Valley Children's CEO Todd Suntrapak speaks to the Fresno Rotary Club on Monday, Feb. 24, 2025. Photo by Ben Hensley

Valley Children’s Hospital President and CEO Todd Suntrapak spoke to the Fresno Rotary Club on Monday, revealing some of the challenges facing pediatric care and how the team at Valley Children’s is preparing for the future.

Highlighting one of the key issues in California — and much of the world — is a dwindling population with significantly higher death rates than birth rates.

“Two centuries of rapid global population growth is coming to an end,” Suntrapak said.

The trend is apparent in places including China and Russia, which have historically seen higher birth rates than those in the US. Suntrapak noted that even the Central Valley, which has fared better than the rest of the state historically, has seen a drop in rates.

“This reality is going to challenge the pediatric provider community in ways that most people won’t consider,” he said.

Suntrapak said that attracting pediatric specialists to areas with fewer patients is becoming increasingly difficult.

He also pointed to a concerning trend in pediatric infectious disease training programs, which number less than 10 in the US.

“Last year, for instance, about 40% of the pediatric infections disease doctor training programs…went unfilled,” he said. “That’s huge because the entire country makes about eight.”

The combination of a declining pediatric population and a shortage of specialists could lead to a long-term health care crisis, he warned.

“You don’t really want to have like 20 people trying to learn with one small child who’s really afraid already, and then a bunch of people staring at them,” he said. “But the baseline challenge is, as the population continues to dwindle, there’s going to be more and more pressure on those training programs.”

Suntrapak added that most pediatric specialists want to specialize in specific areas of practice. 

“The more they do it, the better they are,” Suntrapak added, emphasizing the importance of specialized care in extremely rare cases.

Suntrapak said having a large enough patient base is critical for maintaining expertise.

“Conditions in children that can occur in 1 out of 100,000 or even 1 out of a million kids – scale is extremely important when it comes to training.”

Suntrapak added that partners including University of California, San Francisco; Stanford University; Cedars Sinai, University of Southern California and other leading providers in the country have massive training infrastructure with fewer numbers to train with.

With that in mind, Suntrapak said that all pediatric residents at Stanford do their training in the emergency department at Valley Children’s.