Dear Chairman Alexander, Chairman Upton, Ranking Member Murray and Ranking Member Pallone:
On behalf of the undersigned organizations dedicated to ensuring a strong national pediatric workforce,
we write in support of Section 722 of the Helping Families in Mental Health Crisis Act (H.R. 2646),
which reauthorizes the Pediatric Subspecialty Loan Repayment Program (PSLRP) and urge this
language be included in any final mental health conference package.
Currently, there is not only a shortage but also a significant disparity in the geographic distribution of
pediatric subspecialists trained to treat children in need of specialty care, resulting in many children in
underserved 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. According to a
recent survey conducted by the Children’s Hospital Association, appointment wait times for certain
pediatric subspecialty care far exceed the prevailing benchmark of two-weeks in children’s hospitals.
The survey showed that 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, citing just a few examples.
Shortages threaten to become more severe as fewer medical students choose careers in pediatric
mental health care and pediatric subspecialties. There are three primary economic disincentives that
discourage medical students from pursuing careers in pediatric subspecialties: (1) additional training
beyond their primary residency training of 2-3 years on average, (2) high loan debt due to longer
training; and (3) average Medicaid reimbursement that is 30 percent less than Medicare. In addition,
the shortage of pediatric subspecialists is compounded both by an aging physician workforce, where the
mean age of pediatric subspecialists exceeds 50 years, and by the growing number of children in the
United States. In 2011, there were 73.9 million children in the United States, 1.5 million more than in
2000. This number is expected to grow to 101.6 million by 2050, increasing demand for pediatric health
care services.
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