Pediatrics Isn’t Adult Care — And Workforce Policy Should Reflect That

Health care workforce shortages too often center on adult care. Across children’s hospitals and pediatric settings, we know the reality is different. Pediatrics operates under distinct clinical, financial, and workforce dynamics. Policies that fail to recognize those differences put children’s access to care at risk.

Workforce policies designed for adult systems miss the mark in pediatrics. The result is fewer providers and longer waits for children and families. This challenge is not hypothetical. It is happening now, in communities across the country.

To address the challenges, we have released a blueprint to help policymakers better understand the needs of the pediatric workforce and ways to bolster it.

Pediatric workforce challenges follow a different pattern

Workforce shortages are not one‑size‑fits‑all.

In adult care, shortages are concentrated in primary care. In pediatrics, the most acute gaps are among pediatric subspecialists, advanced practice nurses, home care nurses, respiratory therapists, pharmacists, mental health providers, and others who care for children with complex, chronic, and rare conditions.

A 2023 Children’s Hospital Association assessment of pediatric workforce vacancies and appointment wait times underscores the depth and persistence of these challenges. The assessment found significant vacancies across a number of critical pediatric specialties, with shortages in neurology, developmental‑behavioral pediatrics, child and adolescent psychiatry, and genetics largely unchanged from levels identified in 2017. Notably, three of the four specialties experiencing the most severe shortages were in pediatric neurological, behavioral, and mental health care — areas where timely access is often essential for long‑term health and well-being.

Families feel the impact directly. In some regions, children wait months to see a pediatric subspecialist. In others, families travel hours or cross state lines to access care. These delays can mean postponed diagnoses, interrupted treatment, and increased stress for children and caregivers alike.

Policies built around adult workforce trends fail to address where pediatric shortages are most severe and most consequential.

Medicaid underpins pediatric care — and strains the workforce

Any meaningful discussion of the pediatric workforce must start with Medicaid.

Nearly half of all children in the United States are covered by Medicaid or the Children’s Health Insurance Program (CHIP). As a result, Medicaid is the foundation of pediatric care and the workforce that delivers it. At the same time, chronic underfunding makes it one of the greatest challenges facing children’s hospitals.

More than half of children’s hospital patients are covered by Medicaid or CHIP, yet Medicaid payments cover less than 80% of the actual cost of care. That shortfall directly affects hospitals’ ability to recruit, train, and retain pediatric providers.

Children’s hospitals invest heavily in onboarding and training specialized pediatric staff. These expenses are rarely reimbursed. For example, onboarding a pediatric nurse can take three months or more and cost at least $45,000 due to specialized training, certification, and orientation requirements. When Medicaid does not cover the full cost of care, hospitals must absorb these expenses while operating on increasingly thin margins.

Low reimbursement also threatens the future pipeline. Lower earning potential, paired with significant educational debt, discourages many trainees from choosing pediatrics, particularly in rural and underserved communities.

Pediatric expertise requires targeted training investments

Pediatric care is not scaled-down adult medicine.

Pediatric providers are trained to care for patients across every stage of development, from premature infants to adolescents. They rely on child‑specific equipment, medications, and dosing, and they support families who often need education, guidance, and emotional support alongside clinical care.

This level of expertise requires intentional, sustained investment in pediatric training pathways.

The Children’s Hospitals Graduate Medical Education (CHGME) program plays a critical role. CHGME is the only federal program dedicated to training pediatric physicians at children’s hospitals. Since 1999, it has supported the majority of growth in pediatric specialties, with more than half of the nation’s pediatricians and pediatric subspecialists trained at CHGME‑affiliated hospitals.

Despite its impact, CHGME represents a small share of overall federal graduate medical education funding and has never been funded at a level that reflects the true cost of pediatric training. Without stronger investment, the pediatric workforce will continue to struggle to keep pace with growing demand.

Retaining pediatric providers means prioritizing safety and support

Building the pediatric workforce is only part of the equation. Keeping it strong is equally important.

Burnout and workplace violence are increasing concerns in pediatric settings. When providers leave, children’s hospitals face unique challenges because there are fewer trained pediatric clinicians available to replace them. Each departure places additional strain on remaining staff.

Protecting pediatric health care workers is essential to protecting children. Federal efforts such as the Save Healthcare Workers Act can help ensure hospitals remain safe environments for patients, families, and staff.

Building workforce policy that works for kids

A strong pediatric workforce does not happen by chance. It requires policies intentionally designed for pediatrics instead of policies adapted from adult care.

We have outlined that path in a 2026 workforce blueprint. Securing the Workforce That Cares for America’s Children identifies the policy priorities needed to strengthen recruitment, training, and retention across pediatric care. The blueprint calls for targeted investments in Medicaid, pediatric training programs such as CHGME, and strategies to support and protect the specialized workforce children depend on.

Policymakers have a roadmap. The next step is to act. We urge federal leaders to use this blueprint to guide workforce policy decisions and ensure children can access timely, specialized care today and for generations to come.