An Important Step
Despite being a modest fix, pediatric subspecialty loan repayment is an important step toward avoiding a disastrous outcome: a decline in children’s access to quality subspecialty care. This is why more than 50 pediatric-allied medical associations and foundations have made it a priority to advocate for legislation to support loan repayment and forgiveness over the past decade.
The implications of relieving educational debt may be greater than simply adding a few more applicants each year. It may help build a more diverse workforce. In a widely read New York Times article, Emma Goldberg cited the incredible cost of medical school—including not only tuition, but also applications, books, tests and travel expenses for interviews—as a major deterrent for non-affluent Americans.5
“For some students, the pressure of medical school expenses becomes a limiting factor as they survey their professional options,” Ms. Goldberg wrote. “A well-paying field like plastic surgery begins to look more appealing, while lower-paying jobs in family medicine lose their luster.”
As the U.S. population changes over time, the diversity of our small workforce will be ever more important, not less. Whatever we can do to welcome people of all backgrounds—not dissuade them—will be immensely important to meeting our patients’ demands. This means not just providing a sufficient supply of doctors, but also building a community of doctors with diverse experiences, perspectives and representation to meet patient needs.
The ACR’s Efforts
The hope of being able to advocate for legislation to foster the growth of our workforce was one of the major reasons I volunteered for the ACR’s Government Affairs Committee (GAC). But I learned early in my term that numerous pieces of legislation for pediatric subspecialty loan repayment had been sent through the system over the years: the Pediatric Workforce Investment Act of 2009, the Pediatric Subspecialty and Mental Health Workforce Reauthorization Act of 2013, the Ensuring Children’s Access to Specialty Care Act of 2015, the Ensuring Children’s Access to Specialty Care Act of 2016 and the Ensuring Children’s Access to Specialty Care Act of 2017. None have been enacted. A prior version of the current legislation did pass and was authorized by Congress, but it expired before funds were appropriated.
Nonetheless, I am heartened that support for loan repayment for pediatric rheumatologists and other efforts to bolster the pediatric rheumatology workforce remain on the ACR Health Policy Statements that the GAC revises each year. Persistent and effective advocacy is not accomplished by a 16-member committee. Rather, it is accomplished by the community behind it.
