Small Patients, Big Impacts: The Price of Undervaluing Pediatricians

Prioritizing pediatric care has the potential to save society tens of billions of dollars [1]. Routine childhood immunizations have reduced potential healthcare costs by almost three trillion dollars [2]. Yet, despite enormous savings, pediatricians are among the lowest paid physicians in the United States [3].

As of 2022, the top six lowest-paying medical specialties in the country were Pediatric Endocrinology, Pediatric Infectious Disease, Pediatric Rheumatology, Pediatric Hematology/Oncology, Pediatric Nephrology, and General Pediatrics [4]. The pattern is clear: to become a pediatrician is to reduce your value in the eyes of the healthcare system. 

Consequently, it comes as no surprise that medical students, often saddled with crippling debt, would shy away from a specialty that wouldn’t allow them to pay off their loans. Why should they be expected to choose a career in which they are promised to be paid 25% less than their colleagues who treat adults [5]? As residency application rates are rising, so is the number of pediatric residency spots left unclaimed. In the span of just one year, the proportion of pediatric residency spots filled after the match dropped from 97% to 92% [6].

Without pediatricians, the financial burden on the healthcare system could reach unreasonable numbers. Action must be taken to combat the concerning decline in interest in pediatric healthcare. Some interventions involve providing early exposure to pediatrics to encourage more medical students to pursue this field of medicine [7]. Perhaps a stronger approach would be to target the root cause of the issue by reducing salary disparities and subsidizing pediatric subspecialties [8]. 

From a purely economic standpoint, it is clear that pediatricians are an essential part of the medical system. Recognizing the value of pediatricians through fair pay is necessary for the continued strength of healthcare in the United States.

Designed by: Jimin Lee

Reviewed by: Akhil E

References:

[1] Early childhood health interventions could save billions in health costs later in life. Johns Hopkins Bloomberg School of Public Health. Retrieved November 17, 2025 from https://publichealth.jhu.edu/2009/guyer-early- childhood.

[2] Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023. (2024, August 8). CDC Morbidity and Mortality Weekly Report. https://www.cdc.gov/mmwr/volumes/73/wr/ mm7331a2.htm.

[3] Haeffele, P. (2023, March 24). 20 lowest-paying specialties in 2022. Becker’s ASC Review. https://www.beckersasc.com/uncategorized/20-lowest- paying-specialties-in-2022/.

[4] Haeffele, P. (2023, March 24). 20 lowest-paying specialties in 2022. Becker’s ASC Review. https://www.beckersasc.com/uncategorized/20-lowest- paying-specialties-in-2022/.

[5] According to Dr. Sallie Permar, "A Nation With Too Few Pediatricians Could See a Soar in Health Care Costs." (2024, April 5). Weill Cornell Medicine Pediatrics. https://pediatrics.weill. cornell.edu/news/according-dr-sallie-permar-nation-too-few-pediatricians-could-see-soar-health-care-costs.

[6] Balch, B. (2024, September 26). Why are fewer U.S. MD graduates choosing pediatrics? AAMC News. https://www.aamc.org/news/why-are-fewer-us-md- graduates-choosing-pediatrics.

[7] Workgroup: Redesign Education. AMSPDC Pediatrics Workforce Initiative. Retrieved November 17, 2025 from https://amspdc.org/workforce/redesign-education/.

[8] Permar, S. & Vinci, R.J. (2024, April 1). A nation with too few pediatricians could see health care costs soar. STAT News. https://www.statnews.com/2024/04/02/too- few-pediatricians-health-care-costs/?utm_source=chatgpt.com.

The Economics of Burnout: Why Hospital Staffing Shortages are Costing Billions

When people talk about the high cost of healthcare in the United States, they often point to drug prices, hospital stays, or insurance premiums. Yet, they rarely consider the increasing economic consequences of physician burnout and staffing shortages, despite it being one of the largest burdens on the healthcare system.

What is physician burnout?

