New Workforce, Practice, and Payment Reforms Essential for Improving Access to Pediatric Subspecialty Care Within the Medical Home

Abstract

The availability of pediatric subspecialty care is critically important to the health and well-being of infants, children, and adolescents. Moreover, timely collaboration with pediatric subspecialists is an essential element of the standard of care for children: the community-based medical home. In this model, primary care practice teams coordinate all care for a patient, including subspecialty care. Unfortunately, lack of access to pediatric subspecialty care within the medical home has reached crisis proportions in the United States owing to several interrelated factors: an insufficient number of pediatric subspecialists, dramatically increasing demand for pediatric subspecialty care, a fragmented system of pediatric primary and specialty care, and inadequate financing of medical education and collaborative primary and specialty pediatric care through the medical home. Recognizing the serious and widespread problems regarding access to pediatric subspecialty care, in 2004 the federal Maternal and Child Health Bureau convened the Expert Work Group on Pediatric Subspecialty Capacity. Its charge was to define the scope of the problem, identify promising approaches for extending pediatric subspecialty capacity, and develop recommendations. The group met 4 times between 2004 and 2007 and, through a series of key informant interviews, literature reviews, and analyses of pediatric subspecialty workforce data, prepared a series of reports and recommendations. This commentary is bas…