Northern California has a pediatric care crisis. We must address it now | Opinion

Imagine you live in rural Northern California, anywhere outside of Sacramento, Fresno or the Bay Area. Now, imagine your child is sick — really sick — and needs emergency care. How far is the drive to the nearest emergency department? Will there be a pediatrician or pediatric specialist available when you get there? Will your child need to be rushed to a children’s hospital hours away?

The answers to all those questions are changing for the worse.

Across Northern California, there used to be more hospitals with emergency departments capable of treating children, more pediatricians on staff in community hospitals and more general surgeons able to operate on children for common conditions like appendicitis. When a child needed to transfer to the closest specialized children’s hospital, there was room for them.

Increasingly, however, these scenarios are no longer true. Some Northern California hospitals, like Glenn Medical Center in the Sacramento Valley community of Willows, have closed. Larger hospitals have shuttered their pediatric units (Providence Santa Rosa Memorial Hospital, for example, recently converted its entire inpatient pediatric ward to adult beds).

Hospital policies, staffing limitations and training deficits increasingly prevent surgeons and anesthesiologists from doing surgery even on teenagers and healthy children. The result? Any child who needs care beyond what a local emergency department can provide gets transferred to a children’s hospital. But all the children’s hospitals are running out of beds.

It used to be rare for children’s hospitals to turn down a transfer request. Now, it’s rare for them to go a day without declining at least a handful because they are full. When one children’s hospital is unable to accept a transfer, doctors and families can only hope another hospital in the region says yes. But because every hospital runs its own transfer process, there’s no coordinated system to find that bed efficiently. A sick child is at the mercy of a phone tree.

The cause of this decline in the capacity to provide safe and equitable treatment for children is straightforward: money. Pediatric patients are more likely to be covered by Medi-Cal, the state-managed program (funded primarily by the federal government) which serves about a third of all Californians. It reimburses physicians and hospitals at rates so low that caring for those patients often means losing money. That pushes hospitals to preferentially treat adult patients who are more likely to have higher-paying commercial insurance and to need well-reimbursed conditions and procedures like cancer treatment or surgery.

The result is that hospitals — making financially rational decisions —have steadily built capacity for adults and outsourced pediatric care to the region’s few children’s hospitals. Meanwhile, these same financial effects mean that fewer medical students are choosing to become pediatricians. The pandemic accelerated these trends.

The resulting capacity crisis has come on gradually, but it is reaching a point where serious consequences are inevitable. Children who need care are waiting longer and traveling farther — sometimes much farther — for even basic treatment. There are already examples of children dying in the process.

Our state legislators could do three things that would preserve and restore pediatric hospital capacity:

First, we must address reimbursement rates for Medi-Cal. Hospitals and physicians cannot afford to treat children without losing money on every admission. Community hospitals need to be able to afford to provide care to their whole community, not just adults. Only the most complex cases should require a long trip to a specialized children’s hospital.

Second, hospitals should get incentives to share real-time capacity data through new centralized regional systems — an air-traffic-control model for pediatric beds — so that when a child needs a transfer, the closest appropriate hospital can be found quickly, with a single phone call.

Finally, children’s hospitals must be resourced and incentivized to support the broader system of pediatric care: training community hospital staff, offering telemedicine consultations and mentoring providers who want to care for kids but lack confidence or backup.

There is a pediatric capacity crisis. If Californians value our children, we need our government to prove it.

Jonathan E. Kohler is a pediatric surgeon in Sacramento. James P. Marcin is a pediatric critical care physician in Sacramento.