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Soranno DE, Amaral S, Ashoor I, Atkinson MA, Barletta GM, Braun MC, Carlson J, Carter C, Chua A, Dharnidharka VR, Drake K, Erkan E, Feig D, Goldstein SL, Hains D, Harshman LA, Ingulli E, Kula AJ, Leonard M, Mannemuddhu S, Menon S, Modi ZJ, Moxey-Mims M, Nada A, Norwood V, Starr MC, Verghese PS, Weidemann D, Weinstein A, Smith J. Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology. Pediatr Nephrol 2024:10.1007/s00467-024-06410-9. [PMID: 38976042 DOI: 10.1007/s00467-024-06410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 07/09/2024]
Abstract
IMPORTANCE Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care. OBJECTIVE To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce. EVIDENCE REVIEW Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions. FINDINGS A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology. CONCLUSIONS AND RELEVANCE The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients.
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Affiliation(s)
- Danielle E Soranno
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Bioengineering, Purdue University Weldon School of Engineering, 1044 W. Walnut Street, West Lafayette, IN, R4-42146202, USA.
| | - Sandra Amaral
- Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Isa Ashoor
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gina-Marie Barletta
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Michael C Braun
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Joann Carlson
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Caitlin Carter
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | - Annabelle Chua
- Duke Children's Hospital and Health Center, Durham, NC, USA
| | | | - Keri Drake
- University of Texas Southwestern Medical Center, St. Louis, MO, USA
| | - Elif Erkan
- Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA
| | - Dan Feig
- Department of Pediatrics, University of Alabama, Heersink School of Medicine, Birmingham, AL, USA
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA
| | - David Hains
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Elizabeth Ingulli
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | | | - Mary Leonard
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Shina Menon
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Zubin J Modi
- Department of Pediatrics and Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Marva Moxey-Mims
- Department of Pediatrics, Children's National Hospital/George Washington University SOM, Washington, D.C, USA
| | - Arwa Nada
- Department of Pediatrics, Le Bonheur Children's Hospital, UTHSC, Memphis, TN, USA
| | - Victoria Norwood
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Michelle C Starr
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Darcy Weidemann
- Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Adam Weinstein
- Department of Medical Sciences and Pediatrics, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jodi Smith
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Shah S, Myers P, Enciso JM, Davis AS, Crouch EE, Scheurer AM, Song C, Lakshminrusimha S. Should neonatal-perinatal medicine move to two-year fellowships? J Perinatol 2024:10.1038/s41372-024-02020-3. [PMID: 38851854 DOI: 10.1038/s41372-024-02020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/25/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
The duration of the majority of fellowships in pediatrics has been three-years. With increasing shortages of some outpatient-based pediatric subspecialists, shorter two-year fellowships are being considered for clinically oriented trainees not interested in a career based on research. Shortening the duration of fellowship may have some financial merits such as achieving a higher salary earlier after shorter training. However, we feel that continuing with a three-year duration for neonatology is more pragmatic at this time due to reductions in intensive care rotations during residency, time required to achieve procedural excellence, the need for exposure to quality assurance methodology, proficiency in novel techniques such as bedside ultrasound, and to maintain the physician-scientist pipeline. The demand for neonatal fellowship continues to be high. Ongoing evaluation of the job market, training needs and fellowship curriculum is needed to determine if the duration of fellowship should be altered in the future.
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Affiliation(s)
- Shetal Shah
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Patrick Myers
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Josephine M Enciso
- Department of Pediatrics, Division of Neonatology and Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Elizabeth E Crouch
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California San Francisco, San Francisco, CA, USA
| | - Andrea M Scheurer
- Department of Pediatric and Adolescent Medicine, Homer Stryker School of Medicine, Western Michigan University, Kalamazoo, MI, USA
- Neonatal Intensive Care, Bronson Children's Hospital, Kalamazoo, MI, USA
| | - Clara Song
- Department of Neonatal-Perinatal Medicine, Southern California Permanente Medical Group, Anaheim, CA, USA
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Bhatia A, Nestander M, Lucke A, Bernstein SM, Gautam S, Horowitz E, Day C. Factors Influencing Compensation of Early Career Neonatologists. Am J Perinatol 2024; 41:e1908-e1916. [PMID: 37308087 DOI: 10.1055/s-0043-1769792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Workforce characteristics and compensation specific to early career neonatologists remain poorly defined. Lack of transparency surrounding compensation limits benchmarking for neonatologists entering the workforce and may negatively influence individual lifetime earnings. Our objective was to provide granular data for this unique subpopulation by defining employment characteristics and factors influential to compensation of early career neonatologists. STUDY DESIGN An anonymous 59-question cross-sectional electronic survey was distributed to eligible members of American Academy of Pediatrics Trainees and Early Career Neonatologists. A focused analysis was conducted on salary and bonus compensation data collected from the survey instrument. Respondents were classified based on primary site of employment: nonuniversity located (e.g., private practice, hospital employed, government/military, and hybrid employment groups) versus university located practice settings (e.g., work is primarily