What Happens When Doctors Stop Choosing Pediatrics?
Inside the quiet crisis facing the pediatric workforce, and why our field can no longer afford to stay passive about it.
As a pediatric endocrinology fellow, I spend a lot of time around medical students and residents who are still figuring out what kind of physicians they want to become.
Over time, I have noticed a pattern.
They admire pediatrics.
They respect pediatricians.
Many of them genuinely love caring for children.
But the same concern keeps coming up.
They are not convinced that pediatrics allows for a sustainable life, not after the years of sacrifice it takes to get here.
That belief is reshaping our field.
And we are watching it show up in the data.
The pipeline is sending us signals. Are we listening?
In the 2025 NRMP Match, pediatrics offered 3,193 residency positions and filled 3,043, leaving roughly 150 unfilled. The fill rate rebounded slightly to 95.3% after a sharp drop the year before, when it fell from 97.1% to 91.8%, one of the largest single-year declines the specialty had seen in years.
At first glance, that might not seem alarming.
It should.
The residency Match is only the first signal.
The real problem shows up when you follow the pipeline further: into fellowships, into subspecialty care, into the communities that will be looking for pediatric specialists five and ten years from now.
The fellowship data is the warning siren
The 2025 NRMP Medicine and Pediatric Specialties Match data should be required reading for every pediatric leader in this country.
Across all pediatric subspecialties combined, nearly 35% of programs went unfilled and over 21% of positions sat empty.
But when you look at individual specialties, the picture gets worse:
Pediatric nephrology: 78% of programs unfilled, with over 61% of positions unmatched.
Pediatric endocrinology: 65.6% of programs unfilled, with more than half of all available positions going unmatched.
Adolescent medicine: 58.6% of programs unfilled.
Pediatric infectious disease: 55% of programs unfilled.
Pediatric pulmonology: 48% of programs unfilled.
Developmental-behavioral pediatrics: nearly 43% of programs unfilled.
Now compare that to the adult medicine side. Adult cardiology filled 100% of its positions. Adult gastroenterology filled 99.7%. Adult hematology-oncology filled 99.5%.
These physicians train in the same hospitals.
They graduate from the same medical schools.
They carry the same debt.
They are simply making different decisions.
And when you look at the numbers, it is hard to argue they are making the wrong ones for themselves.
When subspecialty fellowships go unfilled, wait times grow longer. Families travel farther. Primary care physicians manage complex conditions without the specialist support they once had. In some regions, pediatric specialists are already hard to find. When shortages grow, children do not simply shift into another specialty. They wait.
The harder truth inside our field
We could blame this entirely on outside forces: chronic underfunding, Medicaid reimbursement rates, political neglect of children’s health.
Those things are real and they matter.
But there is something else that is harder to say out loud.
We have not been advocating for ourselves.
Pediatrics has always prided itself on sacrifice for children.
The problem is that over time, we became uncomfortable fighting for our own profession.
We watched the warning signs pile up: declining interest among medical students, fellowship programs struggling to recruit, inpatient pediatric beds disappearing across the country.
In 2022, Tufts Children’s Hospital closed, converting its pediatric beds into adult ICU capacity.
Most of medicine treated it as a sad but isolated story.
It was not.
It was a sign of where we were headed.
And as my co-author Jared Boyce and I wrote in STAT News in 2024, the combination of underfunding, political neglect, and our own silence has turned pediatrics into medicine’s largest skeleton crew.
We have known what was coming.
We just have not acted like it.
We have to get comfortable talking about money
When medical students hesitate about pediatrics, the explanation we reach for is usually the same: they must not truly love children.
They must not have the passion for it.
That explanation is a way of avoiding something harder.
Most trainees do love working with children.
What they are questioning is whether loving children should mean accepting financial instability that physicians in other specialties are not asked to accept.
Whether they say it out loud or not, many trainees are hearing a version of this message:
If you really love children, you should be willing to accept the financial consequences of that. And if you won’t, maybe pediatrics isn’t for you.
We need to stop sending that message.
Medical students are making career decisions while carrying substantial educational debt. They are looking at salaries, loan repayment timelines, housing costs, and whether they will be financially stable in ten years.
That is not greed.
That is common sense.
And pediatricians should feel comfortable having those conversations openly, whether it is about loan repayment strategies, retirement planning, or what a financially viable career in our field actually looks like.
The pay gap between pediatrics and adult medicine comes down to payer mix, not what other physicians earn.
Pediatrics depends heavily on Medicaid, which pays far less than commercial insurance or Medicare.
47% of Medicaid and CHIP enrollees are infants, children, and adolescents, yet only about 17% of Medicaid dollars go toward pediatric care.
Cutting an adult cardiologist’s salary does nothing to fix that.
Those physicians should be standing next to us making this argument to insurers, to CMS, to state Medicaid programs, to Congress.
We need their voices on our side.
That is a shared advocacy fight, not an internal one.
Fragmented effort is not a strategy
Across the country, people are working on pieces of this problem. One hospital launches a pipeline program. A professional society publishes a workforce report. An academic center pilots a fellowship incentive. A community group builds a mentorship network.
Each effort has value. But they rarely connect.
When everyone is working separately, we end up with a lot of activity and not much change.
Pediatrics does not need more isolated programs.
It needs a real coalition: academic medicine, community pediatricians, health systems, and industry partners, working from a shared plan with shared goals and shared accountability.
None of these groups can fix this on their own.
But together, there is a real chance.
A field that thinks long-term must act long-term
Pediatricians think in decades. That is part of what makes the work meaningful.
We follow our patients through childhood, through adolescence, into adulthood.
We understand that the decisions made early have consequences that last a lifetime.
We need to apply that same thinking to our own field.
The children who will need a pediatric nephrologist or an adolescent medicine specialist in 2035 are in elementary school right now.
The physicians who will care for them are in college, or high school, or not yet born.
What those future physicians decide to do with their careers will depend, in part, on what we do next.
Workforce problems do not appear overnight. They build through years of signals that are easier to ignore than confront.
We have been ignoring them long enough.
Pediatricians show up for children every day. It is time we showed up for our profession too.
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I plan to keep writing about this.
I hope some of you will keep reading, and that more of you will start pushing on this from wherever you are in the field.
Thank you for this post Dr Faith Danielle, as a medical student who sees the variety of medical specialities it’s hard to see how our choices affect the future of medicine for the general population. This post gives an interesting perspective that has now made me think of my own choices in next couple of years.