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Peggy Troy
Peggy Troy

No fat, all muscle

Children's hospitals GME shouldn't be in sights of budget cutters


By Peggy Troy
Posted: June 6, 2011 - 12:01 am ET
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When President Barack Obama’s budget was rolled out, we heard much talk about the sacrifices that need to be made so our generation does not pass along to our children a painful, unsustainable deficit. We therefore see great irony in one particular provision in the administration’s budget that would burden the children of tomorrow in another profound way.

As part of the effort to rein in spending, the Obama administration proposed eliminating funding for a program that trains the nation’s future pediatricians and pediatric specialists. This cut threatens the healthcare of every child in the U.S. because it will inevitably erode the number of physicians trained to care for children today and for years to come.

Why does this program exist? Hospitals that train physicians to care for adults receive federal support through Medicare. Because children’s teaching hospitals treat children, not seniors, they receive virtually no support through Medicare. Recognizing this unintended inequity, Congress established the Children’s Hospitals Graduate Medical Education Payment Program more than 10 years ago.

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Training pediatricians and pediatric specialists matters. Congress rightly recognized when they enacted CHGME that treating children is vastly different than treating adults. Children are not just small adults, and providing the care they need is not simply a matter of providing kid-sized equipment or scaling down medication doses.

Ask any cardiac surgeon about the complexities of operating on a child’s heart that is the size of a thumb and you will hear that specialized pediatric training makes all the difference to the outcome for that child.

The CHGME program has demonstrated tremendous success. Before it was enacted, the number of residents being trained to treat children had started to dwindle, declining 13% in the 1990s.

CHGME turned the tide, increasing training in children’s teaching hospitals by 35%. Annually, the program supports the training of 5,400 pediatricians and pediatric specialists.

Children’s Hospital of Wisconsin has a three-year pediatric residency program and a two-year pediatric dental program. In 2009, 97 residents completed the three-year pediatric program, and 13 completed the two-year dental program. That same year, more than 75 family practice residents rotated through the hospital, as required by the pediatric training component of their program. Sixty percent of the residents who receive training at Children’s Hospital remain in Wisconsin to care for children, providing primary, specialty and emergency care to infants, children and adolescents.

With this number being trained, CHGME has helped stave off a full-blown crisis in the supply of pediatricians and pediatric specialists. While our country faces regional shortages of pediatricians, demand for specialty care still outstrips supply.

In 2010, the National Association of Children’s Hospitals and Related Institutions reported a national shortage among such pediatric specialties as neurology and developmental behavioral pediatrics.

The impact of the shortage is well-known to many families who have already sought care for children who need evaluations for attention deficit disorder or autism, for example. A wait time of more than three months is too long for any child in need to wait.

Without CHGME, the shortage crisis will only intensify, care will be delayed, and wait times will increase.

Few people can fathom a time when we won’t have enough pediatricians and pediatric specialists to care for our kids. Most figure that surely another program or effort will be able to protect the workforce that cares for children.

Don’t be so sure.

There is great peril in eliminating the very program that has helped boost the number of providers, both primary care and specialists, available to provide much-needed medical care for children. Even though free-standing children’s teaching hospitals represent just 1% of all hospitals, they train more than 40% of general pediatricians, 43% of all pediatric specialists and the majority of pediatric researchers.

More than 60% of all pediatric emergency physicians and all pediatric surgeons are trained in children’s teaching hospitals receiving CHGME support. In fiscal 2008, children’s hospitals and their affiliated pediatric departments conducted 20% of all National Institutes of Health-sponsored pediatric research.

CHGME is a program that is working. It is accomplishing exactly what it was designed to accomplish, has not created unintended consequences and, unlike many programs facing elimination, it’s not redundant with existing programs. If CHGME goes away, we will still care for our children, but we will see an increase in the already long wait times that parents face in gaining access to care for their children.

There are truly difficult fiscal choices to be made right now, and there are many worthy programs on the chopping block. The return on investment in CHGME has been great. It isn’t fair to ask children, who are 24% of the nation’s population, to sacrifice for the sake of a federal budget that only devotes 10% of its outlays to their needs.

Surely there are better ways to tighten the nation’s fiscal belt.

Peggy Troy is president and CEO of Children’s Hospital of Wisconsin, Milwaukee.



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