Nearly 4 million children live in U.S. counties without a pediatrician

ATLANTA, Ga. (InvestigateTV) - Hospitals across the United States have sharply reduced their capacity to care for children over the past two decades, leaving rural communities farther from pediatric hospital care and straining the remaining providers, a new national study found.

The study, led by Dr. Kenneth A. Michelson and published in Pediatrics, analyzed U.S. acute-care hospitals from 2003 to 2022 and found a dramatic shift toward facilities with minimal pediatric services.

Hospitals categorized as the lowest level of pediatric capability rose from 26.7% of hospitals in 2003 to 65.0% in 2022 — an adjusted increase of 137% — while higher-capability hospitals decreased substantially. The analysis, based on the Healthcare Cost and Utilization Project Kids’ Inpatient Database, covered a mean of 3,927 hospitals per year.

“What we found was that hospitals have become less capable of taking care of kids over time,” Michelson said.

The losses were greatest for moderate-intensity pediatric services that typically require an inpatient pediatric unit or pediatric surgical services. Between 2003 and 2022, the percentage of hospitals providing appendectomies for children fell 50.5%; pneumonia hospitalizations fell 42.3%; and asthma hospitalizations fell 41.1%, the study found. Overall, 17 of 24 measured capabilities were available at fewer hospitals in 2022 than in 2003.

“More than half of rural units actually closed over a 15-year period, which is amazing and huge,” Michelson said.

The decline has real-world consequences in Georgia, where InvestigateTV found that 63 of the state’s 159 counties — nearly 40 percent — have no practicing pediatrician.

In Hancock County, for example, resident Markisha Hawkins said she found no pediatricians when she searched online for care for her prematurely born sons. “It was scary because I got this preemie; not the regular preemie, they call them ‘micro-preemies,’” Hawkins said. “Anything can go wrong at any moment with those kids.”

Hawkins drives about 30 minutes to see Dr. Christy Mountain-Bonner, the only pediatrician in private practice in neighboring Washington County. Mountain-Bonner cares for roughly 4,000 children; some families travel nearly an hour to see her.

“It scares me because in those other counties, I know there are premature births and premature babies needing care,” Dr. Mountain-Bonner said. “Sometimes I find in rural communities, there are issues with transportation, and issues with finances to fund transportation.”

For families with children needing specialized or inpatient pediatric care, the closures and divestments mean longer travel times and more transfers to distant hospitals. The Pediatrics study notes regionalization of pediatric services — while concentrating specialized care in a smaller number of centers — can leave community hospitals without the capability to stabilize or treat children for a range of common conditions.

The study’s authors said the trend likely reflects several forces, including lower reimbursement for pediatric care; staffing shortages of pediatric-trained nurses and physicians; and declining pediatric inpatient volumes that reduce the incentive for hospitals to maintain pediatric services.

To address the shortage, Georgia offers medical students tuition reimbursement up to $150,000 if they work in rural, underserved communities for at least four years.

Local parents said the presence of a pediatrician can make the difference in outcomes for medically fragile children. After a long recovery, Hawkins’ sons are now healthy, and she praised the pediatrician who cared for them. “General practitioners are okay for general things, but if you have kids, you want somebody you can see about your kid,” she said. “Their bodies are different.”

The Pediatrics paper calls for policy responses that could include improving Medicaid reimbursement; strengthening pediatric readiness in community emergency departments; expanding teleconsultation; and considering programs to support pediatric services in rural hospitals.

The authors warn that the rapid loss of moderate-intensity pediatric services narrows the nation’s capacity to provide timely, local care for children across a range of conditions and complexity.