After six successful seasons with the Minnesota Vikings, four-time Pro Bowl quarterback Kirk Cousins entered free agency at the age of 35. Many wondered whether he would take a “hometown discount” to stay with the Vikings, or whether he would go elsewhere for higher pay. When asked whether finances would factor into his decision about where he would play next, Cousins responded with advice he received from a former coach: “Kirk, it’s not about the dollars, but it is about what the dollars represent.”
Pediatrics in the U.S. continues to face one of the biggest challenges in its modern history. Pediatricians are among the lowest paid physicians across the nation. Despite a shortage of pediatricians, particularly in rural and resource-limited settings, 8.2% of categorical pediatrics residency positions were unfilled in the 2024 Match, accounting for a record 252 unfilled residency positions. While this slightly improved in the 2025 Match with 147 unfilled positions (4.7% of total available positions) and the 2026 Match with 179 unfilled positions (5.6% of total available positions), recruitment of pediatricians remains a challenge. At the institution where I am in residency, of the approximately 140 graduating medical students, none applied or matched into categorical pediatrics in 2025; two out of the approximately 140 graduating medical students matched into categorical pediatrics in 2026.
Is the decline in pediatrics interest merely a matter of finances and salary? I would argue that it is not solely about the “dollars”; instead, it is about what the “dollars represent.” The decreased salaries for pediatricians signal to medical students and trainees that we as a society and healthcare as a whole do not value the care of children in the same way as adults.
While there are many reasons for declining interest in pediatrics among medical students, most experts agree that one of the biggest reasons is the low salary of general pediatricians and subspecialists. A large percentage of children are insured under Medicaid. While Medicaid is an invaluable program, it reimburses at lower rates than Medicare and commercial insurance companies. Moreover, pediatricians spend large portions of unbillable time answering parent questions, counseling families, and addressing social needs that impact health. What this means is that pediatricians are among the lowest paid physicians in our country. The average medical student debt is well over $200,000.
The perceived lack of value for pediatrics among medical trainees is inconsistent with the high value placed on children’s lives in our society. We treat a pediatric medical emergency on a flight or at an amusement park with the utmost urgency. Could we imagine a world where first responders were incentivized to respond to adults over children? Other health professionals who work with children (e.g., nurses, occupational therapists, physical therapists, and respiratory therapists) are generally paid the same amount as their counterparts who work with adults.
Some may say that a lack of pay for pediatricians is appropriate, believing that children are less complex than adults; such views do not account for the lived experience of caring for sick children and time spent counseling parents and patients. As a parent and a physician dual-trained in both IM and pediatrics, I can attest that practicing pediatrics is difficult. Children have different anatomy than adults, and interventions require precision and careful thought. Errors and unintended outcomes are costly. Many children are not able to verbalize their symptoms, and pediatricians must rely on subtle cues to make diagnoses.
To be sure, other specialty-specific factors, such as a shortage of mentors, decreased exposure to pediatrics in medical school, and an additional two-year pediatrics hospitalist fellowship for trainees interested in a career taking care of patients in the hospital are also thought to contribute to decreased interest in the specialty. There is also a common belief among U.S. medical students that pediatrics is “easy” and a “waste” of career potential compared to more lucrative specialties.
How can we begin to address the declining interest in pediatrics? Advocacy for higher pediatrics reimbursement on the national level is important; yet is there anything that can be done locally? While I acknowledge that this is a very complex topic without easy solutions, here are a few potential ideas for renewing interest in pediatrics.
First, provide medical students with career support, mentorship, and exposure to diverse careers in pediatrics. With support, it can be possible to increase interest in pediatrics among medical students. A big reason why I decided to train in both IM and pediatrics is that in medical school, I worked with pediatricians who were outstanding clinicians, educators, and mentors well respected in the community. At my medical school (the University of Hawaii), 15 medical students (20% of the graduating class) matched into categorical pediatrics in 2024, 10 medical students (14% of the graduating class) matched into categorical pediatrics in 2025, and six medical students (8% of the graduating class) matched into categorical pediatrics in 2026. I believe that one important reason why the University of Hawaii has continued to successfully recruit medical students into pediatrics is that their medical students longitudinally rotate in community-based pediatric practices across the state during their third year. This allows students to envision what it could mean to practice pediatrics outside of an academic center.
Second, encourage trainees to choose pediatrics and pediatric subspecialties. In clinical settings and on social media, medical students and trainees are often encouraged to pursue careers in specialties other than pediatrics. One of my med/peds colleagues pursuing a career in pediatric cardiology has been advised by several of his mentors to train in adult cardiology for better pay and respect. He has resisted the advice because he loves taking care of children with complex congenital cardiac conditions and supporting their holistic needs throughout childhood and adolescence. In academic medicine, we need to stop thinking that trainees who choose careers in pediatrics are “wasting” their talent. Instead, we should praise them for dedicating their lives to the betterment of children and their future — often forgoing alternate career paths with better pay. These types of professional decisions often come out of a sense of a professional calling and should be deeply respected and encouraged.
Third, work toward pay parity locally. While there is a need to continue to advocate for pay parity on the national level, local advocacy can play an important role in pediatricians being appropriately compensated. In some community medical practices — such as in many federally qualified health centers — pediatricians are paid a similar salary as internists and family medicine physicians. These models of pay equity must also be present in academic institutions, where medical students are exposed to careers in pediatrics.
Overall, the declining interest in pediatrics is not only about the salary, though improving Medicaid funding, increasing reimbursement, and standardizing pediatrician salaries could go a long way in recruiting future pediatricians. Low pay for pediatricians represents academic medicine’s lack of value for pediatricians. If we value children’s health as much as we say we do, our health systems and the broader community need to better demonstrate to trainees and medical students that we value the care of children — starting with respect for the important and often challenging work of pediatricians.
Kalei R.J. Hosaka is a fourth-year chief resident physician in IM and pediatrics at UCLA. Kalei is from Hawaii; he received his undergraduate degree in anthropology from Wheaton College, his medical degree from the University of Hawaii John A. Burns School of Medicine, and a certificate of professional achievement in narrative medicine through Columbia University. The opinions expressed in this essay are solely his and do not reflect or represent the viewpoints of his institution.
Animation by Jennifer Bogartz
