As pediatrician shortage rises, local program starts small cohort training in specialty

Lindsey Klein felt inspired by her pediatrician, who talked directly to her during 18 years of visits. Growing up in Kent, Washington, Klein recalls how the doctor made sure she understood her health, including early severe asthma.

Klein credits that physician with her choice to enter a new Spokane pediatric physician residency July 1. She is among six medical school graduates beginning three years of training to do supervised patient care for children.

“My pediatrician encouraged me from such a young age, at an appropriate age level, to engage in my own health care and advocate for myself,” said Klein, who is spending part of her training at a MultiCare clinic.

“He interacted with me, didn’t just talk to my parents. He would make sure I understood and was OK with what was going on. I want to be able to foster my own relationships with patients and their families.”

The need for pediatricians-in-training such as Klein is increasing nationwide, and in Spokane. Many pediatricians are nearing retirement.

Providence Health and Washington State University Elson S. Floyd College of Medicine launched the residency, which adds six pediatric residents each year for 18 people total. It’s aimed at boosting those pediatrician numbers, with a hope that some of them stay here to practice or at least stay in the state.

The current group graduates June 2027.

The residents are individually assigned to clinics, beyond Providence’s, including pediatric care sites for MultiCare Rockwood, Kaiser Permanente and CHAS. The residents see patients at those sites under a pediatrician’s oversight between one to three times a week for a half day.

They also spend time at Sacred Heart Children’s Hospital and Shriners Hospital.

Pediatricians care for children’s physical, mental and social health from birth to young adulthood, including development, well-child visits, childhood illnesses, and diagnosis and treatment of acute and chronic diseases.

But Dr. Aaron Carroll, a pediatrician and president of AcademyHealth for research and policy work, diagnosed some troubling trends for the field in a July 1 New York Times opinion. In some states such as Nevada, children wait weeks or months for pediatrician appointments. Depending on where they are, families wait longer for advanced childhood specialists.

And fewer U.S. medical school graduates are choosing pediatrics.

In the 2024 residency match for training programs, the number of medical students seeking pediatric programs dropped more than 6%. About 30% of pediatric training programs failed to fill available residency slots, leaving 252 positions vacant, compared with 88 vacant spots last year.

Carroll cited a major factor: Pediatricians earn less than specialists in almost every other U.S. medical field, mainly because so many children live in poverty with Medicaid or Children’s Health Insurance Program coverage, which pays less in insurance reimbursements.

The potential lower pay didn’t deter Kate Turk, a 2024 Spokane-based medical school graduate from the University of Washington School of Medicine. She just began a Stanford University pediatric residency.

“To be quite honest, my salary was not the largest factor in deciding the specialty,” Turk said. “I was fully aware that this specialty is not the highest-earning specialty, but the joy that I found in pediatrics and the amount of fulfillment was something that I could not simply find in other specialties.

“Being able to take care of kids is such a privilege. They’re resilient, authentic, show you when they’re ill and get better fast. Another reason it reached out to me is I just loved pediatricians. Through a variety of ways, I saw pediatricians showing up for their communities. They know their patients can’t vote, so who is going to advocate for them? I think their doctors do.”

The Spokane program didn’t have any issue filling its six slots, said David Aufdencamp, director of WSU’s medical school residency graduate programs. Leaders here seek candidates who have state ties or regional interest.

“We’re seeing this alarming trend of a decrease in people going into pediatrics, so for us as we’re starting a new program, it’s a little worrisome because we’re banking on more pediatricians,” Aufdencamp said. “Given that, we still did not have a problem with our first year.”

“Local doctors have said, ‘Yes, we want this program; we want to train our future replacements,’ ” he added. “There are a number of organizations involved in training beyond just WSU and Providence: MultiCare, CHAS, Shriners, Kaiser.”

Spokane WSU and UW medical school graduates have had fairly consistent interest in pediatrics, with slight dips. For 2024, WSU’s medical college had six students, or 9% of the class, entering pediatric residencies. In 2023, four students; 2022, three; and 2021, seven.

Among UW medical students in Spokane this year, six chose pediatrics. In 2023, two Spokane students entered pediatrics; 2022, three; and in 2021, four sought pediatrics and one entered medicine-pediatrics, a four-year residency combining internal medicine and pediatrics.

Also aware of those trends is Dr. Christian Rocholl, Providence-WSU pediatric residency program director and a Sacred Heart Children’s Hospital emergency medicine pediatrician.

He said needing more pediatricians was key to the program’s launch, “because data shows physicians tend to practice where they do residencies.”

The national residency numbers can be cyclical, he said, with years when pediatrics is extremely competitive. “The last several years, there’s been a slow trend down, then a bigger drop this last year.”

Financials are part of it. “Pediatricians go to the same medical school, all the same training, and then once they go into pediatrics, the (insurance) reimbursement when you’re seeing kids is less.”

He also sees the doctor shortages. “There is a pediatrician shortage for all of Eastern Washington,” he said, adding that the numbers per 100,000 pediatric patients east of the Cascades is “drastically lower compared with the west side of the Cascades and well below the national average.”

The UW Center for Health Workforce Studies’ 2021 report said Eastern Washington trails Western Washington, with 17% fewer primary care physicians per 100,000 people. That year, it said Eastern Washington had 158 general pediatric physicians, compared with 1,044 statewide.

Spokane residents working in a collaborative model among different health care organizations’ sites worked better to meet the region’s needs, and it was less costly than opening one pediatric training clinic, Rocholl said. During clinic time, “They are a pediatrician and working one-on-one with a board-certified pediatrician,” he added, as the residents slowly gain independence.

“They go all three years to the same clinic.”

Rocholl said there might be challenges when there’s 18 residents.

“We just have to look at the plan and see how many preceptors there are. Do we have six opportunities each year? That’s the hope.”

He sees general pediatricians as gatekeepers, discovering, managing and often keeping health issues from getting worse, perhaps curbing the need for advanced specialists.

Spokane Kaiser Permanente pediatrician Dr. Cicely White said a combination of factors is “making access in general tighter,” including pediatricians here nearing retirement or cutting back hours.

“The ability to hire isn’t as rapid or as fast as the rate of people cutting back their time or retiring,” White said. “A lot of our large health care systems are still recovering financially from COVID,” so positions or clinic hours aren’t always replaced. “Now, you have less people responsible for seeing more patients, just out of default.”

There’s another general pediatrics shift: an expanded role in mental health care. For that and chronic health issues, pediatricians can co-manage because patients typically can’t get into a Spokane advanced care child specialist more than once or twice a year, or the family lives remotely, she said.

She agrees that pediatricians’ financial compensation as a national issue is much bigger than “we just need to produce more pediatricians.”

Pediatrician Dr. Jenn Kalisvaart has a private practice, Centennial Pediatrics of Spokane, with three other providers.

“Part of my concern is there is a generation of pediatricians in Spokane getting closer to retirement,” Kalisvaart added. “There is going to be this group that in five years, 10 years is going to retire. Who’s going to care for their patients?”

She’s thankful for the new residency.

“I think a goal of that program is to have people come to Spokane, see what a great place it is, and then lay down some roots,” she said.

Rocholl refers to at least a start.

“The only way to get more subspecialists is to train more general pediatricians,” he said.

“Even if the residents go on to fellowships, there is still a chance they’ll go do that training and then come back.”