conducted in a neonatal intensive care unit (NICU) setting located within a university organization). Median quantile regression was used to conduct univariate and multivariate analyses using SAS Software version 9.4. RESULTS We received 348 responses (26.7% response rate). Median salary was $220,000 (interquartile range: $200,000-250,000). Factors associated with salary include academic rank (instructor: $196,000; assistant professor: $220,000 [12% increase; p < 0.001]; associate professor: $260,000 [18% increase]; p = 0.027) and years of experience (p = 0.017), after adjusting for relevant factors. Employment location, practice type, group size, clinical schedule, location of medical school training, and gender identity did not significantly influence salary in multivariate quantile regression. Median annual bonus was $7,000 higher for nonuniversity located positions ($20,000 vs. 13,000; p = 0.021), with assumption of additional administrative roles and practice group seniority as most commonly cited bonus criteria (p = 0.002 and <0.001, respectively). CONCLUSION Academic rank and years of experience may influence salary. Bonus earnings are higher for nonuniversity located positions. Employment models are evolving to incorporate academic teaching appointments while practicing in nonuniversity located NICUs. This is the first detailed compensation analysis of early career neonatologists. KEY POINTS · Transparent compensation data specific to early career neonatologists is lacking.. · Associated factors influential to compensation of early career neonatologists remain unclear.. · This study identifies years of experience and academic rank as possible factors influencing salary earnings of early career neonatologists.. · Practicing in nonuniversity located positions was associated with greater bonus earning potential..
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Affiliation(s)
- Anisha Bhatia
- Division of Neonatology, Rush University Medical Center, Aurora, Illinois
| | - Matt Nestander
- Division of Newborn Medicine, Carl R. Darnall Hospital, Fort Hood, Texas
| | - Ashley Lucke
- Department of Pediatrics, Dell Children's Hospital, Austin, Texas
| | | | - Shiva Gautam
- Department of Biostatistics, University of Florida, Jacksonville, Florida
| | - Eric Horowitz
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Colby Day
- Department of Pediatrics, University of Rochester Medical Center, Golisano Children's Hospital at Strong, Rochester, New York
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Lakshminrusimha S, Cheng TL, Leonard MB, Devaskar SU, Vinci RJ, Degnon L, St Geme JW. Raising the Bar: The Need for Increased Financial Support to Sustain and Expand the Community of Pediatric Subspecialists. J Pediatr 2024; 267:113758. [PMID: 37748730 DOI: 10.1016/j.jpeds.2023.113758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Satyan Lakshminrusimha
- Department of Pediatrics, University of California at Davis, UC Davis Children's Hospital, Sacramento, CA.
| | - Tina L Cheng
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA
| | - Robert J Vinci
- Department of Pediatrics, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA
| | | | - Joseph W St Geme
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
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Azok JG, O'Donnell KA, Long ME, Wang HC, Crook T, Pogemiller MI, Momotaz H, Knight AB, Burns RA, Harrison VA, Schmidt SM, Van Opstal ER, Weinstein AR. Factors Influencing Medical Students' Career Choice to Pursue Pediatrics. J Pediatr 2024; 265:113525. [PMID: 37247816 DOI: 10.1016/j.jpeds.2023.113525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Jill G Azok
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH; Department of Pediatrics, Case Western Reserve University, Cleveland, OH.
| | | | - Michele E Long
- Department of Pediatrics, University of California, San Francisco, Alamo State, CA
| | - Helen C Wang
- Department of Pediatrics, University of California, San Diego, La Jolla, CA
| | - Travis Crook
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Mark I Pogemiller
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Hasina Momotaz
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Abena B Knight
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Rebekah A Burns
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Virginia A Harrison
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Suzanne M Schmidt
- Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Adam R Weinstein
- Department of Medical Sciences and Pediatrics, Frank H. Netter MD School of Medicine at Quinnipiac University, Hamden, CT
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Iyer MS, Nagler J, Mink RB, Gonzalez Del Rey J. Child Health Needs and the Pediatric Emergency Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678I. [PMID: 38300011 DOI: 10.1542/peds.2023-063678i] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Approximately 30 million ill and injured children annually visit emergency departments (EDs) in the United States. Data suggest that patients seen in pediatric EDs by board-certified pediatric emergency medicine (PEM) physicians receive higher-quality care than those cared for by non-PEM physicians. These benefits, coupled with the continued growth in PEM since its inception in the early 1990s, have impacted child health broadly. This article is part of a Pediatrics supplement focused on predicting the future pediatric subspecialty workforce supply by drawing on the American Board of Pediatrics workforce data and a microsimulation model of the future pediatric subspecialty workforce. The article discusses the utilization of acute care services in EDs, reviews the current state of the PEM subspecialty workforce, and presents projected numbers of PEM subspecialists at the national, census region, and census division on the basis of this pediatric subspecialty workforce supply model through 2040. Implications of this model on education and training, clinical practice, policy, and future workforce research are discussed. Findings suggest that, if the current growth in the field of PEM continues on the basis of the increasing number and size of fellowship programs, even with a potential reduction in percentage of clinical time and attrition of senior physicians, the PEM workforce is anticipated to increase nationally. However, the maldistribution of PEM physicians is likely to be perpetuated with the highest concentration in New England and Mid-Atlantic regions and "PEM deserts" in less populated areas.
