The U.S. may be headed toward a pediatric care crisis as more programs geared to treat children are closing, fewer residents are specializing in pediatrics and lower reimbursements make caring for children a financial burden. While adult hospitals are grappling with how to care for their youngest patients, children’s hospitals and systems across the country are taking a national approach to fill gaps.
Between 2008 and 2022, hospitals closed nearly 30% of inpatient pediatric units, and anecdotally, this trend does not appear to be slowing. Closing services is often due to the combined pressures of fewer residents specializing in pediatric care — which has lower compensation and longer training — and financial difficulties. Nearly half of all children in the U.S. are covered by Medicaid, which reimburses providers less than the cost required to deliver care.
On the workforce front, the percentage of pediatric residency positions that were filled fell from 97% in 2023 to 92% in 2024. This year, four primary care specialties — internal medicine, internal medicine-pediatrics, pediatrics and family medicine — saw a 9.21% fill rate, a 1.4% decline from 2025. A growing shortage of pediatric specialists is leading to monthslong waitlists for children, according to a March 9 report from the Children’s Hospital Association.
With fewer hospitals and clinics able to support specialized pediatric care, many children’s hospitals are stepping in to provide expertise, services and clinical partnerships beyond their traditional markets.
“If current trends continue, access to pediatric specialty care will depend on how effectively health systems collaborate,” Matthew Love, president and CEO of Nicklaus Children’s Health System, told Becker’s. “Children’s hospitals like ours are uniquely positioned to fill that gap through partnership models that extend pediatric subspecialty services to geographic areas that lack them. The opportunity is to redefine pediatric care delivery through partnerships that bring high-quality care closer to home. Our guiding principle remains clear: No child should have to travel far from home to receive the care they need if it can be delivered safely and effectively in their community.”
On a larger scale, it also falls to children’s hospitals to advocate for pediatric healthcare, Raphe Schwartz, chief strategy officer at Children’s Hospital Colorado, told Becker’s.
“Children’s hospitals like ours need to be guardians of children’s health — speaking up and advocating for policies that allow children to grow up healthy and strong,” he said. “We do this in our own state, and increasingly in neighboring states as well.”
How children’s hospitals provide care looks different depending on the system.
Children’s Hospital Colorado
The Aurora-based system started creating partnerships in 2015. Now, it has 15 formal Care Alliance partnerships ranging from large health systems to regional providers and rural hospitals across Colorado, Montana, Wyoming, New Mexico, Kansas, Nebraska and South Dakota.
Each partnership is tailored to meet the needs of the facility and patients, but the system offers pediatric specialty visits, critical care services, education services, clinical consultations both in person and virtually, interpreting diagnostic tests and remote patient monitoring. They also partner with access to precision medicine, AI tools and other innovations.
“There are fewer babies and children to serve today; birth rates are at record lows,” Mr. Schwartz said. “Hospitals struggle to hire and retain the requisite pediatric staff, and they need support delivering outstanding pediatric outcomes when they’re operating at lower volumes. In pediatrics, scale drives quality. You need significant volume to deliver good results, and we partner with institutions to help them achieve that.”
In the Western U.S., many families have to drive hundreds of miles to reach the nearest children’s hospital. To help reduce the travel burden and provide the highest quality care, Children’s Hospital Colorado sends its providers to community facilities. About 60 to 100 of the system’s pediatric specialists travel regularly to remote communities to see patients, Mr. Schwartz said.
Cincinnati Children’s
Cincinnati Children’s is taking a national, collaborative approach to providing pediatric care. In February, the system partnered with a fifth hospital, which was also its fourth partnership outside of Ohio. Its partners include Lexington-based Golisano Children’s at University of Kentucky, Peyton Manning Children’s in Indianapolis, Akron (Ohio) Children’s Hospital, Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates, and its newest addition, Mary Bridge Children’s Hospital in Tacoma, Wash.
“What I have been seeing over 20-some years of practice is these small children’s hospitals opening a pediatric program and then closing a pediatric program,” David Morales, MD, executive co-director of Cincinnati Children’s Heart Institute and division director of cardiothoracic surgery at the health system, told Becker’s. “Pediatric heart surgery is probably the specialty that opens and closes more than any other.”
