Critical funding for vulnerable lives

Opinion: July 25, 2011 at 12:00a.m.

By James Mandell and O. MARION BURTON

McClatchy-Tribune

Every day in Washington, in the halls of Congress and in the homes of their constituents, the talk is of the fiscal crisis our country is facing. It is a legitimate concern, and many federal programs are facing increased scrutiny as budget cuts need to be made.

As leaders in Washington seek ways to pay the government’s bills, some are making suggestions that could have short-term financial gains at the expense of long-term health and safety. One such plan can be seen in President Obama’s proposed elimination of the Children’s Hospitals Graduate Medical Education program in his 2012 budget. If this elimination were to take place, our children’s health will be put at risk.

The program funds the medical training of pediatricians and pediatric specialists who care for children. Imagine your child is born with a congenital heart defect and needs surgery during her first week of life. The cardiovascular surgeons, cardiologists, anesthesiologists and intensive-care physicians who will treat your child all require specialized pediatric training because operating on a heart the size of a walnut is dramatically different than doing bypass surgery on an adult. If the funding for this specific training disappears, so do the specialists capable of saving your child’s life.

In 1999, a program was enacted with the strong bipartisan support of Republican and Democratic champions in the Congress who agreed that independent children’s teaching hospitals should receive some level of federal support for pediatric training. Adult teaching hospitals at the time received more than 200 times the federal support per resident that independent children’s teaching hospitals received, and children’s hospitals residency programs were on the decline.

Training increases

Over the last decade, while the program’s funding has increased by a modest 1.6 percent annually, the number of residency programs has grown by 32 percent. This growth has helped address a national shortage of pediatric specialists. Today, 56 independent children’s teaching hospitals in the CHGME program train 40 percent of all pediatricians and 43 percent of all pediatric specialists.

In many communities across the country, this commitment to training has helped build the supply of pediatricians who increasingly are managing more complicated conditions in children. Yet children still face problems accessing pediatric care. In 2010, a National Association of Children’s Hospitals and Related Institutions study found severe shortages in high-demand pediatric specialties like behavioral developmental pediatrics and pediatric pulmonology.

While there are many factors that contribute to shortages, CHGME is in fact helping to address these deficiencies and improve health outcomes for children at the national level and in local communities. For example, along with investments in biomedical research, pediatric specialists, more than half of whom are trained in children’s hospitals that receive CHGME, have helped reduce mortality rates significantly in children with cancer.

The program is also helping to address the challenging problems of access, cost and quality at the local level. For example, Nationwide Children’s Hospital, which receives annual CHGME funding, has doubled the pediatricians and specialists it is able to train, which has expanded access, and enabled it to become accountable for the care of nearly 300,000 Ohio children on Medicaid from urban Columbus to rural Appalachia. For these children, the hospital, in partnership with more than 750 physicians, accepts payments to coordinate and improve care from primary care medical homes to the most complex hospital treatment.

Funding in doubt

Congressional leaders have introduced bills to reauthorize the program for an additional five years. Although reauthorization looks promising at this juncture, annual funding of the program hangs in the balance as lawmakers negotiate a budget deal that must address long-term deficit reduction.

There are truly difficult fiscal choices to be made right now, but CHGME is a program that works. There are some commitments to children our nation needs to keep and this is unquestionably one of them.

James Mandell is chairman of the Board of Trustees of the National Association of Children’s Hospitals, Alexandria, Va., and CEO of Children’s Hospital Boston. O. Marion Burton is president of the American Academy of Pediatrics. Distributed by McClatchy-Tribune Information Services.