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Affiliation(s)
- Maya S Iyer
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | - Joshua Nagler
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor, University of California Los Angeles Medical Center, Torrance, California
| | - Javier Gonzalez Del Rey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Harrison WN, Mittal VS, O'Toole JK, Quinonez RA, Mink R, Leyenaar JK. Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678M. [PMID: 38300016 DOI: 10.1542/peds.2023-063678m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.
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Affiliation(s)
- Wade N Harrison
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vineeta S Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jennifer K O'Toole
- Division of Hospital Medicine, Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ricardo A Quinonez
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Mink
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center and the David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - JoAnna K Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Health, Lebanon, New Hampshire
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Leslie LK, Orr CJ, Turner AL, Mink R, Leonard MB, Sabadosa KA, Vinci RJ. Child Health and the US Pediatric Subspecialty Workforce: Planning for the Future. Pediatrics 2024; 153:e2023063678B. [PMID: 38299999 DOI: 10.1542/peds.2023-063678b] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article opens a multi-article Pediatrics supplement that provides a rigorous analysis of the projected pediatric subspecialty workforce in the United States. Congenital variations, epigenetics, exposures, lifestyle, preventive care, and medical interventions from conception through young adulthood set the stage for health and wellbeing in adulthood. Although care provided by pediatric subspecialists is associated with better outcomes and lower costs compared with adult providers, the authors of recent articles in the lay and medical literature have questioned the capacity of pediatric subspecialists to meet children's health care needs. This article highlights that, despite numerous advances in prevention, diagnosis, and treatment, the last decade has witnessed increasing numbers of children with acute or chronic physical and mental health disorders, including medical complexity, obesity, type 2 diabetes, anxiety, depression, and suicidality, all of which are exacerbated by poverty, racism, and other social drivers of health. In this article, we then describe the variability in the demographics, practice characteristics, and geographic distribution of the 15 core pediatric subspecialties certified by the American Board of Pediatrics. We then discuss the rationale and approach to the development of a pediatric subspecialty workforce model that forecasts subspecialist supply from 2020 to 2040 for 14 subspecialties at the national and subnational levels (not including the newest subspecialty, pediatric hospital medicine), accounting for US Census Bureau child population projections. The model does not account for the unique physical and mental needs of individual children, nor does it address the increasingly precarious commitment to, and financing of, pediatric subspecialty care in the US health care system impacting market demand.
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Affiliation(s)
- Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
| | - Colin J Orr
- University of North Carolina School of Medicine at Chapel Hill, ChapelHill, North Carolina
| | - Adam L Turner
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Richard Mink
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, Torrance, California
| | - Mary B Leonard
- Stanford University School of Medicine, Palo Alto, California
| | | | - Robert J Vinci
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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Kelly MS, Cataldi JR, Schlaudecker EP, Shah SS, Vinci RJ, Myers AL. Child Health Needs and the Pediatric Infectious Diseases Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678N. [PMID: 38300015 PMCID: PMC10852198 DOI: 10.1542/peds.2023-063678n] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric infectious diseases (PID) physicians prevent and treat childhood infections through clinical care, research, public health, education, antimicrobial stewardship, and infection prevention. This article is part of an American Board of Pediatrics Foundation-sponsored supplement investigating the future of the pediatric subspecialty workforce. The article offers context to findings from a modeling analysis estimating the supply of PID subspecialists in the United States between 2020 and 2040. It provides an overview of children cared for by PID subspecialists, reviews the current state of the PID workforce, and discusses the projected headcount and clinical workforce equivalents of PID subspecialists at the national, census region, and census division levels over this 2-decade period. The article concludes by discussing the education and training, clinical practice, policy, and research implications of the data presented. Adjusting for population growth, the PID workforce is projected to grow more slowly than most other pediatric subspecialties and geographic disparities in access to PID care are expected to worsen. In models considering alternative scenarios, decreases in the number of fellows and time spent in clinical care significantly affect the PID workforce. Notably, model assumptions may not adequately account for potential threats to the PID workforce, including a declining number of fellows entering training and the unknown impact of the COVID-19 pandemic and future emerging infections on workforce attrition. Changes to education and training, clinical care, and policy are needed to ensure the PID workforce can meet the future needs of US children.
