The U.S. health care system is facing a serious workforce shortage. In pediatric oncology, the stakes are especially high. But the issue is not simply a lack of available positions. Increasingly, it is a recruitment and retention challenge.
Recent pediatric hematology-oncology fellowship data shows that while training positions increased by 36.6 percent between 2009 and 2025, applicants increased by only 8.3 percent. During that same period, the applicant-to-position ratio declined from 1.01 to 0.80, while unfilled positions rose from 13.4 percent to 21.6 percent. In other words, the system is creating more training opportunities than the current workforce can fill.
That gap has practical consequences. With less specialized doctors, children may face delays in diagnosis or treatment. Families may need to travel farther for specialized care. Survivorship support may become harder to access.
This is not simply a staffing issue. It is a long-term threat to pediatric cancer care and research. Addressing it will require a clearer understanding of what is driving the pipeline problem, and a coordinated effort to support the people who make this field possible.
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Health care leaders must rebuild the physician and research pipeline
Pediatric oncology is struggling to recruit and retain the next generation of clinicians and researchers. Many young physicians enter the field because of a deeply personal connection to childhood cancer or a desire to work in mission-driven medicine. Yet they quickly encounter the realities of the specialty: lower compensation relative to workload, difficult funding environments, emotional exhaustion and limited institutional support.
The result is a pipeline problem that extends beyond physicians alone. The most affected roles include pediatric oncologists, oncology nurses, advanced practice providers, psychosocial clinicians, survivorship specialists, clinical trial coordinators and research nurses. These are the professionals who make pediatric cancer care possible, yet many institutions are struggling to fill and sustain those positions.
This also directly affects research. Pediatric cancer progress depends on clinical trials, but trials require people. Principal investigators, research nurses, pharmacists, regulatory specialists and data managers are all essential to moving therapies from discovery to patients. Yet workforce shortages are already slowing oncology research operations nationwide. One oncology workforce report found that 80 percent of clinical trial offices were understaffed, while as many as 95 percent of cancer centers reported staffing shortages affecting research operations.
Health care leaders should treat workforce development as a strategic priority, not a secondary operational issue. That means strengthening mentorship pathways, expanding fellowship support, protecting research time and creating sustainable career structures that encourage clinicians and scientists to stay in pediatric oncology long-term.
At PCRF, for example, this is why Emerging Investigator Grants are so important. These programs help early-career researchers generate the preliminary data, mentorship and institutional momentum needed to remain in pediatric cancer research rather than leaving for more sustainable specialties.
Pediatric oncology workforce planning must include the whole family, not just the child
Pediatric cancer care is fundamentally different from adult oncology because the impact extends across an entire family system. Treating a child with cancer requires far more than medical intervention alone. Families often depend on coordinated psychosocial care, behavioral health services, rehabilitation, survivorship planning and long-term follow-up that can continue for years after treatment ends. Despite this, many of the largest workforce shortages are occurring in exactly those areas.
Children’s hospitals are already navigating a national pediatric mental health crisis, with many systems struggling to meet existing behavioral health needs. When specialized support services are unavailable, the burden shifts back onto already overstretched frontline teams and families themselves.
Survivorship care is particularly vulnerable. Many childhood cancer survivors require long-term follow-up for cardiac complications, neurocognitive impacts, secondary cancers and mental health needs. Yet the National Cancer Institute continues to identify major gaps in survivorship care access and coordination. If health systems want sustainable retention, they must invest in the broader infrastructure that allows pediatric oncology teams, and the families they serve, to function long-term.
Solving this crisis will require collective action across the health care ecosystem
Pediatric oncology has always depended on collaboration because no single institution can solve these diseases alone. More than half of pediatric oncology funding comes from charities and nonprofit organizations, reflecting both the strength of the community and the structural gaps that still exist within the system. Meanwhile, only 4 percent of federal funding goes toward researching childhood cancers. Researchers already collaborate extensively across institutions to accelerate progress in rare diseases. The same level of coordination is now needed for workforce sustainability.
This is not about assigning blame to hospitals, government agencies or expecting one sector to solve the issue independently. It is about recognizing that the current deficit is unacceptable and that meaningful progress will require health care leaders, policymakers, academic centers, nonprofits, researchers and industry partners to work together more intentionally. That collaboration can take many forms: mentorship-based research networks, workforce think tanks, stronger funding partnerships, protected support for frontline teams, expanded psychosocial programs and investments in clinical trial infrastructure that allow institutions to retain specialized talent.
Most importantly, the field needs more urgency around sustainability. The positions already exist. The patients are already here. The challenge is that fewer people are entering the field, and fewer are staying.
Children with cancer deserve more than a health care system operating at its limits. They deserve specialized teams with the resources, support and infrastructure needed to deliver better treatments, stronger survivorship care and less toxic cures.
The future of pediatric oncology will depend on whether the health care community is willing to invest not only in research, but in the people responsible for carrying that research, and these children, forward.
This essay is cited in the KevinMD record on cancer.
Danielle Fragalla is a health care executive.
