Reflections from PAS 2026: Workforce, Medicaid and Compensation — Three Issues Pediatrics Can No Longer Separate
I had the opportunity to attend the 2026 PAS Meeting in Boston and to connect with many new and old friends. This year’s meeting felt different and more serious in a very important way. While scientific discovery and innovation remained central themes, many of the most urgent conversations centered around the sustainability of children’s healthcare. From medical students to emeritus thought leaders, the future viability of the specialty was on the tip of the tongue.
Three themes consistently surfaced across sessions, coffee breaks, the exhibit hall and in awardee acceptance speeches:
- Addressing pediatric workforce shortages
- Medicaid reimbursement reform
- Pediatric faculty compensation shortfalls
It became increasingly clear throughout the meeting that these three issues are no longer separate conversations or initiatives. They are deeply and intimately intertwined. The common sentiment centered on a belief that without significant progress on faculty compensation, workforce and Medicaid solutions, while critical, would likely fall short of transformational change needed in academic pediatrics.
Workforce Themes: Recruitment pipelines are shrinking, burnout remains high with increasing signs of moral injury, retirements are accelerating, and the gaps in access to care for children continues to widen.
Medicaid Themes: Reimbursement continually fails to reflect the complexity of pediatric care, the time-intensive nature of family-centered medicine, care coordination requirements, behavioral health integration, and the growing needs of children with medical complexity. Attendees spoke candidly about how inadequate reimbursement affects hospital margins and missional reinvestments, faculty hiring, outreach programs, and competitive compensation.
Physician Compensation: The “Tie That Binds” Everything Together
If there was one conversation that felt impossible to avoid at this year’s meeting, it was faculty compensation. For years, pediatric compensation discussions occurred quietly in hallways rather than on main stages. This year, the topic was in your face and much appreciated. Without public awareness of the gravity of the situation, change is not possible.
Leaders engaged openly around the widening compensation disparities between pediatrics and adult medicine, their challenges recruiting academic pediatric subspecialists, increasing package competition between institutions, and the limitations of traditional RVU-based compensation models in many subspecialties. It was clear our current compensation models are failing us in attracting the next generation of physicians to the specialty.
Medicaid reimbursement and pediatric faculty compensation are inseparable. Pediatric departments cannot sustainably recruit and retain the subspecialist to build divisions and programs for kids while operating within historically underfunded reimbursement models. It was clear at PAS that compensation is not simply a budgeting issue anymore—it is an access-to-care national crisis.
Lights in the Darkness: Despite the many challenges discussed, my time at PAS also showcased tremendous innovation, collaboration, and resilience. So many great leaders and minds across academic child health seeking positive change for kids. I was particularly encouraged by:
- the national recognition of pediatric workforce challenges,
- increased openness around the need for compensation reform,
- advancements in AI-based digital health tools and recognized efficiencies,
- seeing the recognized need for deeper collaboration between children’s hospitals, universities, and policymakers.
- a continued emphasis on leadership development, mentorship, and recognition of emerging voices in pediatrics.
- Last but not least, a special shout out to Child Health Advisory Council Executive Board Member, Danielle Laraque-Arena, recognized as a George Armstrong Lecture Awardee. Well-deserved!
As a proud sponsor of PAS, AMSPDC and AAAP, we are in a unique position to see positive changes that will surely lift all organizations and pediatricians diligently working for brighter futures for our Nation’s children. We were honored to participate in so many thoughtful conversations at this year’s PAS meeting and believe the future is challenging, but very bright!
Wesley Millican
Past Posts
It is increasingly clear that 2026 will be a pivotal moment within the academic child health leadership continuum. Escalating workforce shortages, rising burnout, national policy changes and increasing financial pressures are rapidly reshaping the strategies and tactics leaders must embrace for meaningful advancement across all missions. While solutions are complex and challenging, 2025 has shown us leadership opportunities for high impact.
As we move into the new year, I look forward to sharing perspectives and learning alongside colleagues who are navigating this rapidly changing environment.
