We appreciate the letter from Drs Houck and Oldham,1 which adds important context regarding the American College of Surgeons Children’s Surgery Verification (ACS CSV) Quality Improvement Program. The goal of this program to improve the alignment of resources for pediatric patients is commendable and represents a step forward in pediatric care. Our work highlights the geographic disparities in access to identified pediatric anesthesiologists; however, we certainly acknowledge that the broader care community is vitally important and that other anesthesiologists and midlevel anesthesia providers competently care for pediatric patients routinely. With further research, it will be interesting to understand whether the location of pediatric anesthesiologists is a marker for the presence of underlying, integrated pediatric systems of care, which would enable a focus on improving access to patients in those more distant areas, through regional or local resources. As next steps, we plan to further elucidate the numbers and varieties of pediatric cases that require anesthesia and the settings in which they occur to help increase the understanding of where opportunities for improvement exist. We, too, hope that where those underlying systems do not exist, the ACS CSV Quality Improvement Program will establish the framework for safe, high-quality care.