These smaller programs often shut down due to limited staff, a lack of infrastructure and sometimes poor outcomes, he said. A collaboration with a comprehensive center such as Cincinnati Children’s can stabilize programs by providing specialty care consultations for patients and mentorship for leaders building the program.
Cincinnati Children’s provides a number of collaboration opportunities, including remote consultations with any of its more than 1,000 pediatricians and pediatric specialists, shared clinical decision-making conferences, clinical guidelines and protocols, sending staff to overlay with a new operation or catheter intervention, and on-site education such as a course for cardiac ICU and acute care nurses to improve care.
Driscoll Children’s Hospital
The Corpus Christi, Texas-based hospital has a geographic footprint roughly the size of South Carolina. Within that area are 23 adult hospitals — nine of which collaborated with Driscoll Children’s to provide and/or manage NICU beds. In NICUs, Driscoll Children’s physicians work full time at the hospital, while specialists are flown to facilities as needed.
These partnerships began five years ago, and now Driscoll Children’s owns or operates 245 NICU beds, the largest footprint in Texas.
“There aren’t many NICU units in our market that we don’t already manage, and I’m in active discussions with several of them about potentially owning or managing those beds over the next 12 to 36 months,” Eric Hamon, president and CEO of Driscoll Children’s, told Becker’s.
The hospital also provides pediatric care in 20 specialties to its current partners, and it is looking to offer operating services in pediatric cardiovascular care and neurosurgery.
Nicklaus Children’s Health System
The Miami-based system is working to build a connected pediatric ecosystem across Florida. The ecosystem focuses on expanding access in high-growth and underserved markets, strengthening local care delivery and integrating subspecialty expertise, and aligning culture and operations with its child-first philosophy.
In these partnerships, Nicklaus Children’s offers pediatric subspecialty clinics and physician integration; neonatal and pediatric intensive care support; emergency and urgent care pediatric expertise; a surgical program for complex cases; and telehealth and virtual consultants.
The system has partnered with Florida International University in Miami to build a pediatric workforce pipeline, expand clinical research and ensure evidence-based care. It also has partnered with Broward Health in Fort Lauderdale, Fla., NCH Naples (Fla.) and Nicklaus Children’s Health Care Foundation in West Palm Beach, Fla., to increase regional access to pediatric care.
Phoenix Children’s
Phoenix Children’s has partnered with seven hospitals to provide neonatal care and staff their respective NICUs. The system already staffs NICUs at Chandler (Ariz.) Regional Medical Center, Mercy Gilbert (Ariz.) Medical Center and St. Joseph’s Hospital and Medical Center in Phoenix, and it recently partnered with Scottsdale, Ariz.-based HonorHealth to provide neonatal care at three of its hospitals.
Since June, the system’s neonatology team — consisting of five physicians and 14 advanced practice providers — has provided care to more than 1,700 HonorHealth patients and helped increase patient access. Before the partnership, HonorHealth Shea Hospital in Scottsdale had 26 NICU patients per day, and after nine months working with Phoenix Children’s, it now has 37. The growth is due to the fetal care team that identifies higher-risk pregnancies earlier and keeps families at HonorHealth for delivery and neonatal care, Gregg Martin, MD, Phoenix Children’s division chief of neonatology, told Becker’s.
Partners also have access to comprehensive pediatric support and resources, as well as consultations with more than 75 pediatric subspecialties. Support services are also available through Phoenix Children’s Center for Fetal and Neonatal Care, which provides care before and after delivery for high-risk pregnancies.
Other partnerships
Some children’s hospitals are making an impact through more localized partnerships.
- Wilmington, Del.-based ChristianaCare partnered with Children’s Hospital of Philadelphia and launched their affiliation at ChristianaCare’s Center for Women’s & Children’s Health in Newark, Del. The center offers pediatric emergency and inpatient care, with CHOP specialists offering additional pediatric and neonatal services.
- Madera, Calif.-based Valley Children’s Healthcare has invested heavily in outpatient access points across its 45,000-square-mile service area and deepened partnerships with general acute care hospitals throughout the region.
- Boston-based Dana-Farber Cancer Institute, Boston Children’s Hospital and Broad Clinical Labs have partnered to launch a research initiative aimed at developing and disseminating clinical molecular testing assays for pediatric cancers.
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