Based on what we are seeing, high-impact leaders in 2026 will consistently demonstrate four core behaviors:
1. Be Proactive
Evolving beyond traditional university and HR faculty recruitment and retention practices—many of which remain adult-medicine centric—is required this year. Effective leaders will proactively engage in rethinking faculty talent strategies early in 2026 and will seek to formalize innovative best practices and programs in partnership with their children’s hospital colleagues. Relying solely on advertisements and limited in-house resources will be futile and will continue to drive escalating faculty shortages and retention challenges.
2. Be Present
Faculty are under extraordinary stress and dealing with unprecedented levels of burnout and moral injury. Leaders achieving impact in these areas are viewed as “present” by their faculty in both clinic and hospital settings. Visibility, engagement and accessibility matter more than ever.
3. Be an Advocate
Competitive compensation is an absolute requirement for effective recruitment and retention strategies. All strategies for solving current workforce issues will be a risk if competitive compensation remains unsolved. In 2026, pediatric subspecialty compensation will need to be at or above the 50% for faculty and 75% for leaders. Determined diligence and advocacy with health system and university partners is the only path for getting there. Medical Students and undergraduates are watching!
4. Be a Delegator
Leadership styles are evolving from top-down toward greater delegation and autonomy. Such cultures appear to me to be healthier and suffering from fewer retention challenges, especially with mid-career and younger faculty. The intentional creation of opportunities for growth and development, even in small measures, will be critical.
We believe academic pediatrics can make real strides forward in 2026 but we must be diligent and look forward to seeing the innovative solutions that will evolve from the efforts of effective leaders who understand that strong leadership is no longer optional and is essential to protecting patient care, supporting faculty wellbeing and sustaining the academic mission for the next generation.
Wesley Millican
In our work partnering with children’s hospitals, schools of medicine and pediatric departments across the country, I’ve had a front-row seat to a talent acquisition shift that can no longer be ignored. Pediatric workforce dynamics are changing rapidly and compensation strategy has quickly become the most consequential – and often misunderstood – lever in faculty talent recruitment and retention. What once was a slow-building concern is now an urgent, system-level imperative and will be a pre-process priority for all applicants. The top three themes shaping the compensation debate include:
- Shrinking Leadership Pipelines
The most consistent theme heard from pediatric department chairs and division directors centers on “the rapidly declining pools of fully qualified faculty leadership candidates.” Training pipelines in pediatric subspecialties are narrowing, which leaves little hope for enhanced future pipelines. The result is predictable but increasingly acute—longer time-to-fill, more declined offers and heightened competition among institutions for a limited pool of talent.
- RVU Based Compensation Mismatch
Another recurring theme is directed at how poorly traditional RVU-based remuneration frameworks translate to competitive compensation for many pediatric subspecialties. Our highly cognitive, consultative specialties continue to feel undervalued in comparison to their procedural based specialty colleagues. What we often hear from leaders is their physicians are incredibly busy but the numbers and compensation don’t reflect it. It is rarely a performance issue and we must find a better model.
- Painful Costs of Underpayment
The tendency still exists in many health systems to support below-market compensation as a starting point or a negotiation strategy. Choosing to be proactively competitive and innovative in your compensation strategy is now mission critical. Faculty who believe they are undervalued are experiencing burnout and frustrations at higher levels and are highly susceptible to the recruiting advances of neighboring and national programs. Every departure triggers a cascade: search costs, interim coverage, lost revenue, onboarding delays, team disruption, and, in many cases, increased burnout.
We’re at a critical inflection point. Pediatric subspecialty care will not survive within outdated compensation cultures. Health systems that fail to adapt and invest risk deepening child health workforce shortages, limiting access, and a continual undermining of their long-term sustainability. Organizations that are taking a proactive, market-aligned approach to compensation are gaining a clear competitive advantage, not just in recruitment, but in stability, quality and performance.
Looking ahead, compensation is no longer a downstream financial decision. It is a core workforce strategy. Aligning pay with market realities is essential to attracting top talent and retaining our experienced faculty.
Leadership candidates asking about compensation are typically not asking for themselves. They are attuned to the workforce shortages and know what it will take to add faculty. If you are below market, the best applicants will not engage for fear of future years of failed recruiting due to compensation and resources. The stakes are high and the window to engage and innovate with our institutional partners is today.
Wesley Millican