Physician burnout is not just being tired after a long shift. It’s a chronic occupational syndrome resulting from emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment in the workplace. Amongst physicians, emotional exhaustion includes feeling depleted at the end of a workday and feeling as though they have nothing left to offer patients emotionally. Depersonalization manifests as feelings of detachment and callousness towards patients, often treating them as objects rather than as human beings. This developing sense of cynicism towards one’s work leads physicians to feel disengaged from patients and simply “go through the motions” of their day-to-day demands. Physicians in this mental state often feel a sense of reduced personal accomplishment, reporting feelings of ineffectiveness and lack of value in their work [1].

Burnout amongst physicians is widespread, with 45.2% of physicians in 2023 reporting at least one symptom of burnout during their career. This number has significantly decreased from a substantial 62.8% burnout rate in 2021 during the COVID-19 pandemic [2]. Despite this seemingly positive decrease in burnout over the past 4 years, physicians still have burnout rates that are significantly higher than any other profession [3].

How burnout translates into billions

Burnout is the leading cause of physicians leaving the workforce early. Burnout directly contributes to costs of replacement for physicians leaving the practice or reducing their hours. The cost of physician burnout includes the cost of recruitment, onboarding and training new staff, and lost revenue due to position vacancy. However, it also includes hidden costs such as medical malpractice, reduced patient satisfaction, and damage to brand reputation and patient loyalty. This total can range from $500,000 to more than $1 million per doctor, depending on specialty and location [4]. When this number is multiplied by the thousands of physicians leaving the workforce each year, this number can skyrocket into the billions of dollars. On a national scale, a conservative estimate of $4.6 billion annually is attributed to burnout-driven turnover and reduced clinical hours [5].

Staffing shortages and the economy

Staffing shortages and burnout are closely intertwined, creating a detrimental cycle that threatens both patient care and hospital finances. When hospitals operate with fewer nurses and physicians than needed, remaining staff face heavier workloads, longer shifts, and increased overtime, which drives burnout and continues the cycle [6]. This burnout, in turn, forces hospitals to spend heavily on recruitment, temporary staff, and overtime.

Conclusion

Burnout is far more than a personal wellbeing problem; it is a financial and systemic issue. Hospitals that rely on overworked, under-supported physicians may save on payroll in the short term, but the hidden costs — turnover, reduced productivity, medical errors, and penalties — quickly surpass those savings. Understanding and addressing burnout is not only necessary for the physicians in question but is essential for sustainable, high-quality, and economically efficient healthcare.

Designed by: Sebastian Mardales

References:

[1] West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516–529. https://doi.org/10.1111/joim.12752

[2] Measuring and addressing physician burnout. (2025, May 15). American Medical Association. https://www.ama-assn.org/practice-management/physician-health/measuring-and-addressing-physician-burnout

[3] Sanford, J. (2025, April 9). U.S. physician burnout rates drop yet remain worryingly high, Stanford Medicine-led study finds. News Center. https://med.stanford.edu/news/all-news/2025/04/doctor-burnout-rates-what-they-mean.html

[4] How much physician burnout is costing your organization. (2018, October 11). American Medical Association. https://www.ama-assn.org/practice-management/physician-health/how-much-physician-burnout-costing-your-organization

[5] Han, S., Shanafelt, T. D., Sinsky, C. A., Awad, K. M., Dyrbye, L. N., Fiscus, L. C., Trockel, M., & Goh, J. (2019). Estimating the Attributable Cost of Physician Burnout in the United States. Annals of Internal Medicine, 170(11), 784–790. https://doi.org/10.7326/M18-1422

[6] Jones, D., & Allin, S. (2025). Causes and effects of hospital nursing shortages to consider potential feedback effects: An umbrella review. Human Resources for Health, 23(1), 61. https://doi.org/10.1186/s12960-025-01028-w

Who Pays, Who Participates, and Who Benefits? Women’s Health in the Hidden Economy of Research

Most patients will never read the fine print at the end of a research article and will not see who wrote the grants, which company supplied the drug, or which committee approved the protocol, yet these quiet details shape who is invited into research, whose data are collected, and which bodies are considered too complicated or too risky to include. The result is an invisible economy in which funding streams, ethical guidelines, and institutional habits determine what knowledge medicine produces. Women’s health sits at the center of this problem, since questions about who funds research and how conflicts of interest are managed intersect directly with decisions about who is permitted to participate in clinical trials, especially people who can become pregnant, who are pregnant, or who are lactating. Together, these forces dictate not only what gets discovered, but also who is ultimately able to benefit from those discoveries.

