Dear Representative Schakowsky and Ranking Member Burgess:
On behalf of organizations dedicated to improving the health and well-being of children and
adolescents, we write in support of Section 4 of your legislation, the EMPOWER for Health Act of
2019 (H.R. 2781), which would reauthorize the Pediatric Subspecialty Loan Repayment Program.
Support for pediatric subspecialists is a needed step toward curbing today’s demonstrated critical
shortage of pediatric medical subspecialists, pediatric surgical specialists, and child and adolescent
psychiatrists to help provide children with timely access to the vital health services they need. We
appreciate your commitment to ensuring a robust and well-trained health care workforce to care
for America’s children.
Currently, there is not only a shortage but also a significant disparity in the geographic distribution
of pediatric subspecialists trained to treat children in need of specialty care, resulting in many
children in underserved areas not receiving timely or appropriate health care. Children and their
families often face long waiting lists to see subspecialists or must travel long distances to find
needed care. According to a recent survey conducted by the Children’s Hospital Association,
appointment wait times for certain pediatric subspecialty care far exceed the prevailing benchmark
of two-weeks in children’s hospitals. The survey showed that the average time for a pediatric
genetics specialist is 20.8 weeks, 18.7 weeks for a developmental pediatric specialist, and 12.1
weeks for a pediatric pain management palliative care specialist, citing just a few examples.
Shortages threaten to become more severe as fewer medical students choose careers in pediatric
mental health care and pediatric subspecialties. There are three primary economic disincentives
that discourage medical students from pursuing careers in pediatric subspecialties: (1) additional
training beyond their primary residency training of 2-3 years on average, (2) high loan debt due to
longer training;1 and (3) average Medicaid reimbursement that is 30 percent less than Medicare. In
addition, the shortage of pediatric subspecialists is compounded both by an aging physician
workforce, where the mean age of pediatric subspecialists exceeds 50 years,2 and by the growing
number of children in the United States. In 2011, there were 73.9 million children in the United
States, 1.5 million more than in 2000. This number is expected to grow to 101.6 million by 2050,
increasing demand for pediatric health care services.
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