"Don't waste all that schooling on being a pediatrician. Pick a specialty that will actually pay back your loans."
This is something future physicians hear all the time. Pediatricians have an average earning potential 25% lower than their adult physician counterparts. Choosing pediatric medicine over adult medicine is an objectively poor financial decision, especially for students who are financing their education with loans.
Beyond disincentivizing a field that can be rewarding for empathetic people who enjoy being around kids, the significant wage gap has consequences for the future well-being of America's youth.
Undervalued and Underpaid
In 2022 alone, I withdrew $106,351 in loans to fund the upcoming year in my MD/MPH program (just over the estimated cost of attendance for a first-year MD student at my school: $99,151). Meanwhile, first-year resident physicians at my school's health system make only $58,985.24 (pre-tax) annually for 80-hour scheduled work weeks. (This ignores the many unscheduled hours that hospitals often expect residents to work.) A high-cost education followed by a low payout during training isn't unique to my institution.
After 4 years of college, 4 years of medical school, and up to 7 years slaving away for a resident's salary, how can the medical system rationalize rewarding pediatric physicians with only 75% of their peers' compensation?
One excuse for this inequality is the suggestion that working with children is easier. I'd counter that with the fact that pediatricians must relearn a modified version of much of their medical training. They must study the unusual childhood presentations of common pathologies and dosing systems unique to pediatrics. They must tactfully balance the wants and needs of both the patients and their family members, advocating for the former when their desires do not align. Additionally, many pediatric subspecialists require an even greater number of years of training than their adult equivalents. One might assume that these extra years are the cause of their lower earnings, since longer training means fewer years of high earnings. However, even after accounting for these years of lost earning potential by modeling a shortened length of training, the lifetime profits of pediatricians were still 19% lower than of adult specialists.
The current structure of our payment system makes it near impossible for pediatricians to earn a fair salary. About 39% of children in the U.S. are insured through either Medicaid or the Children's Health Insurance Program (CHIP), insurance options for low-income families. On the other hand, the single largest insurer of the adult population is Medicare, which is known to provide higher reimbursement rates. Furthermore, the way in which CMS determines reimbursement rates depends on a committee of physicians. This committee allows only one seat for pediatrics. This may inadvertently lead to better reimbursement for services that primarily serve adult patients, since other specialties have a louder voice through more "adult specialty" seats at the table. This issue is further aggravated by the fact that invasive procedures tend to be reimbursed at higher rates but are less common in children. Consider $1,200+ colonoscopies for example: a means of screening in adults but generally only a diagnostic tool in children.
The Consequences of Devaluing Pediatrics
As of 2022, pediatricians had the second lowest physician salary, beat only by public health and preventive medicine doctors. This is dangerous because it decreases interest in the field of pediatrics, making it a less competitive specialty. It fosters an attitude of disappointment when "overqualified" students show interest in it and normalizes it as a "backup choice."
The narrative that pediatricians are less valuable than other doctors may prevent some pediatrics-inclined students from pursuing the field. At a time when almost 30% of medical students report signs of depression (a number that is surely underreported due to fear of professional repercussions) and 53% of current physicians report burnout, shouldn't we be encouraging students to pursue their top specialty? It's only logical to assume that would help sustain their passion for medicine.
Living in a country where 1 in 5 children are obese, 30% of female high schoolers have seriously considered suicide, and 1 in 25 of today's 5-year-olds will not make it to see their 40th birthday, indifferent pediatricians are something we absolutely cannot afford. The rippling effects of this pay gap are particularly damning in states such as Florida where 18.3% of children have healthcare needs requiring the care of a pediatric subspecialist.
Over time, this salary imbalance will only worsen the shortage of pediatricians and diminish the quality of care available.
The pay gap between pediatric and adult medicine physicians is rooted partly in archaic misconceptions and imbalanced insurance payouts, and further influenced by a multitude of other factors. Pediatricians play a critical role in keeping our future generations healthy. We owe it to them and to our children to urgently push for changes in healthcare reimbursement and public attitude if we want to preserve the quality and accessibility of pediatric care.
Megan McLaughlin is a rising fourth year student in the MD/MPH dual degree program at the University of Miami Miller School of Medicine. She plans to apply to family medicine residency programs and focus her career on improving maternal and child health.