Funding for pediatric residencies remains in doubt

Reduction or elimination of federal money for the Children's Hospitals Graduate Medical Education program would mean fewer pediatricians and subspecialists.

By Carolyne Krupa — Posted July 11, 2011

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The future of pediatric graduate medical education remains unclear after major cuts in federal funding for the 2011 fiscal year and President Obama's proposed elimination of funding for next year.

The Children's Hospitals Graduate Medical Education Payment Program helps the nation's 56 freestanding children's hospitals train more than 40% of the nation's general pediatricians and 43% of pediatric specialists. This year, the program was hit with a $48.5 million budget cut -- the equivalent of 450 pediatric residency slots -- bringing funding to $268.4 million for the fiscal year ending Sept. 30, according to the National Assn. of Children's Hospitals.

Loss of funding is particularly harmful when the nation is gearing up to expand coverage to an estimated 32 million Americans through the health system reform law, said Jim Kaufman, NACH vice president of public policy.

"It would create a serious crisis in health care," he said. "This really impacts children's health care in general."

Congress is considering two bills in the House and Senate to reauthorize CHGME funding at $330 million annually through 2016. Both bills were in committee at this article's deadline.

Disparities in funding

Threats of budget cuts are nothing new to CHGME. While graduate medical education for adult specialties is funded through Medicare, pediatric GME funding is appropriated each year, said Christiane Mitchell, director of federal affairs at the Assn. of American Medical Colleges.

"So they have to secure the funding on an annual basis, which is highly problematic," she said.

Though the program has been successful in getting bipartisan support to renew funding in the past, this year is more challenging because of the economy, said William Considine, president and CEO of Akron Children's Hospital in Ohio. "It seems more of an uphill fight this time," he said.

The CHGME program was created in 1999 in response to disparities in federal funding for adult GME versus pediatric GME and a decline in young physicians choosing pediatrics and pediatric subspecialties.

Those disparities persist today, with CHGME residency slots funded at 70% of adult residency slot funding levels, Kaufman said.

CHGME has enabled Akron Children's Hospital to double the number of residents it trains during the past decade to 54, Considine said. The program typically provides about $4 million of the hospital's $14 million annual medical education budget. That funding was cut about 20% this fiscal year.

Uncertainty about funding creates a dilemma for hospitals because they can't guarantee they will have the money to support positions for the three to six years a resident trains, Mitchell said.

"It will be very difficult for children's hospitals to find alternative funding for those programs and, as a result, you will see fewer pediatric subspecialists," she said.

Physician shortages in some areas already mean families have to wait up to 10 weeks to see a specialist, such as a pediatric neurologist, Kaufman said.

"It's difficult to tell a parent that we think something's wrong with your kid, but you have to wait 10 weeks to find out," he said. "And with the cuts, the shortages will get even worse, so those wait times will get worse and worse. That's not a good standard of care."

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