Caring for children goes beyond the everyday checkups and preventative care that primary care physicians and family nurse practitioners can offer. Chronic illness, exceptional diseases, genetic disorders, acute care needs and more are all part of pediatrics, and yet there is a growing shortage of pediatric physicians.
The good news is that doctorate-holding advance practice registered nurses can also take up the helm and will be instrumental in helping offset the critical shortage of pediatricians that has left many without access to their essential care.
The Dire Situation of Pediatrics
While there are a few states that have a relatively healthy ratio of pediatricians to children, most states are facing dire shortages – only made worse due to the discrepancies between rural and urban areas.
In Massachusetts, for example, there are around 600 children per pediatrician, which is the best ratio in the entire country according to the American Board of Pediatrics. In Idaho, the state with the worst ratio, there are 2,200 children for every pediatrician.
It is estimated that over one million children in the United States do not have access to a pediatrician. These children are primarily found in lower-income households and also in rural areas.
Nurse Practitioners have been used consistently to offset the lack of primary care physicians, but of FNPs there are reported to be less than 25% who specialize in pediatric care. Of the NPs who are certified in pediatrics, only 8% are qualified to provide acute care. Not only are more pediatricians necessary, but more NPs that specialize in both pediatrics and in acute care pediatrics are going to be essential to resolving this shortage and giving every child better access to the care they deserve.
In Ohio, wait times for pediatric specialists are ten times longer than other specialist waiting times. If a family needs to see a pediatrician that specializes in developmental disorders and care, it could take around 5 months.
The issue surrounding the lack of pediatricians (both physicians and nurses) is not only down to wait times. Those that require specialist or simple pediatric care may need to travel long distances. In Ohio, the average family will drive around 50 miles to see around 15 different child-health specialists.
Why the Lack of Pediatricians
The why boils down to cost, and to the employers. To become a pediatrician additional training is necessary. For physicians, this is an additional three years of training. For nurse practitioners it will mean needing to go from a BSN or MSN to a DNP.
The good news for nurses in particular is that there are fairly direct routes into the role. A BSN holding RN nurse, for example, could enroll in a pediatric nurse practitioner program. These pediatric nurse practitioner programs offer two paths forward; the first is as a direct BSN to DNP route that takes three years total to complete on average, and the second is a post-graduate certificate that will train up an MSN holding APRN and allow them to specialize while earning their DNP.
Acute care training is also essential, and yet many pediatric nurses will not be trained in acute care, often because of the additional time and cost. To become double-certified in pediatrics and in acute care they will need to take on an additional 600 hours of training. Double-training, however, is by far the best way to provide even greater quality of care to children, particularly in life-saving situations.
The good news is that the government has taken notice. In 2010 a program was created to help ease the financial burden of doctors taking on that additional specialization, though it was only in the last year that the House of Representatives have passed a bill to provide $25 million in funding to get that program off its feet. It still needs to go through the Senate, but it is looking positive.
As always, however, it will be the APRNs who truly come to save the day. APRNs have become increasingly critical, and their roles have subsequently expanded massively to offset physician shortages and to provide better quality care throughout healthcare. Doctorate-holding nurses in particularly are very highly trained and have autonomy to practice independently in many states throughout the country.
Though increasing the number of pediatric physicians is a must, particularly if they hold even further specializations, for example in developmental disorders or in children’s mental health, it is nurses who can and will provide the bulk of care.
Regardless of which route you take into pediatrics; the fact remains the same. You will be providing essential care to the most vulnerable and innocent among us.
Routes Into Pediatrics
When it comes to pediatric care the most common and prestigious role is that of a pediatrician, but shortages are worsening. There are quite simply not enough doctors training to become pediatricians, and with an aging workforce the shortages are only set to expand as existing pediatricians begin to retire.
To become a pediatrician, you will need to first become a licensed doctor, and then go back and apply for a residency in pediatrics. This takes an additional three years and can greatly impact your overall lifetime income, but the good news is that there are greater options when it comes to funding your education.
The lack of physicians has always been stop-gapped by nurses, and it is once again APRNs who will provide that expert level of care to the widest number of children. Encouraging and offering similar financial support to get more nurses to double-certify in both pediatrics and in acute care.
Taking Advantage of the Shortage
Doing the best you can for yourself and your career in no way diminishes the work that you do, and can rather make it worthwhile to pursue that extra training and the additional requirements necessary to start working as a specialist for children and babies. From caring for premature babies to caring for children with illnesses, diseases, or disorders, the importance of the role of pediatrician (both physician and nurse) cannot be overstated enough.