The Money Behind the Medicine

Research depends on grants, infrastructure, and institutional support, and as Mandal and colleagues explain, funding can come from internal sources or from outside organizations such as governments, corporations, and nongovernmental groups, a mix that is never ethically neutral [1]. When sponsors have commercial interests in the outcome, pressure to produce favorable findings can shape which questions are asked and how results are presented, and hidden relationships or incomplete conflict-of-interest disclosure can weaken trust in scientific work. Mandal et al. argue for transparency and oversight rather than rejection of industry involvement, insisting that institutions and researchers manage funds responsibly and disclose how sponsorship may shape a study [1]. For women’s health, these concerns are especially important because funders who view pregnancy, lactation, or hormonal conditions as legally risky or scientifically inconvenient may avoid trials that include these groups, which limits the evidence base needed to care for patients whose physiology has long been understudied.

From Exclusion to Conditional Inclusion

Women, particularly those who were pregnant or could become pregnant, were historically excluded from research. ACOG traces this pattern to harms such as the thalidomide tragedy, after which regulators barred people of childbearing potential from many trials in an attempt to protect future children [2]. This approach meant that drugs were tested almost entirely in nonpregnant bodies and then prescribed during pregnancy with little direct evidence to support their safety.

ACOG’s 2024 Committee Statement reframes this exclusion as an ethical failure rather than a safeguard. It argues that people who can become pregnant, who are pregnant, who are lactating, or who identify as women should be presumed eligible for research and that their inclusion is a matter of justice [2]. When these groups are left out, the benefits of research are distributed unfairly and the risks shift to patients who must make decisions without reliable data. Exclusion does not remove risk but instead relocates it, since clinicians still have to prescribe medications during pregnancy and often must rely on estimation rather than evidence.

Autonomy and the Conditions Placed on Participation

Ethics committees and funding bodies often impose conditions such as mandatory contraception or extra consent requirements, and ACOG argues that when these rules apply only to people who can become pregnant, they are paternalistic and discriminatory because they imply that one group’s autonomy is less trustworthy than others [2]. This creates a distribution problem as well as a procedural one. When restrictive criteria determine which studies receive funding, pregnant and lactating people are often excluded from participation, which means the evidence base skews toward nonpregnant bodies and later shapes clinical guidelines and insurance coverage.

Mandal et al. point out that funding structures influence how research questions are framed, while ACOG shows how ethical rules around inclusion and consent can either reinforce or challenge those pressures [1, 2]. Together they reveal a cycle in which funding influences protocol design, protocol design determines who can participate, and participation patterns shape which bodies medicine understands and knows how to treat.

Reimagining an Ethical Research Economy for Women’s Health

When pregnant or lactating people are systematically excluded from research, clinicians frequently must improvise when treating asthma, depression, autoimmune disease, or pregnancy-specific complications. This improvisation can lead to extra visits, off-label prescribing, and higher costs. The financial burden that patients experience often reflects earlier decisions made by grant reviewers and ethics committees.

A more ethical research landscape would place justice, transparency, and respect for participants at the center of funding decisions. Mandal et al. remind us that every source of support requires clear oversight and honest disclosure [1], while ACOG shows that people who can become pregnant should be actively included in studies rather than sidelined [2]. The hidden economy of medicine is ultimately about whose experiences shape scientific knowledge and whose needs are left unsupported. If research is to serve all patients, the choices made long before a study begins must reflect that responsibility.

Designed by: Julia Williams

References:

[1] Mandal, J., Parija, M., & Parija, S. C. (2012). Ethics of funding of research. Tropical parasitology, 2(2), 89–90. https://doi.org/10.4103/2229-5070.105172

[2] American College of Obstetricians and Gynecologists. Ethical considerations for increasing inclusivity in research participants. Committee Statement No. 9. Obstetrics & Gynecology. 2024;143:e155–63.