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Affiliation(s)
- Matthew S. Kelly
- Department of Pediatrics, Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jessica R. Cataldi
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samir S. Shah
- Division of Infectious Diseases
- Division of Hospital Medicine, Cincinnati Children’s Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert J. Vinci
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Angela L. Myers
- Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri – Kansas City
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Sauer CG, Barnard JA, Vinci RJ, Strople JA. Child Health Needs and the Pediatric Gastroenterology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678K. [PMID: 38300013 DOI: 10.1542/peds.2023-063678k] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article is part of an American Board of Pediatrics Foundation-sponsored effort to analyze and forecast the pediatric subspecialty workforce between 2020 and 2040. Herein, an overview of the current pediatric gastroenterology workforce is provided, including demographics, work characteristics, and geographic distribution of practitioners. Brief context is provided on the changing nature of current practice models and the increasing prevalence of some commonly seen disorders. On the basis of a rigorous microsimulation workforce projection model, projected changes from 2020 to 2040 in the number of pediatric gastroenterologists and clinical workforce equivalents in the United States are presented. The article closes with a brief discussion of training, clinical practice, policy, and future workforce research implications of the data presented. This data-driven analysis suggests that the field of pediatric gastroenterology will continue to grow in scope and complexity, propelled by scientific advances and the increasing prevalence of many disorders relevant to the discipline. The workforce is projected to double by 2040, a growth rate faster than most other pediatric subspecialties. Disparities in care related to geography, race, and ethnicity are among the most significant challenges for the years ahead. Changes to training and education, incentives to meet the needs of underserved populations, and new multidisciplinary models for health care delivery will be necessary to optimally meet the volume, diversity, and complexity of children with gastroenterological diseases in the years ahead.
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Affiliation(s)
- Cary G Sauer
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - John A Barnard
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio
| | - Robert J Vinci
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jennifer A Strople
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois
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Orr CJ, McCartha E, Vinci RJ, Mink RB, Leonard MB, Bissell M, Gaona AR, Leslie LK. Projecting the Future Pediatric Subspecialty Workforce: Summary and Recommendations. Pediatrics 2024; 153:e2023063678T. [PMID: 38300012 DOI: 10.1542/peds.2023-063678t] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article summarizes the findings of a Pediatrics supplement addressing the United States workforce for 15 pediatric subspecialties. It includes results from a microsimulation model projecting supply through 2040; growth is forecasted to be uneven across the subspecialties with worsening geographic maldistribution. Although each subspecialty has unique characteristics, commonalities include (1) the changing demographics and healthcare needs of children, including mental health; (2) poor outcomes for children experiencing adverse social drivers of health, including racism; and (3) dependence on other subspecialties. Common healthcare delivery challenges include (1) physician shortages for some subspecialties; (2) misalignment between locations of training programs and subspecialists and areas of projected child population growth; (3) tension between increasing subsubspecialization to address rare diseases and general subspecialty care; (4) the need to expand clinical reach through collaboration with other physicians and advanced practice providers; (5) the lack of parity between Medicare, which funds much of adult care, and Medicaid, which funds over half of pediatric subspecialty care; and (6) low compensation of pediatric subspecialists compared with adult subspecialists. Overall, subspecialists identified the lack of a central authority to monitor and inform child healthcare provided by pediatric subspecialists as a challenge. Future research on the pediatric subspecialty workforce and the children it serves will be necessary to ensure these children's needs are met. Together, these articles provide overarching and subspecialty-specific recommendations to improve training, recruitment, and retention of a diverse workforce, implement innovative models of care, drive policy changes, and advise future research.
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Affiliation(s)
- Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily McCartha
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert J Vinci
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, California
| | - Mary Bissell
- Child Focus, Washington, District of Columbia
- Georgetown University Law Center, Georgetown University, Washington, District of Columbia
| | - Adriana R Gaona
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
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12
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Russell H, Hord J, Orr CJ, Moerdler S. Child Health and the Pediatric Hematology-Oncology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678L. [PMID: 38299998 DOI: 10.1542/peds.2023-063678l] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hematology-oncology (PHO) is 1 of the oldest recognized pediatric subspecialities. PHO physicians care for infants, children, adolescents, and young adults with all types of cancer and nonmalignant blood conditions, in many cases temporarily assuming the role of a primary care physician because of the complexity and intensity of treatment. However, the number of clinically active PHO subspecialists needed to care for children in the United States remains unknown. Recent papers suggest a potential oversaturation of PHO physicians in some geographic areas. This article is part of a Pediatrics supplement focused on projecting the future supply of the pediatric subspecialty workforce. It draws on information available in the literature, data from the American Board of Pediatrics, and findings from a new microsimulation model estimating the future supply of pediatric subspecialists through 2040. The model predicts a workforce growth in PHO subspecialists of 66% by 2040. Alternative scenarios, including changes in clinical time and fellowship size, resulted in a difference in growth of ±18% from baseline. The model also forecasts significant geographic maldistribution. For example, the current workforce is concentrated in the Northeast Census region and the model predicts the New England Census division will have a 2.9-fold higher clinical workforce equivalent per 100 000 children aged 0 to 18 years than the Mountain Census division by 2040. These findings suggest potential opportunities to improve the PHO subspecialty workforce and the outcomes and experiences of its patient population through educational changes, practice initiatives, policy interventions, and dedicated research.
