What’s at Stake: The Workforce Caring for Kids

Every unfilled pediatric health care position represents more than a vacancy.

It’s a child waiting months for a diagnosis. A family traveling hundreds of miles for specialty care. Or a community losing access to critical pediatric services altogether.

Across the country, children’s hospitals are struggling to recruit and retain pediatric subspecialists, allied professionals, nurses, mental health providers, and other experts who care for children with serious, complex conditions. These shortages are making it harder for children and families to access the care they need.

The stakes couldn’t be higher. Inadequate reimbursement limits hospitals’ ability to recruit and retain specialized teams. Fewer medical residents are pursuing careers in pediatrics. Experienced professionals are leaving their careers due to pressures and burnout.

This is one of the biggest headwinds facing children’s hospitals today. And because children’s health care is different from adult care, the workforce caring for kids requires solutions designed for them.

Pediatric vs. adult workforce shortages

In adult health care, some of the largest workforce shortages are among primary care providers.

In pediatrics, the challenge looks different.

The most severe shortages aren’t in primary care. They’re more prevalent among physician subspecialists, respiratory therapists, mental health providers, and other highly trained providers who care for kids with complex needs.

Pediatric providers are trained to deliver compassionate, comprehensive, and developmentally appropriate care to children of all ages, stages of development, backgrounds, and needs. They also need to know how to help patients’ family members who may need emotional support.

In a pediatric workforce report, children’s hospitals reported vacancies of 12 months and longer for some pediatric physician subspecialties. On average, children were waiting close to 21 weeks for medical genetics appointments, 21 weeks for developmental-behavioral visits, and 14 weeks to see a pediatric neurologist.

Children’s hospitals also reported “severe or major” shortages of allied health professionals including respiratory therapists (64%), certified nursing assistants, medical assistants, and medical technicians (35%), imaging technicians (43%), and surgical technicians (29%).

Staffing shortages create additional pressures on remaining team members. When a pediatric neurologist, respiratory therapist, or child psychiatrist leaves, there are fewer trained pediatric professionals available to fill these roles.

This level of expertise takes years to develop and is difficult to replace, which is why pediatric workforce shortages threaten access to timely, high-quality care for kids and families nationwide.

The reimbursement connection

One of the least understood drivers of pediatric workforce shortages is reimbursement.

Nearly half of America’s children are covered by Medicaid, and, according to CHA data, more than half of children’s hospital patients rely on Medicaid or CHIP on average.

The program is vital to children’s health. However, chronic underpayment significantly contributes to staff shortages.

Medicaid reimbursement rates have historically lagged behind other payors and often do not cover the full cost of care. According to CHA data, on average, total Medicaid/CHIP payments cover less than 80% of children’s hospitals’ cost of providing care.

Low Medicaid reimbursement rates contribute to access challenges for children by making it harder for hospitals to recruit and retain the specialized workforce needed to provide pediatric care. Persistent underpayment limits resources available to support and grow the pediatric workforce, while lower reimbursement also contributes to lower physician earnings in pediatrics compared with many adult-focused specialties. According to pediatric workforce leaders, pediatricians earn substantially less over the course of their careers than physicians practicing adult medicine, despite having completed additional years of specialized training.

At the same time, children’s hospitals absorb much of the costs associated with training and onboarding new pediatric providers. For example, one hospital reported that onboarding a pediatric nurse takes at least three months and costs $45,000 or more.

These costs add to the financial strains children’s hospitals already experience due to Medicaid underpayments. That’s why workforce policy and payment policy cannot be separated.

A workforce moving in the wrong direction

Every March, Match Day offers a glimpse into the future physician workforce.

While children account for roughly 23% of the U.S. population, just 7.8% of residents initially matched into pediatric residency programs in 2026, down from 8.8% in 2021.

After Match Day, physicians spend years completing residency and fellowship training before they can practice independently in pediatric subspecialties. Between undergraduate education, medical school, residency, and fellowships, a doctor might spend up to 14 years learning how to care for a specific type of patient or illness.

Additionally, the low Medicaid payment rates discourage medical students and residents from entering pediatrics, particularly in underserved and rural areas.  Shortages in rural communities create additional barriers to care and require families to travel long distances to reach pediatric subspecialists.

And recruiting new clinicians is only part of the challenge.

Keeping experienced pediatric professionals is equally important.

Like many health care workers across the country, children’s hospitals have reported high rates of staff burnout, emotional distress, and workplace violence.

Delivering pediatric care is labor-intensive and can be emotionally challenging. According to an analysis, pediatric settings rank third among the most dangerous hospital environments for staff.

Children’s hospitals also depend on child life therapists, social workers, behavioral health professionals, and other psychosocial providers who help children understand diagnoses, cope with treatment, reduce anxiety, and continue development while receiving care. Many of these services are not reimbursed by current payment systems and create additional workforce pressures.

Invest in training

The Children’s Hospitals Graduate Medical Education (CHGME) program is the only federal program dedicated to training pediatricians and pediatric subspecialists in children’s hospitals. Since 1999, CHGME has accounted for 80% of the increase in pediatric subspecialists trained nationwide.

Despite this, there continues to be a significant shortage of pediatric subspecialists because of inequities between funding for training at children’s hospitals compared to adult-focused training programs. Every year, this gap gets larger because CHGME funding is dependent on the annual appropriations process and is not guaranteed to grow each year like the Medicare GME.

Robust support for CHGME would help ensure children have access to pediatricians and subspecialists in the future. Without sustained investment in CHGME, workforce shortages will continue to grow, and access to care will become increasingly difficult.

Protect what works for kids

Policymakers must recognize workforce solutions designed for adult health care often don’t work for pediatrics.

Children need providers and teams with specialized training to deliver developmentally appropriate care and support families through complex diagnoses and treatment.

Congress must advance policies that strengthen the pediatric workforce and recognize the distinct needs of children’s health care.

Investing in CHGME supports pediatric training and the physician pipeline. Protecting and strengthening Medicaid helps children’s hospitals recruit and retain specialized providers. Addressing workplace violence, burnout, and emotional distress helps keep experienced clinicians at the bedside.

Because when we protect the pediatric workforce, we protect every child’s chance to get the care they need, when they need it.

Explore CHA’s pediatric workforce blueprint to learn more about the unique challenges facing the pediatric workforce and a guide to federal policy solutions.