Dear Mr. Zients:
On behalf of organizations dedicated to improving the health and well-being of children and
adolescents, we write to you thank you for the Administration’s previous support for the Pediatric
Subspecialty Loan Repayment Program and ask for your continued support in the President’s Fiscal Year
2014 budget. The number of pediatric medical subspecialists, pediatric surgical specialists, and pediatric
mental health specialists today is inadequate to meet the growing health needs of America’s children.
We respectfully request that the Pediatric Subspecialty Loan Repayment Program, Section 775 of the
Public Health Service Act (42 U.S.C. 295f), be recognized as a critical priority and strongly urge the
Administration to request $5 million for the program in Fiscal Year 2014.
There is a not only a shortage but a significant disparity in the geographic distribution of pediatric
subspecialists trained to treat children with special health care needs, resulting in many children in
underserved rural and urban 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. Compounding the problem, fewer individuals are choosing careers in pediatric subspecialties and
pediatric mental health care, while the existing workforce continues to age. Financial concerns, such as
debt load, are a significant factor and a deterrent influencing career choice away from pediatric
subspecialty. According to a 2012 survey conducted by the Children’s Hospital Association,
appointments for certain pediatric subspecialty care far exceed the prevailing benchmark of a two-week
wait time in children’s hospitals. For example, according to survey respondents, the average time for a
developmental pediatric specialist is 14.5 weeks; 8.9 weeks for neurology; and 7.5 weeks for child and
adolescent psychiatry. Children’s hospitals also reported extended vacancies, 12 months or longer, for
certain pediatric subspecialist positions, which contribute to the difficulty of accessing pediatric
subspecialty care in a timely manner.
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