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Affiliation(s)
- Heidi Russell
- University of Texas Health Houston School of Public Health, Department of Management, Policy and Community Health, Houston, Texas
| | - Jeffrey Hord
- Akron Children's Hospital, Pediatric Hematology-Oncology, Akron, Ohio
| | - Colin J Orr
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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13
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Fields EL, Louis-Jacques J, Kas-Osoka O, Holland-Hall C, Richardson LP, Ott M, Leslie LK, Pitts SAB. Child Health Needs and the Adolescent Medicine Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678D. [PMID: 38300009 DOI: 10.1542/peds.2023-063678d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Adolescent medicine (AM) subspecialists provide primary, subspecialty, and consultative care to adolescents and young adults (AYAs). Given insufficient numbers of AM subspecialists to care for all AYAs, the workforce supports AYAs health care capacity through education, research, advocacy, and the development of policies and programs sensitive to their unique needs. A modeling project funded by the American Board of Pediatrics Foundation was developed to forecast the pediatric subspecialty workforce in the United States from 2020 to 2040 on the basis of current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios, and reports results in headcount and headcount adjusted for percentage of time spent in clinical care, termed "clinical workforce equivalent." For the AM subspecialty, several scenarios were considered that modified the number of fellows and/or clinical time. The baseline model predicted low growth nationally (27% and 13% increase in total AM subspecialists and AM subspecialists per 100 000 children, respectively) and declines in AM workforce relative to population growth in census divisions with existing geographic workforce disparities. In the alternative scenarios, fellow number and clinical time changes did not significantly change predictions relative to the baseline model, but a 12.5% decrease in fellows predicted a 40% reduction in the workforce from baseline with a widening of geographic workforce disparities. On the basis of the expansive clinical and nonclinical roles of AM subspecialists and these forecasted workforce challenges, significant educational, practice, and policy changes will be necessary to bolster the supply of well-trained clinicians addressing the dynamic health care needs of AYAs.
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Affiliation(s)
| | | | - Oriaku Kas-Osoka
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cynthia Holland-Hall
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura P Richardson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Mary Ott
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Sarah A B Pitts
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Myers AL, James SH, Watson JR, Yeh S, Bryant KA. Averting a Crisis: Innovating Pediatric Infectious Diseases Recruitment and Training. J Pediatric Infect Dis Soc 2023; 12:559-563. [PMID: 37931058 DOI: 10.1093/jpids/piad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Angela L Myers
- Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Hospital and the Univeristy of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Scott H James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua R Watson
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Sylvia Yeh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Harbor-UCLA Medical Center, Los Angeles, California, USA
| | - Kristina A Bryant
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Louisville and Norton Children's Hospital, Louisville, Kentucky, USA
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15
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Vinci RJ, Clapp DW, Reed A, Degnon L. A Flattening of the Curve: The Challenge of Disparate Growth Rates in the Pediatric Subspecialties. J Pediatr 2023; 261:113509. [PMID: 37301280 DOI: 10.1016/j.jpeds.2023.113509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Robert J Vinci
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - D Wade Clapp
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Ann Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Durham, NC
| | - Laura Degnon
- Association of Medical School Pediatric Department Chairs, McLean, VA
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16
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Esther CR, Rama JA, Nelson BA. Pediatric Pulmonary Fellowship Program Size Effect on Recruitment and Workforce Distribution. ATS Sch 2023; 4:311-319. [PMID: 37795123 PMCID: PMC10547028 DOI: 10.34197/ats-scholar.2022-0117oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Concerns about the pediatric pulmonology workforce suggest a need to improve fellowship recruitment. Program size is related to the financial health and recruitment success of pediatric subspecialty education programs, but there are few data on how program size impacts recruitment and workforce in pediatric pulmonology. Objective Assess the impact of program size in pediatric pulmonology through examination of the distribution of applicants matching into pediatric pulmonology training programs over time and relationships to workforce distribution. Methods Data from the National Residency Match Program from 2010 to 2022 were extracted from published documents. Positions offered, positioned filled, and match rates were calculated for each appointment year. Statewide statistics for the number of fellows matched were analyzed relative to the number of pediatric pulmonologists per capita using data from the American Board of Pediatrics. Results From 2010 to 2018, the size and distribution of programs in pediatric pulmonology were stable, with most fellows (82.4%) matching into programs with one or two positions per cycle. Starting in 2019, programs offering three or more positions steadily increased in number and aggregate positions offered. This change was associated with an increase in total filled positions (38.9 ± 7.3 in 2010-2018 vs. 50.5 ± 8.7 in 2019-2022; P < 0.03) and an increased fraction who matched into larger programs (17.6% in 2010-2018 vs. 36.9% in 2019-2022; P < 0.001). Among states with fellowship programs, the number of fellows matched over the past 5 years correlated with the number of practicing pediatric pulmonologists per capita (r = 0.78; P < 0.001). Conclusion The period 2019-2022 saw a marked shift of pediatric pulmonary trainees matching into a relatively small number of larger programs. This shift was associated with overall growth in the number of trainees but may have implications on geographical distribution of practicing pediatric pulmonologists.
