Pediatric specialists can't match demand
By Misti Crane
The Columbus Dispatch
Frustrated parents with sick children are waiting months for appointments with medical specialists. Others, seeking the best treatment for complicated illnesses, travel hours for care.
Leaders of the nation's pediatric hospitals say they're struggling with shortages and vacancies in many specialty areas.
Doctors who specialize in neurology, development and behavioral problems, diabetes, lung disease and intestinal disorders are in the highest demand, according to a survey of children's hospitals conducted late last year by the National Association of Children's Hospitals and Related Institutions.
And demand for some of those specialties is skyrocketing. Pediatric endocrinologists, in particular, could seemingly work around the clock and not catch up with the backlog of newly diagnosed diabetes cases. "I probably get two requests every month about a job opening whether I'm interested or not," said Dr. William Riley, director of the diabetes and endocrinology center at Akron Children's Hospital.
The hospital recently doubled the number of pediatric endocrinologists to four, and they have four nurse practitioners who care for established patients and help manage the influx of new ones. But a child who is not in a crisis still waits a month to see someone, Riley said.
Here in Columbus, Nationwide Children's Hospital is training more specialists and then trying to persuade the doctors to stay here, said Dr. John Mahan, a pediatric nephrologist and director of the pediatric residency and pediatric nephrology fellowship programs.
The hospital had eight subspecialty programs in 2000. Now, 42 programs are training 79 fellows. Training provides an additional benefit, he said: Established, talented specialists often like to work where they can help train up-and-comers.
Still, waiting times for patients can be long in certain specialties. "It can be weeks or two or three months. Families are not thrilled about that," Mahan said.
Others sometimes have to travel, especially if their children have rare disorders. Katie and Doug Leedy of Westerville went to Cincinnati to get surgery for their baby, Owen, to correct a problem that led to pervasive and potentially deadly seizures. He'd been treated with medications by doctors at Nationwide Children's, but when those treatments didn't work, the doctors here referred the family to Cincinnati Children's, where surgery was an option.
The Leedys spent a total of three weeks in Cincinnati in 2008 and 2009. Owen, who will be 3 in June, is doing well, and Mrs. Leedy said she is grateful for the care he had in Cincinnati.
Mahan said two neurologists, who play a key role in the procedure that Owen underwent, recently were recruited to Columbus, and the surgery is now available here.
In some ways, Ohio is faring well. The state is home to six children's hospitals, meaning most specialists are within a couple of hours' drive for everyone. But doctors in high demand and those who recruit them say the situation is far from ideal. They blame several factors: There are a limited number of pediatric residencies and fellowships, pediatric subspecialties require more training, and reimbursement for certain types of care is low.
Nick Lashutka, president of the Ohio Children's Hospital Association, would like more federal money for graduate medical education, and he'd like specialists who treat children on Medicaid to make the same kind of money as specialists who treat adult Medicare patients. "You have to really like this practice. It's actually very low-paying," said Riley, the endocrinologist from Akron Children's Hospital. "For diabetes, you're more of a counselor, a psychologist and a cheerleader."
Many experts would like to see more training slots open up throughout the country. Although medical-class sizes have increased in recent years, there hasn't been an effort to increase the federal dollars that support residencies and fellowships at children's hospitals, said Dr. Norman Christopher, chairman of pediatrics in Akron. Nurse practitioners are helping fill gaps in care at many hospitals, he said.
In addition to taxing the specialists, shortages can mean that doctors who also are working on clinical trials must give up some of their research time, said Mike Farrell, president of University Hospitals Rainbow Babies & Children's Hospital in Cleveland.
Both Farrell and Mahan said they'd like to see more efforts to help medical students repay loans. One example is a National Institutes of Health loan-repayment program that helps aspiring specialists.