Finding footing as a new chief medical officer looks different for each executive at each hospital, but at children's hospitals, there are different layers to consider in a leadership role.
Results from the 2024 National Resident Matching Program showed that residency positions in pediatric medicine dropped by 5% year-over-year from 97.1% in 2023 to only 92% of offered residency spots in pediatrics getting filled in 2024.
This change resulted in an increase of 164 more positions that went unfilled in the specialty this year, than in 2023. Additionally, 47.6% of MD seniors matched to pediatric categorical positions in 2024, a decline of 7.2% from 2023, according to the data.
"Children's hospitals play an essential role in kids' health and well-being by providing specialized care, crucial research, essential education, and vital community outreach," Torey Mack, MD, chief medical officer of the Children's Hospital Association said in a June news release. "However, when it comes to operational metrics, children's hospitals are often benchmarked against adult hospitals that provide pediatric care."
The ongoing, nationwide physician shortage can sometimes feel like a double-edged sword for executives in children's hospitals, a spokesperson from the Pediatric Infectious Diseases Society confirmed to Becker's.
For instance, there is a major shortage of infectious disease physicians nationwide, with 80% of counties in the U.S. not even having one, according to the American Medical Association. Then, there is also a shortage of pediatric physicians. For children's hospitals, these issues overlap, with an even greater shortage of pediatric infectious disease specialists nationwide.
Therefore, finding the right staff for specialty care at children's hospitals can be a challenge.
"This year's national pediatric residency match data show a very worrisome, dwindling percentage of medical students entering pediatrics. Of course, those new residents serve as our substrate for future subspecialty fellows," William Steinbach, MD, president of PIDS wrote to members in a letter. "The national pediatric subspecialty match data were not much different, showcasing that many pediatric specialties are going to have massive workforce shortages in the immediate and near future."
"One could argue there is no single larger issue in our field, or in any field, than the workforce comprised of all of us," Dr. Steinbach added.
Data from a June 2024 report compiled by the Children's Hospital Association revealed that pediatric patients today are entering hospitals with slightly more severe illnesses, indicating "a slightly sicker cohort of patients now versus 2019," according to the release.
Inpatient and observation cases went up at children's hospitals in every region of the U.S., except the Northeast, which saw a decline, indicating overall that "children’s hospitals in the West and Northeast regions may have had a different experience over the last three year compared to those in the Midwest and South," the release states.
This means that in 2024, chief medical officers at children's hospitals are not only grappling with staffing shortages and specialty recruitment, but even geographic location has been a factor influencing care and patient outcomes, as the report shows.
There are extra layers to consider for these executives due to these compounding factors, but even position scope for chief medical officers can vary hospital to hospital, which shapes how each executive guides staff through the headwinds differently.
"All health systems are set up differently, as are the expectations of the CMO," Blake Bulloch, MD, chief medical officer at Phoenix Children's, told Becker's. "We have a CMO, surgeon-in-chief, physician-in-chief, and chief physician executive. We all have our own responsibilities and report up to the chief physician executive, but there is some overlap in all of our functions."
The overlap requires constant coordination and communication among physician leadership, he said. The health system is adding two more community hospitals that are scheduled to open later this year, which is also requiring the C-suite physician leaders at Phoenix Children's to double-down on the coordination and communication even further.
"It is my responsibility to communicate to the other physician leaders what we are working on, where we think there could be risks and options for proactive risk mitigation," Dr. Bulloch added.
The challenges that are exclusive to children's hospitals are expected to get worse, unfortunately, and they might become even harder to tackle going forward, if things continue to play out this way, Aaron Carroll, MD, pediatrician and professor at the Indiana University School of Medicine wrote in a July opinion piece for The New York Times.
"What’s been uniformly concerning for 20 years has been the waning interest in pediatrics subspecialties as the need has grown," Atul Grover, MD, executive director of the Association of American Medical College's Research and Action Institute shared with Dr. Carroll and The New York Times.
While the future of pediatric care and children's hospitals is likely to hold more obstacles for chief medical officers and physician leaders to overcome, what is certain, Dr. Bulloch said, is change.
"I am not sure people are aware of how dynamic this role can be," Dr. Bulloch said. "While some meetings, committee memberships and projects are ongoing, there are constantly new opportunities arising and challenges to overcome. Every day is different, and the job evolves over time."