How do you navigate this environment when it's not probably realistic to expect substantial increases from the federal government?

A: “In the current year, there is a very modest bump in CHGME funding. It doesn't keep pace with inflation, which has been part of the problem. It's underfunded, and typically the increases don't match inflation. So, you know, that's one thing that Congress really needs to do, is appropriate more money to the CHGME program, so that hospitals can actually afford to train pediatricians and train them in larger numbers, which in today's world is really not the case.”

Q: Even if it's not immediate, in terms of preparing more folks to get into the workforce, for pediatrics, do we need more aggressive loan forgiveness programs, or loan programs to help people manage the costs of medical education?

A: “Yeah, I certainly do. I think the loan repayment programs are pretty important, and there are many programs where they really don't apply to pediatricians because, either one, they're more adult-oriented, or two, because our children's hospitals tend to be in more urban environments. Even though they serve large geographic areas, including rural areas, they're often not eligible for the loan repayment programs.

“So I think Congress needs to go back and take a look at those and say, ‘Gee, if we have this kind of a workforce shortage, what are all the levers that we can pull in order to help solve that?’ And the loan repayment is certainly one of those that, to date, has not been all that effective, because of the limitations on it, even though the need for it is is most certainly there.”