UCSF Launches Structured Pediatric Residency Pipeline to Address an 82-per-100,000 Doctor Shortage

American children wait longer for medical care than children in most other high-income countries, and the gap in pediatrician supply is a major reason why. The national ratio stands at 82 pediatricians per 100,000 children - compared with 348 adult physicians per 100,000 adults. That disparity contributes to delayed diagnoses, fragmented care, and outcomes on childhood health measures that lag behind peer nations.

UC San Francisco launched a new medical education program in January 2025 to push against that problem. The Pediatric Specialized Training and Advancement to Residency Track, known as Peds-START, is the only program of its kind west of the Mississippi. It enrolls medical students early in their training, connects them with pediatric mentors, provides pediatrics-focused clinical experiences, and - critically - offers a structured pathway into UCSF's pediatric residency program upon graduation.

Why students avoid pediatrics

Pediatrics is one of the lowest-paying physician specialties. Medical students graduate with an average of more than $200,000 in debt, and the financial calculus of specialty choice is unavoidable. Children make up 22 percent of the U.S. population, yet fewer than 10 percent of residency positions are in pediatrics - a structural imbalance rooted in federal funding decisions that have allocated residency positions disproportionately toward adult medicine.

"Medical students face intense pressure related to specialty choice, residency placement, and educational debt," said Michele Long, a pediatric hospitalist at UCSF Benioff Children's Hospitals and director of Peds-START. "By offering structured support and a clear pathway, Peds-START allows students to focus on becoming excellent pediatricians."

The program was inspired by a prior UCSF pilot that ultimately produced nearly two dozen practicing pediatricians and pediatric subspecialists. That track's graduates have gone on to serve patients in underserved communities, demonstrating that early structured commitment to pediatrics translates into sustained careers rather than specialty drift.

What Peds-START provides

The program pairs enrolled students with pediatric faculty mentors from the outset of medical school, provides access to pediatrics-focused clinical rotations, and offers academic support and community among a cohort of students with similar career goals. The residency pathway removes one of the most anxiety-provoking uncertainties in medical training: where you will match after graduation.

Kathleen Wallace, a UCSF alumna of the prior pilot program, is now a practicing pediatrician in San Francisco. "The mentorship and early clinical exposure were essential," she said. "It gave me the confidence to pursue pediatrics and tailor my education to serve children who reflect the communities I grew up in."

California's modest advantage and the policy gap beneath it

California does slightly better than the national average, with 86 pediatricians per 100,000 children. Other states fare far worse. Idaho has the lowest per-capita pediatrician count in the nation. Rural and low-income communities within every state face acute shortages regardless of state averages.

Janet Coffman, a researcher at UCSF's Institute for Health Policy Studies, locates the root cause squarely in policy decisions rather than pipeline problems. "It is important to remember that policy created the physician and pediatrician shortage, and policy can solve the shortage," she said.

The solutions Coffman and other health workforce experts identify are structural: expanded federal Graduate Medical Education funding for pediatric positions, removal of caps on federally supported residency slots, higher Medicaid reimbursement rates for pediatric services, more generous loan-forgiveness programs for physicians who choose pediatrics, and increased funding for children's hospitals. Without these changes, programs like Peds-START can shift individual career trajectories but cannot close the aggregate gap.

"Programs like Peds-START are essential," Coffman said. "But without systemic policy change, the pediatrician shortage will persist - and children will continue to pay the price."

Long's own experience reinforces the urgency. As a hospitalist trying to arrange follow-up care for patients leaving the hospital, she routinely encountered waits of six months or more for subspecialty appointments. "That delay can have real consequences for children's health," she said. The program she now directs addresses a single link in a long chain, but it is a link that UCSF is positioned to act on now.