North Carolina project aims to shorten wait times for pediatric subspecialists

The unique collaboration among physicians, academic medical centers and Medicaid to provide more timely pediatric subspecialist care could serve as a model for other states.

By Amy Snow Landa, AMNews correspondent. Sept. 11, 2006.

A child in North Carolina typically has to wait nearly two months to see an endocrinologist, three months for a gastroenterologist and nearly a year for a rheumatologist, according to a recent survey that looked at the appointment calendars of pediatric subspecialists in the state's academic medical centers.

That's longer than many children with special health care needs can afford, said Alan Stiles, MD, chair of the Pediatrics Dept. at the University of North Carolina, Chapel Hill. "Any child who has a serious chronic illness and has to wait 45 weeks [to see a specialist] is probably going to end up in the emergency room," he said.

The problem is that pediatric subspecialists are in short supply. There are only five pediatric rheumatologists in all of North Carolina, according to the survey, conducted by the Maternal and Child Health Policy Research Center. That's just one rheumatologist for every 237,102 children. Similarly, there are just nine pediatric gastroenterologists and 19 pediatric endocrinologists.

The shortage of pediatric subspecialists is not limited to North Carolina, but is a nationwide crisis, according to pediatricians and experts who study children's access to health care.

But what is unique to North Carolina is the approach that its physicians, teaching hospitals and Medicaid program have developed to address the problem.

They recently launched a public-private collaboration aimed at making more efficient use of pediatric subspecialists by improving communication and coordination between them and primary care physicians.