A mother calls a neurologist’s office the morning after watching her daughter seize in her sleep. She calls as soon as the office opens, explains exactly what happened, and waits for guidance. The earliest appointment is three months away. That is not a worst-case scenario. It is routine.
This is what the child neurology shortage actually looks like. It does not arrive as a headline. It arrives as hold music. It arrives as a mother circling a date in March after calling in January, not because anyone deemed her daughter’s case low priority, but because no earlier appointment exists. It arrives in the resignation of families who have learned to view a four-month wait as good fortune because they know someone who waited eight.
The numbers behind that reality are difficult to ignore. In April 2025, the CDC reported that 1 in 31 children in the United States is now diagnosed with autism spectrum disorder, up from 1 in 36 just two years earlier and nearly five times the rate recorded when tracking began in 2000. More than 1 in 5 children has some form of neurodevelopmental disorder. The Child Neurology Foundation estimates a physician shortage of roughly 20 percent, a figure many experts consider conservative. Need continues to rise while the workforce grows too slowly to keep pace. The result is measured not in spreadsheets but in delayed diagnoses, deferred treatment, and families waiting months for care.
So why are more physicians not choosing this field?
The answer is structural, not personal. Traditionally, to become a child neurologist, a physician completes medical school, followed by two years of general pediatrics, one year of adult neurology, and two additional years of pediatric neurology training. At a minimum, that is a five-year commitment after earning an MD or DO degree, making it one of the longest training pathways among pediatric subspecialties. Physicians emerge with highly specialized expertise and, often, six-figure debt. Median compensation ranges from roughly $225,000 to $250,000 annually, a respectable salary until it is compared with adult neurology or surgical specialties that require fewer years of training. A 2020 study in Neurology found that more than 86 percent of pediatric neurologists reported symptoms of burnout. The field demands extraordinary commitment. Too often, the incentives point elsewhere.
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There is genuine progress worth acknowledging. The 2026 NRMP Match offered 211 child neurology positions, up 27 percent from 2022, and filled 205 of them for a 97.2 percent fill rate. Driven by record participation, both U.S. MD and DO seniors matched into the specialty in historic numbers. Growth is encouraging. Adequacy is another question entirely. The Children’s Hospital Association has consistently identified pediatric neurology as one of the most severely understaffed specialties in children’s hospitals, a reality that has changed little since its 2017 survey. The pipeline is expanding, but the gap remains substantial.
Several changes would help address it. The Children’s Hospitals Graduate Medical Education program (CHGME) serves as the primary federal funding mechanism for residency training at children’s hospitals. In fiscal year 2025, it provided $367 million to 59 hospitals that collectively train 55 percent of all general pediatrics residents and 56 percent of all pediatric subspecialty residents. Yet, on a per-resident basis, CHGME funding remains roughly half of what Medicare provides for residency training at general hospitals. The reason is simple: Children’s hospitals care for patients under 18, while Medicare was designed around patients over 65. A coalition of more than two dozen health organizations, including the AMA and AHA, has called on Congress to increase CHGME funding to $758 million. Congress has yet to act. Closing this funding gap is not ambitious policy. It is basic maintenance of the training infrastructure on which pediatric care depends.
The training pathway also warrants serious examination. Leaders within the specialty have increasingly questioned whether the current structure, including three years of prerequisite training in pediatrics and adult neurology, could be redesigned without sacrificing clinical rigor. Some have proposed a four-year pathway. The goal is not to lower standards. It is to recognize that a training model designed for a different era may be discouraging talented physicians from entering a field that urgently needs them.
Medicaid reimbursement represents another challenge beneath the surface of the workforce shortage. Many children with complex neurological conditions rely on public insurance. When reimbursement rates fail to cover the cost of care, practices face difficult financial decisions. They limit new Medicaid patients, reduce clinic availability, or close panels altogether. Families with the fewest alternatives bear the consequences in the form of longer waits and reduced access.
Then there is the issue of exposure, which begins long before residency applications are submitted. Most medical students never rotate through child neurology. Many have never met a child neurologist. The Child Neurology Society’s outreach programs are valuable, but they primarily reach students who already know the specialty exists. What is needed is broader and earlier exposure: elective opportunities, mentorship programs for students at schools without affiliated children’s hospitals, and greater representation of child neurology in preclinical curricula. Interest rarely emerges in a vacuum. It develops through mentorship, meaningful clinical experiences, and patient encounters that leave a lasting impression. The specialty cannot afford to wait for students to discover it on their own. It must actively introduce itself.
I am a second-year osteopathic medical student who hopes to enter this field. I am writing this because a structural problem is too often treated as an inevitability rather than a consequence of policy decisions. The shortage of child neurologists is not a weather event. It is the predictable outcome of choices about how we fund training, structure pathways into the profession, reimburse care, and cultivate future physicians.
The children sitting on those waitlists are not there because too few doctors love pediatric neuroscience. They are there because we have built a system that makes loving it not quite enough. That mother deserved an appointment the week she called. So did every family who called before her. The solutions are not mysterious. What is missing is the urgency to implement them.
This essay is cited in the KevinMD record on children’s health.
Shaan R. Mody is a medical student.
