California is facing a shortage of pediatricians as children with complex illnesses double in number

Children’s health care in California is approaching a critical turning point. The number of children with complex medical conditions — estimated at 358,000 — expected to double in the next decadeas medical advances allow more children with serious illnesses to survive.

Children with medical problems live with chronic illnesses, significant functional limitations, and frequent hospitalizations. They rely on highly trained pediatric specialists who understand how the disease uniquely affects growing bodies and developing minds.

For many of these children, California Children’s Services provides a lifeline connecting families to pediatric specialists when a child has an appropriate condition and meets income requirements. Children’s service providers provide significant expertise in managing complex conditions such as sickle cell anemia and cystic fibrosis.

Yet this lifeline is crumbling. almost 90% of Children’s Services are pediatric specialists expected to retire within the next five years. This loss will hit rural and underserved communities the hardest.

Add to that the impact of state and federal budget cuts on patient care. More than 400 hospitals already have laid off 3,400 healthcare workers from March, with more expected in the future.

How did we get here?

First, fewer students choose careers in pediatric specialties due to crushing post-graduation debt and lower lifetime earnings compared to adult medical specialties.

That deterrent is poised to worsen as the U.S. Department of Education is considering removing nursing and other health care professions from its list of eligible roles for higher levels of student loans. Even for those with a passion for caring for children, this decision can make a pediatric career financially impossible.

Second, pediatric subspecialty care is becoming more common regionalized. Hospital mergers and health system consolidations are frequent centralize services to maintain patient volume and expertise. While this may make sense on paper, it forces families to do it travel long distances for care — an impossible burden for many parents juggling work, transportation challenges and medically fragile children.

The Rural Health Transformation Programme is an example of a federal initiative to increase health care workforce shortages, particularly in rural communities. These funds can be used to recruit and retain qualified pediatric physicians to practice in public health areas and to develop coordinated partnerships with health systems and pilot innovative models of care.

Third, inadequate reimbursement pushes health care providers out. Medi-Cal payments lag far behind Medicare. For example, reimbursement for placing a breathing tube in a child’s airway is approx 60% lower under Medi-Cal than under Medicare, despite the skills and complexity.

The crisis in pediatric care requires collective action. Caregivers must continue to share their stories to clarify what is at stake when access to pediatric expertise disappears. Policymakers should increase funding for programs such as Golden State Pathways Programthat support early engagement and expose health and medical students to the breadth and purpose of a pediatric career. And collaboration between families, clinicians, educators, and advocates can turn lived experience into meaningful reform.

Some argue that expanding the pediatric workforce diverts resources from adult and geriatric care, especially as the population ages. But this is a false choice.

Thanks to programs like California Children’s Services, we’re tackling childhood chronic illness better than ever. Investing in children’s health and addressing issues early offers significant long-term benefits, including potentially easing future strain on adult health care systems and reducing overall health care costs.

Technology can also offer efficiencies—through telehealth, diagnostics, and care coordination—but it cannot replace the clinical judgment, hands-on skills, and human connection needed to care for medically complex children and their families. Technology should support pediatric professionals, not be mistaken for a substitute.

No family should have to face the terror of wondering if expert care will be available when their child needs it. By strengthening the pediatric workforce and preserving access to specialty care, California can build a health care system worthy of its children—today and for generations to come.