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Affiliation(s)
- Charles R. Esther
- Department of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer A. Rama
- Department of Pediatric Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas; and
| | - Benjamin A. Nelson
- Department of Pediatric Pulmonology, Mass General Hospital for Children, Boston, Massachusetts
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Shah S, Lou L. Advocacy in neonatology: current issues and introduction to the series. J Perinatol 2023; 43:1050-1054. [PMID: 36725986 DOI: 10.1038/s41372-023-01615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
Advocacy is an increasingly important skill for neonatologists. As social factors play a greater influence on short & long-term newborn outcomes, neonatal physicians must be attentive to policy factors and work to ensure they benefit the health of both patients and the specialty. In this article, we review advocacy issues of current relevance to neonatal practice, including the "Born Alive Executive Order," the "Newborn Screening Saves Lives Act," subspecialty loan repayment and legislation related to donor human milk, as well as introduce topics further discussed as part of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine Advocacy Series.
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Affiliation(s)
- Shetal Shah
- Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Lily Lou
- Division of Newborn Medicine, Children's Hospital University of Illinois, Chicago, IL, USA
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Sachdeva S, Dhulipudi B. Current career perspective of pediatric cardiologists in India. Ann Pediatr Cardiol 2023; 16:201-203. [PMID: 37876954 PMCID: PMC10593283 DOI: 10.4103/apc.apc_121_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
A survey was conducted to ascertain the current situation of early-mid-career pediatric cardiologists (<20 years of experience) practicing in India. A formatted questionnaire was sent as a Google Form through email and WhatsApp link. Out of 275 eligible participants, 138 responses were received. Two pediatric cardiologists independently analyzed the data and responses are presented. Results showed pediatric cardiology is not considered a lucrative career option by most of the surveyed Indian pediatric cardiologists. Urgent remedial measures are needed to maintain the recently found momentum in the field in the country.
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Affiliation(s)
- Sakshi Sachdeva
- Assistant Professor, Pediatric Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Bhargavi Dhulipudi
- Consultant Pediatric Cardiologist, Rainbow Children’s Heart Institute, Hyderabad, Telangana, India
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19
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Heller RE, Joshi A, Sircar R, Hayatghaibi S. Medicaid and the Children's Health Insurance Program: an overview for the pediatric radiologist. Pediatr Radiol 2023; 53:1179-1187. [PMID: 36879048 PMCID: PMC9988602 DOI: 10.1007/s00247-023-05640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid's structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP.
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Affiliation(s)
- Richard E Heller
- Radiology Partners, 2330 Utah Avenue, Suite 200, El Segundo, CA, 90245, USA.
| | - Aparna Joshi
- Section of Pediatric Radiology, University of Michigan C.S. Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4252, Ann Arbor, MI, 48109-4252, USA
| | - Robin Sircar
- Advocate Children's Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - Shireen Hayatghaibi
- Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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20
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Orr CJ, Turner AL, Ritter VS, Gutierrez-Wu J, Leslie LK. Pursuing a Career in Pediatrics: Intersection of Educational Debt and Race/Ethnicity. J Pediatr 2023; 252:162-170. [PMID: 35973445 DOI: 10.1016/j.jpeds.2022.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the associations among pediatric trainees' self-reported race/ethnicity, educational debt, and other factors for pursuing a pediatrics career. STUDY DESIGN Cross-sectional study using data from the American Board of Pediatrics In-training Examination Post-examination Survey years 2018-2020 of categorical pediatric interns. Independent variable of interest was race/ethnicity. Classifications used were White, Hispanic/Latinx, Black/African American, Asian, and other/multiracial. The primary dependent variable was educational debt; secondary dependent variables included the importance of personal, professional, and financial factors in selecting a pediatric career. Means with 95% CIs were computed to summarize scores regarding a factor's importance. Chi-square tests of homogeneity and one-way ANOVA F tests were used to compare proportions and means of dependent variables across levels of self-reported race/ethnicity. RESULTS A total of 11 150 (91.5%) completed the survey. Of the final analytical sample (7 943), approximately 6.3% self-identified as Black/African American, 8.2% as Hispanic/Latinx, 22% as Asian, and 55% as White; 44% reported >$200 000 of debt. Overall, 33% of those identifying as Black/African American had >$300 000 in educational debt. The highest ranked career factor was interest in a specific disease/patient population. The importance of educational debt in career choices was highest among those identifying as Black/African American, followed by Asians and Hispanic/Latinx. Among all races/ethnicities, the importance of mentorship decreased with higher educational debt. CONCLUSION Among individuals pursuing pediatrics, the intersection of race/ethnicity and debt may influence trainees' pursuit of pediatric careers. Educational debt negatively impacts the importance of mentorship.
