Brian Maranan Pineda
When Jaime Greathouse's family moved to the Detroit area two years ago, she knew that she'd eventually need to find a dermatologist for her sons. Since birth, 4-year-old Sam and 3-year-old Whit had suffered periodically from itchy bouts of eczema. Sure enough, shortly after they had settled into their new home in Shelby Township, Whit developed a bad rash, and his prescription for topical cream had expired. Greathouse phoned a pediatric dermatologist two miles away for an appointment, but he was booked solid for six weeks. "The rash probably wouldn't have lasted long if we'd started treating it right away, but by the time we had our appointment, Whit was bleeding in several places and covered in painful red bumps," she says. What's more, Sam had started breaking out too, so she brought both boys to the office visit, hoping to get two prescriptions. However, the doctor insisted that Sam couldn't be treated without his own appointment -- in six more weeks. Frustrated, Greathouse found another dermatologist an hour away who could see Sam in several days. When they arrived after battling traffic, the waiting room was packed. "I had to sit for an hour with the boys, whose nap schedules were disrupted because the whole trip took such a major chunk out of the day."
Welcome to the world of specialty care for kids. Whether your child needs to see a dermatologist, a gastroenterologist, or any other pediatrician who has had additional training in the unique aspects of children's health conditions, you're likely to face long waits, long drives, or both. Nationwide, there is a serious shortage of pediatric specialists -- officially known as subspecialists because pediatrics itself is a medical specialty -- and one recent national report concluded that the number of physicians practicing in every one of the 31 subspecialties for kids is hazardously low. "The ratio of pediatric subspecialists to children in almost all fields is shocking," says Peggy McManus, who led the report as codirector of the Maternal and Child Health Policy Research Center.
If you're worried about your child who has diabetes or a growth problem, for example, and needs the care of a pediatric endocrinologist, data shows that there are only 989 in the entire country. "That's one for every 81,000 children," says McManus. You'll have an even harder time finding doctors in fields such as child psychiatry, developmental and behavioral pediatrics, rheumatology, and neurology, according to a survey by the American Academy of Pediatrics (AAP). Hospitals have just as much trouble hiring specialists, finds the latest research from the National Association of Children's Hospitals and Related Institutions. "We haven't had a pediatric neurologist for six years," says Bonna Benjamin, M.D., professor and regional chair of pediatrics at Texas Tech University Health Science Center, in Amarillo.
The situation is most dire in rural areas and small cities with no children's hospital (there are about 250 such hospitals in the U.S.). Families in large, sparsely populated states often must travel hundreds of miles across state lines. Studies have found that when parents have to go more than 50 miles for a pediatric expert, they often bring their child to an adult specialist closer to home instead. "However, children are not miniature adults," says Beth Pletcher, M.D., chair of the AAP's Committee on Pediatric Workforce. "It's important for an experienced pediatric subspecialist to manage the care of a child who has a significant illness."