Pediatrics
“I’ve been telling them, my group, that I’m going to retire for over a year. They haven’t found a replacement for me.”
Yet, it is still difficult to replace pediatric specialties when they leave, said Dr. Jamil Khan, the president of Children’s Specialty Group and medical director of the neonatal intensive care unit at Children’s Hospital of The King’s Daughters and associate pediatrics professor at Eastern Virginia Medical School.
“We are producing more doctors, what we are not producing in the same degree of magnitude, is residency positions really for all doctors including pediatrics,” he said.
The growth of telehealth services can help in certain situations, but is not a silver bullet.
“That may help us a little bit but if you’re going to be short hundreds and hundreds of some specialty, it really is a problem,” Khan said.
Dr. Percita Ellis, a pediatrician in Lexington at Rockbridge Area Health Center, agreed with the value of telehealth, especially in rural areas, and that the shortage is more dire in certain specialties.
“For instance, pediatric endocrinology, there’s a shortage; pediatric rheumatology, pediatric neurology, pediatric cardiology, really a lot of them,” Ellis said. “For my patient clientele, because we are 47 minutes from Roanoke, 60 minutes from (the University of Virginia Medical Center), my patients, when it comes to subspecialists have to travel at least that far either way. Sometimes we actually have to send them to Richmond for pediatric neurology because there is such a shortage,” Ellis said.
The shortage for child and adolescent psychiatrists and pediatric developmental behavioral specialists is also critical now, Ellis said. There were large increases of students from all races that reported feeling sad or hopeless in 2021 compared to 2011, such as more than 10% of female students having attempted to commit suicide in the past year, according to the most recent Youth Risk Behavior Study released by the Centers for Disease Control and Prevention in
February.
“There’s an increased demand for mental health services while there’s still a decrease in those that are able to provide the services,” Ellis said.
The shortage of pediatric subspecialists by geographic area improved between 2003 and 2019 and yet more needed to be done, according to a 2020 JAMA Pediatrics Investigation.
Grants and other programs that help pediatricians better recognize behavioral symptoms have helped offset the shortage of specialists, according to Ellis.
Virginia is better off than the nation as a whole, with the average family having to travel 16.7 miles to get developmental-behavioral pediatric specialty care compared to the national average of 26.7 miles, according to data from the American Board of Pediatrics. The greatest estimated distance is just over 100 miles for a Virginia family seeking
Dr. Marta Satin-Smith, pediatric endocrinologist at Children’s Hospital of The King’s Daughters clinic
that kind of care.
Another issue facing pediatric specialties is passing pediatric patients to new adult-focused providers, not only because of scheduling, but also because of a potential new provider not taking the patient’s insurance, according to Satin-Smith. Slightly more than half the kids treated at CHKD have government or government supported insurance, often through managed care, according to Khan.
“Pediatricians are not in general compensated for doing about the same thing, as well as adults (providers for adult patients) are,” Khan said.
Dr. Marc Tsou, a Chesapeake pediatric gastroenterologist, retired from seeing patients at CHKD after 30 years in December. Tsou said he can’t point to one thing that made him want to be a doctor but was certain he wanted to help children get healthy once he decided on his career.
He still is a CHKD physician liaison and an associate professor at EVMS.
Tsou said teenagers who aspire to be doctors are astounded to discover how much longer they will have to attend school.
“They almost fall on the floor when I tell them they will spend an equal number of years or more before you get to really practice as a physician,” Khan said.
“That’s such a commitment in terms of time, lifestyle and unfortunately the financial situation — the debt,” Tsou said.
A lot has changed in the health care sector over the years, including the rise of many new types of specialties and career paths, according to Tsou and Khan. This includes appealing alternate health careers, such as physician assistants, various technicians and newer paths such as hospitalists.
Larger institutions like CHKD also serve as magnets for specialties — because of the chance to learn from experienced specialists and other advantages that come with larger staffs, such as having to be on call less frequently, the doctors said.
There was only one senior pediatric gastroenterologist who Tsou had the chance to learn from and work under when he came to CHKD. Like Tsou, when Satin-Smith came to CHKD, she was one of a team of two at CHKD for several years.
“There are five pediatric endocrine practices in the state of Virginia and they’re at the major medical centers,” Satin-Smith said.
As a result, Satin-Smith and fellow CHKD pediatric endocrinologists treated patients from a large area, from the Eastern Shore, where Pruitt is from, down to North Carolina, west to Franklin and north to Williamsburg.
Pruitt isn’t sure she’ll have the same relationship with any new specialist after seeing Satin-Smith for the last time.
“It’s going to be a big change but it’s time for her to enjoy her retirement,” Pruitt said.
Ian Munro, 757-447-4097, ian.munro @virginiamedia.com