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Affiliation(s)
- Colin J Orr
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Victor S Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Gutierrez-Wu
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, NC; Tufts School of Medicine, Boston, MA
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Catenaccio E, Rochlin JM, Weitzman C, Augustyn M, Simon HK. Lifetime Earning Potential and Workforce Distribution in Developmental and Behavioral Pediatrics. Acad Pediatr 2022; 23:579-586. [PMID: 36191811 DOI: 10.1016/j.acap.2022.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Compare lifetime earning potential (LEP) for developmental and behavioral pediatrics (DBP) to general pediatrics and other pediatric subspecialties. Evaluate association between LEP for DBP and measures of workforce distribution. METHODS Using compensation and debt data from 2018 to 2019 and a net present value analysis, we estimated LEP for DBP compared to general pediatrics and other pediatric subspecialties. We evaluated potential effects of eliminating educational debt, shortening length of fellowship training, and implementing loan repayment or forgiveness programs for pediatric subspecialists. We evaluated the association between LEP for DBP and measures of workforce distribution, including distance to subspecialists, percentage of hospital referral regions (HRRs) with a subspecialist, ratio of subspecialists to regional child population, and fellowship fill rates. RESULTS LEP was lower for DBP than for general private practice pediatrics ($1.9 million less), general academic pediatrics ($1.1 million less), and all other pediatric subspecialties. LEP of DBP could be improved by shortening fellowship training or implementing loan repayment or forgiveness programs. LEP for subspecialists, including DBP, was associated with distance to subspecialists (-0.5 miles/$100,000 increase in LEP, 95% confidence interval [CI] -0.98 to -0.08), percentage of HRRs with a subspecialist (+1.1%/$100,000 increase in LEP, 95% CI 0.37-1.83), ratio of subspecialists to regional child population (+0.1 subspecialists/100,000 children/$100,000 increase in LEP, 95% CI 0.04-0.17), and average 2014 to 2018 fellowship fill rates (+1% spots filled/$100,000 increase in LEP, 95% CI 0.25-1.65). CONCLUSIONS DBP has the lowest LEP of all pediatric fields and this is associated with DBP workforce shortages. Interventions to improve LEP may promote workforce growth.
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Affiliation(s)
- Eva Catenaccio
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Philadelphia (E Catenaccio), Philadelphia, Pa.
| | - Jonathan M Rochlin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center (JM Rochlin), Brooklyn, NY
| | - Carol Weitzman
- Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital/Harvard School of Medicine (C Weitzman), Boston, Mass
| | - Marilyn Augustyn
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine (M Augustyn), Boston, Mass
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta (HK Simon), Atlanta, Ga
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22
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Catenaccio E, Rochlin JM, Simon HK. Association Between Workforce Gender Distribution and Lifetime Earning Potential in the Pediatric Subspecialties. Acad Pediatr 2022; 22:1153-1157. [PMID: 35219852 DOI: 10.1016/j.acap.2022.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Examine the relationship between the gender distribution of the pediatric subspecialty workforce and lifetime earning potential. METHODS We estimated lifetime earning potential for pediatric academic subspecialists using mean debt and compensation data from national physician surveys for 2019 to 2020 and examined the relationship between the workforce gender composition and lifetime earning potential across the pediatric subspecialties using linear regression analysis. RESULTS Subspecialties with a higher proportion of women had lower lifetime earning potential (-$55,215 in lifetime earning potential/1% increase in the percentage of female subspecialists; P value .002, 95% CI -$24,429 to -$86,000). Similarly, a higher proportion of female first-year fellows was associated with lower lifetime earning potential (-$61,808 in lifetime earning potential/1% increase in the percentage of female first-year fellows; P value .026, 95% CI -$9,210 to -$114,405). CONCLUSIONS Consistent with patterns seen in other areas of adult medicine and surgery, pediatric subspecialties with higher proportions of women, such as adolescent medicine and endocrinology, tended to have lower lifetime earning potentials than subspecialties with higher proportions of men, such as cardiology and critical care. Lower earning subspecialties also tended to train higher proportions of women, suggesting that this trend may worsen over time as pediatrics in general and individual subspecialties in particular become increasingly female predominant.
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Affiliation(s)
- Eva Catenaccio
- Department of Pediatrics, Division of Pediatric Neurology (E Catenaccio), Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Jonathan M Rochlin
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine (JM Rochlin), Maimonides Medical Center, Brooklyn, NY
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine (HK Simon), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
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23
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Shah S, Cheng TL. Optimizing the Children's Hospitals Graduate Medical Education Payment Program at a Time of Pediatric Workforce Challenges and Health Need. J Pediatr 2022; 245:4-6.e2. [PMID: 34793825 DOI: 10.1016/j.jpeds.2021.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Shetal Shah
- Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY.
