Investing in the Pediatric Workforce with the CHGME Program

It’s no secret doctors require advanced education. Between medical school, residency, and fellowships, a doctor may spend up to 14 years learning how to care for a specific type of patient or illness.

When it comes to pediatrics, the needs are even more specific. That’s why pediatricians and pediatric specialists often train at children’s hospitals where they learn to care for kids with acute, chronic, or complex conditions.

Unlike adult doctors, they need to learn to use special-sized equipment for each stage of a child’s development, including tiny tubing for premature infants and child-appropriate medications and dosing for children of varying ages and sizes. They also need to know how to help patients’ family members, including parents and siblings, who may need emotional support.

Funding pediatric continuing medical education

Adult-focused teaching hospitals receive support through Medicare, which pays hospitals to train residents and fellows in approved training programs.

Medicare Graduate Medical Education (GME) funds hospitals based on factors like the number of medical residents training in Medicare-recognized disciplines and the hospital’s Medicare inpatient volume.

Very few children have Medicare. Instead, 95% of children are insured by Medicaid, the Children’s Health Insurance Program (CHIP) or private insurance. That means children's hospitals receive very little, if any Medicare graduate medical education funding.

Congress created the Children’s Hospitals Graduate Medical Education (CHGME) program in 1999 to help pediatric teaching hospitals train the next generation of pediatricians and pediatric specialists.

What is CHGME?

CHGME is the only federal pediatric physician training program specifically for children’s hospitals. Fifty-nine children’s hospitals – or 1% of American hospitals – receive CHGME funding.

These 59 hospitals have similar characteristics:

• They primarily serve children under 18.
• They host accredited pediatric training programs.
• They deliver nearly one-third of inpatient care for children on Medicaid.

Who trains at CHGME hospitals?

In the academic year 2023-2024, 16,374 residents and fellows trained at CHGME hospitals. These hubs for pediatric education train many health care professionals, including:

• Pediatricians.
• Pediatric subspecialists, such as pediatric oncologists and child and adolescent psychiatrists.
• Pediatric dentists.
• Pediatric podiatrists.
• Child and adolescent psychiatrists.
• Family medicine and adult providers, including providers in the military, for their pediatric rotations.

CHGME hospitals train most doctors working in highly complex pediatric medical subspecialties. In the academic year 2022-2023, more than 90% of some pediatric subspecialists received their training at a CHGME hospital. For instance, 95% of pediatric pathologists and 93% of pediatric cardiac anesthesiologists trained at CHGME hospitals.

Even children who live in the 21 states without a CHGME hospital depend on the pediatric subspecialists who train at a CHGME hospital. For example, there’s a three out of four chance that pediatric providers in those states who specialize in congenital cardiac surgery, pediatric orthopedics, pediatric sports medicine, and other pediatric specialties trained at a CHGME hospital.

These hospitals have a large impact across the health care landscape, training both civilian and military providers, serving many rural communities.

How the CHGME program is funded

The CHGME program is administered by the Bureau of Health Workforce within the Health Resources and Services Administration.

Despite its importance to the future of the pediatric workforce, CHGME accounts for just 1.7% of federal spending on GME. Additionally, per resident funding for CHGME is just 50% of the amount that Medicare pays for resident training at general acute care teaching hospitals.

CHGME is a discretionary grant program, meaning funding is capped at the same annual level and subject to annual appropriations and reauthorization every five years.

The future of CHGME

CHGME accounts for 80% of the increase in the number of pediatricians and pediatric specialists trained nationwide since its inception in 1999.

This increase is crucial since the number of children with complex medical conditions is growing at a faster rate than the overall child population. CHGME support allows children’s hospitals to develop training programs in highly specialized disciplines that target these children’s unique health needs.

As the demand for specialized pediatric care grows, the CHGME program remains a vital investment in the health of the nation's children. By supporting the hospitals that train pediatric providers, CHGME ensures children across the country have access to the compassionate, expert care they need — today and tomorrow.

Learn more about CHGME.