We Have a Bipartisan Solution to the Pediatric Anesthesiologist Shortage

Watching someone take your child away for a major operation can be daunting, terrifying, utterly frightening. Many years ago, a mother gave me a simple green gemstone with an angel painted on it. This gift reminded me of the “why” of what we do as pediatric cardiac anesthesiologists. The trust it takes to allow someone to take your child and get them through a major operation is immense.

The feeling I get when a parent feels calm as I transport their child to the operating room hits home: I have had to trust colleagues to take care of one of my own children in the past.

There is a well-known shortage of anesthesia clinicians in the United States. But the shortage is not evenly distributed. It is worst, by a wide margin, in clinicians trained to work with children. And within that group, it is amplified in the small number of physicians trained to safely anesthetize a child undergoing heart surgery.

Congress has a role in fixing this.

Of the 34 pediatric cardiac anesthesia fellowship positions offered nationally in the 2023-2024 cycle, only 21 were filled, a 38% vacancy rate. The 20 fellowship programs that train these specialists graduate roughly 16 new pediatric cardiac anesthesiologists a year, combined, nationwide. Dr. Susan Nicolson of the Children’s Hospital of Philadelphia titled her paper on the subject bluntly, “Pediatric Cardiac Anesthesiologists: An Endangered Species.”

General pediatric anesthesia is close behind. In the 2023 match cycle, 86 of the 211 pediatric anesthesiology fellowship positions offered went unfilled, according to a 2024 study in Pediatric Anesthesia and match data reported by the Pediatric Anesthesiology Program Directors Association. An open letter from the American Society of Anesthesiologists to residents considering pediatric anesthesia cited an internal poll showing nearly 100% of pediatric anesthesia leaders were actively hiring.

Why does this matter more for children than the broader shortage suggests? Because a child is not just a small adult, and treating one like a small adult under anesthesia can cause harm.

Neonatal hearts are the size of a walnut; infant hearts, a plum; toddler hearts, an apple. An infant’s airway is shaped differently than an adult’s — narrower, more anterior and far less forgiving. A small reduction in airway diameter produces a disproportionate spike in resistance to breathing, so what would be a minor obstruction in an adult can cause a dangerous drop in oxygen in a baby within seconds.

A newborn’s heart rate, not blood pressure, is often the first and most reliable warning sign of trouble, very different than how adult anesthesia is monitored. Drug dosing has to account for a child’s weight, an immature liver and kidneys still learning to metabolize medication, and a body surface area that loses heat far faster than an adult’s.

In a child with congenital heart disease, the physiology is stranger still: blood may be flowing through the heart and lungs in a pattern surgeons spent decades learning to correct, and the anesthesiologist has to manage that flow, drug by drug and breath by breath, without tipping a fragile circulation into collapse.

This is why pediatric and pediatric cardiac anesthesiologists complete training that general anesthesiologists do not.

After a full anesthesiology residency, a pediatric fellowship adds a year devoted specifically to newborn, infant and child physiology and pharmacology, difficult pediatric airways, and the anesthetic care of congenital heart disease.

Many pediatric cardiac anesthesiologists then add a second fellowship year focused on cardiopulmonary bypass and the far more delicate calculus of anesthetizing a child whose heart itself is the surgical target.

The shortage has clear causes. A resident’s fellowship training adds one to two years of income foregone and debt accumulated, often without a corresponding salary increase on the other side.

Recent data show pediatric cardiac fellowship graduates can earn less than colleagues who go straight into adult practice from residency. More than half the pediatric cardiac anesthesia workforce is 55 or older, retiring faster than fellowships can replace them.

Federal Medicare funding for graduate medical education has been effectively frozen since 1997, capping the number of residency and fellowship slots hospitals can support regardless of need.

The solution is not mysterious. Congress has a bipartisan vehicle already in motion, the Resident Physician Shortage Reduction Act of 2025, which would add 14,000 Medicare-funded Graduate Medical Education slots over seven years.

None of those slots are earmarked for pediatric subspecialties.

Lawmakers should remedy that, while also reversing proposals to defund the Children’s Hospitals GME program that trains pediatric subspecialists outside the Medicare system altogether.

Federal loan repayment programs for pediatric subspecialists, like the Pediatric Specialty Loan Repayment Program, need expanded funding and eligibility. Hospitals and physician groups need to build salary structures that reward fellowship training rather than penalize it. And medical schools need to expose residents to pediatric and pediatric cardiac anesthesia earlier, before the financial math of a second fellowship year starts working against the specialty.

None of this is happening quickly enough. Every year it doesn’t, another cohort of pediatric cardiac anesthesiologists retires faster than one is trained to replace it.

The health of children in the future depends on decisions our lawmakers and residents make today to help bolster and encourage more residents to do pediatric and pediatric cardiac fellowships.

Frederick Mansfield, MD, FASA, is a partner anesthesiologist with U.S. Anesthesia Partners and Pediatric Cardiac Anesthesia Medical Director at AdventHealth for Children in Orlando. He can be found on LinkedIn.

As seens in The Well News, Sept. 10, 2026