Children’s hospitals are still wrestling with staffing shortages

Hospitals across America are dealing with staffing shortages, and children’s hospitals are also struggling to fill positions.

While many children’s hospitals are faring better than they were a year or two ago, some are still finding it difficult to recruit and retain all the people they need, says Matthew Cook, president and CEO of the Children’s Hospital Association.

“Manpower, really broadly speaking, has been a significant challenge for years for children's hospitals,” Cook says. “So this is not a new phenomenon. The pandemic aggravated an issue that was already there.”

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Some pediatric nurses have left children’s hospitals, and Cook says it’s not easy to recruit doctors.

Fewer physicians are entering the field of pediatrics, he says. And more doctors in children’s hospitals are battling burnout, and that’s a problem across the industry.

“We saw this incredible increase in the level of burnout, and really across every single pediatric specialty,” Cook says. “So it's not even that it's one specific group. It's really a broad-based, specialty, independent problem.”

“You need a certain number of physicians in order to cover a children's hospital,” he continues. “And when you're right at the limit, and you have somebody who's sick, or somebody who needs a day off, then the coverage of that falls to somebody else. And so I think what we're seeing is … sort of the outcome of something that's been years in the making.”

But Cook also pointed to a problem cited by many physicians as a key factor in burnout: the headaches of documentation.

“I would be remiss if I didn't bring up the electronic medical record,” he says. “You know, that has been very beneficial in some ways. But if you talk to any physician, they'll talk to you about something called ‘pajama time.’ And pajama time is how much time they spend finishing up their documentation when they're sitting at home at night.”

Many doctors at children’s hospitals are also struggling with the high volume of messages they are getting from patient portals, with parents sending notes asking questions.

“Most physicians receive an enormous number of messages through those portals from patients and families now as well,” Cook says. “And that's a completely separate burden from the issue of documenting in the medical record.”

And some of those family members end up calling for physicians if the message in the portal isn’t answered quickly, he adds.

“We've sort of created part of the problem for ourselves, because now we're sending all these messages, bombarding physicians and expecting them to turn around and answer right away,” he says.

But beyond physicians, hospitals are also having trouble filling other roles.

“There are a lot of other positions that people don't normally think of that support a children's hospital that have also seen significant shortages: pharmacy techs, radiology techs, respiratory therapy providers,” he says. “So it's really a broad-based issue.”

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While working in a children’s hospital can be very rewarding, clinicians also experience a great deal of stress when it comes to caring for kids, and their families.

“It does take a special person to want to be a pediatric health care provider, whether that is a physician, whether it's a nurse, whether it's a respiratory therapist,” Cook says.

“The emotional burden of watching and treating a sick child is really very significant, and it's not something that anybody can do or everybody wants to do," he adds. "And you know, when you think about the nurses and physicians and the critical care units taking care of kids, there is an emotional burden to that.”

Some children’s hospitals have rebounded from financial difficulties during the COVID-19 pandemic, but some are still trying to make up ground.

Nationwide, the profitability of children’s hospitals dropped to their lowest point in a decade, according to Fitch Ratings. In addition to labor shortages, children’s hospitals are spending more on salaries and benefits. They are also seeing higher costs for drugs and other supplies.

Texas Children’s Hospital announced last month that the organization is laying off 5% of its workforce, which represents about 1,000 workers, The Houston Chronicle reported.

The financial performance of children’s hospitals is “highly variable,” Cook says.

It’s also increasingly dependent on geography, he says. Some children’s hospitals in the South are performing better, while there's been a slower recovery for pediatric systems in the Northeast and Mid-Atlantic states.

“It's been very uneven, and margin pressures have really been very substantial for the children's hospitals,” Cook says.

Even as children’s hospitals deal with higher costs, they have less ability to pass on those higher expenses to patients and families, Fitch analysts note. Medicaid is the dominant payer for patients in children’s hospitals. Pediatric systems are looking at expanding services to be more profitable.

Cook also points to another challenge for pediatric facilities: some are serving patients from multiple states. Seattle Children’s, for example, treats children from Idaho, Montana, and Alaska, because those states don’t have pediatric hospitals. That’s another hurdle for children’s hospitals looking to tackle problems such as the mental health crisis.

“You don't have a children's hospital in all 50 states,” Cook says. “And if you think really about rural areas, that's another challenge for us.”

The association continues to press for more federal funding for graduate medical education in children’s hospitals. Cook is hoping lawmakers and the Biden administration will authorize more aid.

“That is the training program for physicians in the freestanding children's hospitals,” Cook says. “That is an incredibly important program for us.”