A Blank Stare and a Demand for Transformation: Tackling Pediatric Health Care Disparities

A blank stare was etched on the face of a 14-year-old boy who lay nearly motionless in a hospital bed, entirely oblivious to the frantic activity surrounding him. Once a remarkable student-athlete, an intracerebral hemorrhage unfairly stripped him of his vibrant spirit. This was my most pivotal encounter with a patient. I recognized him not as the student-athlete or the boy from neurosurgery, but as my youngest brother. With scarce access to pediatric health care, I observed my family grapple with the weighty choice of either transporting him two hours to a pediatric hospital or accepting the dangers of a local operation without pediatric expertise. Although we ultimately opted for the latter, this was a choice that no family should ever face in a moment of emergency.

Growing up in Lackawanna County, I experienced the challenges of a medically underserved community. My brother’s life-threatening injury was not a singular event but rather indicative of a broader systemic issue concerning pediatric care deficiencies in rural and underserved areas nationwide. This tragedy unfolded as I was completing my undergraduate studies at the University of Pennsylvania. Comparing the clinical environments of various hospitals in Philadelphia with my hometown revealed an almost tangible disparity. While Philadelphia grapples with many of its own health care struggles, world-class care is just minutes away. In Scranton, families must depend on the limited options for pediatric care, often hoping to avoid emergencies where essential care is over an hour distant.

Although my family’s turmoil is specific to Pennsylvania, geographic disparities in pediatric care are prevalent across the United States. A 2024 NASEM report on pediatric health care noted an 11.5 percent decline in applicants for pediatric residency programs and a general drop in applications for pediatric subspecialty fellowships. In rural settings, hospitals and health centers already operate on razor-thin financial margins, making it impractical to hire full-time specialists and surgical personnel. This is particularly concerning since nearly 20 percent of Americans reside in rural areas, but only 9 percent of physicians practice there. The implications of this are significant, as families are left to make seemingly unimaginable choices to endure long delays in care or relocate their lives to seek treatment further away, where lost time can result in adverse outcomes.

Multiple health care advocacy organizations, including the Children’s Hospital Association, have recommended redistributing the physician workforce to mitigate geographic shortages in pediatric care. Proposed strategies include broadening eligibility for loan repayments or forgiveness, enhancing financial assistance for pediatric specialty residency programs, and offering stronger incentives for rural practice. Developing robust programs throughout Pennsylvania, particularly in collaboration with professional organizations, is crucial for ensuring equity and adequate health care for children and their families, no matter their zip code.

Redistribution of the physician workforce is a feasible, realistic goal. Historically, the National Health Service Corps provided loan repayment programs for primary care clinicians who chose to serve underserved communities. This is especially crucial given the significant salary discrepancies between pediatricians and those trained in adult medicine. Moreover, substantial disparities exist in payment reimbursement rates for pediatric services between Medicare and Medicaid. Implementing a similar approach to target pediatric subspecialists could further reform care in these regions. Research has highlighted the importance of geographic exposure in medical education, with physicians being more inclined to practice in underserved locations when trained there.

Without intervention, these statistics remain merely numbers in reports. Politicians and leaders at local, state, and federal levels must act. It is vital for legislators to invest in children’s health and channel more funding toward pediatric subspecialist compensation, thereby narrowing the income gap. Additionally, national reforms should aim to achieve at least parity between Medicare and Medicaid payment rates. Change requires collective effort. As a profession, every member of the health care team should recognize workforce redistribution as essential for medical justice and advocate for addressing the structural inequities in pediatric subspecialist compensation and service reimbursement.

Caregivers should not have to make the preventable choice my parents faced regarding their child’s health outcomes during a crisis. Children in underserved communities deserve equal quality of care as those in urban health care centers. Immediate change is essential: a child’s zip code should not dictate their clinical results.

James Bianchi is a medical student.