| | - Tina L Cheng
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Cincinnati Children's Research Foundation, Cincinnati, OH
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24
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Lakshminrusimha S, Olsen SL, Lubarsky DA. Behavioral economics in neonatology-balancing provider wellness and departmental finances. J Perinatol 2022; 42:683-688. [PMID: 35318428 PMCID: PMC8939884 DOI: 10.1038/s41372-022-01370-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022]
Abstract
High work relative value units (wRVU) per clinical full-time-equivalent (cFTE) productivity by Neonatologists have played a key role in enhancing departmental revenue in Pediatrics. However, such high productivity is not sustainable due to recent changes in trainee schedules and global daily codes and is likely to impact physician morale and wellness. Incentives based on wRVU benchmarks have the capacity to promote desirable behavior such as better documentation and in-person attendance in delivery room resuscitation and consults but comes at a cost of physician time providing care. An alternate method of funding academic Pediatric departments using time- or point-based staffing models, a reduction in productivity benchmarks for academic neonatologists through more accurate reporting of effort and physician leadership that promotes transparency and mutual respect are warranted to improve neonatologist well-being and morale.
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Affiliation(s)
| | - Steven L Olsen
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
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25
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Abstract
IMPORTANCE Gender-based disparities in compensation in academic medicine are recognized, but their estimated impacts on early career earning potential and strategies to mitigate them have not been well studied. OBJECTIVES To compare earning potential between female and male academic physicians in the first 10 years of posttraining employment and to evaluate the estimated impact of promotion timing, starting salary, and salary growth rate on earning potential. DESIGN, SETTING, AND PARTICIPANTS Using publicly available mean debt and compensation data for full-time employed academic physicians in the US from 2019 to 2020, starting salary, salary in year 10 of employment, annual salary growth rate, and overall earning potential in the first 10 years of employment were estimated for each gender by subspecialty. The estimated impacts of promotion timing and potential interventions, including equalizing starting salaries and annual salary growth rates, were modeled. Data analysis was performed from March to May 2021. EXPOSURES Gender and subspecialty. MAIN OUTCOMES AND MEASURES Starting salary, annual salary growth rate, year-10 salary, and earning potential in first 10 years of employment. RESULTS This cross-sectional study included compensation data from 24 593 female and 29 886 male academic physicians across 45 subspecialties. Women had lower starting salaries in 42 of 45 subspecialties (93%), year-10 salaries in 43 of 45 subspecialties (96%), mean annual salary growth rates in 22 of 45 subspecialties (49%), and earning potential in 43 of 45 subspecialties (96%) (median [IQR], $214 440 [$130 423-$384 954], or 10%, less). A 1-year delay in promotion from assistant to associate professor reduced women's earning potential by a median (IQR) of $26 042 ($19 672-$35 671), but failure to be promoted at all reduced it by a median (IQR) of $218 724 ($176 317-$284 466). Equalizing starting salaries could increase women's earning potential by a median (IQR) of $250 075 ($161 299-$381 799) in the subspecialties for which starting salaries for women were lower than those for men. Equalizing annual salary growth rates could increase women's earning potential by a median (IQR) of $53 661 ($24 258-$102 892) in the subspecialties for which mean annual salary growth rates were lower for women than for men. CONCLUSIONS AND RELEVANCE The findings of this study suggest that gender-based disparities in starting salary and early career earning potential are pervasive in academic medicine in the US. Equalizing starting salaries would address the majority of the differences in earning potential.
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Affiliation(s)
- Eva Catenaccio
- Division of Pediatric Neurology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan M. Rochlin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Harold K. Simon
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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26
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Affiliation(s)
- Adam Turner
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Thomas Ricketts
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
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27
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Weidemann DK, Ashoor IA, Soranno DE, Sheth R, Carter C, Brophy PD. Moving the Needle Toward Fair Compensation in Pediatric Nephrology. Front Pediatr 2022; 10:849826. [PMID: 35359890 PMCID: PMC8960267 DOI: 10.3389/fped.2022.849826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease is neither sufficiently valued, nor appropriately compensated. Current compensation models derived from the relative value unit (RVU) system contribute to the structural biases inherent in the current inequitable payment system. The perceived negative financial compensation is a significant driver of waning trainee interest in the field which is one of the least attractive specialties for students, with a significant proportion of training spots going unfilled each year and relatively stagnant growth rate as compared to the other pediatric subspecialties. This article reviews the current state of financial compensation issues plaguing the pediatric nephrology subspecialty. We further outline strategies for pediatric nephrologists, hospital administrators, and policy-makers to improve the landscape of financial reimbursement to pediatric subspecialists. A physician compensation model is proposed which aligns clinical activity with alternate metrics for current non-RVU producing activities that harmonizes hospital and personal mission statements.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, United States.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - I A Ashoor
- Division of Nephrology, LSU Health New Orleans and Children's Hospital, New Orleans, LA, United States
| | - D E Soranno
- Departments of Pediatrics, University of Colorado, Bioengineering, and Medicine, Anschutz Medical Campus, Aurora, CO, United States
| | - R Sheth
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - C Carter
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
| | - P D Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, United States
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