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Scott K, Castera M, Gray MM, Myers P, Bonachea EM, Karpen H, French H, Carbajal M, Johnston L. One size does not fit all for URiM applicants: a comparison of NPM program size on URiM applications. J Perinatol 2024:10.1038/s41372-024-02151-7. [PMID: 39397057 DOI: 10.1038/s41372-024-02151-7] [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: 07/30/2024] [Revised: 10/04/2024] [Accepted: 10/07/2024] [Indexed: 10/15/2024]
Abstract
Neonatal-perinatal medicine (NPM) lacks a racially and ethnically diverse physician workforce. Fewer trainees from groups underrepresented in medicine (URiM) are entering NPM due to declining match rates in general pediatrics, financial burdens from delaying workforce entry, and ineffective recruitment into NPM. Annual surveys from the Organization of Neonatology Training Program Directors (ONTPD) were analyzed to assess URiM recruitment trends between 2021 and 2023. Concerningly, the number of URiM candidates applying to NPM fellowship programs remains low, highlighting the need for investment in pathway programming and enhanced recruitment strategies to diversify the NPM workforce. A multifaceted approach, including promoting early interest in pediatrics, minimizing financial disincentives, collecting robust URiM trainee and workforce data, and creating inclusive, diverse educational environments will be critical to increasing URiM representation in NPM and ultimately improving health outcomes for neonates.
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Affiliation(s)
- Kristan Scott
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine/The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Castera
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Megan M Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Patrick Myers
- Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL, USA
| | - Elizabeth M Bonachea
- Department of Pediatrics, Ohio State University School of Medicine, Columbus, OH, USA
| | - Heidi Karpen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Heather French
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine/The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa Carbajal
- Department of Pediatrics, Baylor University School of Medicine, Houston, TX, USA
| | - Lindsay Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
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2
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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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3
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Horowitz E, Hudak ML, Peña MM, Vinci RJ, Savich R. Child Health and the Neonatal-Perinatal Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678O. [PMID: 38300002 DOI: 10.1542/peds.2023-063678o] [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
In 2022, 3.7 million children were born in the United States, of whom ∼600 000 received care from a neonatologist. The dramatic growth of the neonatal-perinatal medicine (NPM) workforce from 375 in 1975 to 5250 in 2022 has paralleled exploding clinical demand. As newborn medicine continues to push the limits of gestational viability and medical complexity, the NPM workforce must advance in numbers, clinical capability, scientific discovery, and leadership. This article, as part of an American Board of Pediatrics Foundation-sponsored supplement that is designed to project the future of the pediatric subspecialty workforce, features a discussion of the NPM workforce's history and current status, factors that have shaped its current profile, and some plausible scenarios of the workforce's needs and configuration in the future. In the article, we use an analytical model that forecasts the growth trajectory of the neonatologist workforce from 2020 through 2040. The model uses recent data on the number of neonatologists and clinical work equivalents per 100 000 children and projects future workforce supply under several theoretical scenarios created by modifying key baseline parameters. The predictions of this model confirm the need for a greater sustainable clinical capacity of the NPM workforce. Several future trends indicate that there may be geographic shortages of neonatologists, similar to expected shortages in other pediatric subspecialties. We do not address what an appropriate target for workforce size should be with the model or this article because the current and projected geographic variability in the NPM workforce and risk-appropriate care suggest that a uniform answer is unlikely.
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Affiliation(s)
| | - Mark L Hudak
- University of Florida College of Medicine, Jacksonville, Florida
| | - Michelle-Marie Peña
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Robert J Vinci
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Renate Savich
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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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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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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Comeau M, Padlan AM, Houlihan B, Coleman C, Louis C, Brown T, Mann M. The Collaborative Improvement and Innovation Network for Children With Medical Complexity. Pediatrics 2024; 153:e2023063424B. [PMID: 38165235 DOI: 10.1542/peds.2023-063424b] [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: 10/25/2023] [Indexed: 01/03/2024] Open
Abstract
In response to a number of emerging issues, in 2017 the federal Maternal and Child Health Bureau funded its first collaborative quality improvement network aimed at improving the quality of life for children with medical complexity, the well-being of their families and the cost-effectiveness of their care. This paper is intended as a brief introduction to the Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity or CMC CoIIN project. In it, you will learn about the origins of the project, the guiding principles used to cocreate and promote measurable, meaningful family engagement in systems-level change efforts, its goals and objectives, the impact of the coronavirus disease 2019 pandemic on the project and some high-level learnings from our experiences, which have implications for future care delivery improvements for this growing and vulnerable population of children.
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Affiliation(s)
| | - Anna Maria Padlan
- Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Washington, District of Columbia
| | | | | | | | - Treeby Brown
- Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Washington, District of Columbia
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Bishop CE, Machut KZ, Dammann CEL, Cuevas Guaman M, Miller ER, Lakshminrusimha S. Academic neonatologist-a species at the brink of extinction? J Perinatol 2023; 43:1526-1529. [PMID: 37872382 DOI: 10.1038/s41372-023-01803-4] [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: 06/18/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Neonatology is a field that is currently facing many challenges. These challenges include outdated work models in clinical environments with increasing acuity and patient workloads, physician burnout exacerbated by gender inequity and the recent COVID-19 pandemic, and inappropriate metrics to measure clinical productivity. Academic neonatologists have additional missions that include research, teaching, and scholarly productivity in the setting of an increasing clinical workload and reduced time and support for teaching and research. Within the university-based practice setting, reimbursement, and salary structure result in relatively low compensation for neonatologist clinical productivity and time. These challenges threaten the sustainability of academic neonatology as a field. Working towards potential solutions such as creation of sustainable, transparent work models, and aligned funds flow within university-based settings is imperative.
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Affiliation(s)
- Christine E Bishop
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Milenka Cuevas Guaman
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Emily R Miller
- Department of Pediatrics, Division of Neonatology, and Perinatal Institute, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Dammann CEL, Kieran K, Fromme HB, Espinosa C, Tarantino CA, Trent M, Lightdale JR, Bline K. Female Excellence and Leadership in Pediatrics Subspecialties (FLEXPeds): Creating a Network for Women Across Academic Pediatrics. J Pediatr 2023; 263:113512. [PMID: 37244585 DOI: 10.1016/j.jpeds.2023.113512] [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: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Christiane E L Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, MA.
| | - Kathleen Kieran
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA
| | - H Barrett Fromme
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Claudia Espinosa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Morsani College of Medicine, University of South Tampa, Tampa, FL
| | - Celeste A Tarantino
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Katherine Bline
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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Lakshminrusimha S, Reed AM, Cheng TL, Cunningham JM, Devaskar SU. An Approach to Compensation Plans for Physician Faculty in Academic Pediatric Departments. J Pediatr 2023; 262:113511. [PMID: 37244572 DOI: 10.1016/j.jpeds.2023.113511] [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: 05/04/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC
| | - Tina L Cheng
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John M Cunningham
- Department of Pediatrics and Comer Children's Hospital, University of Chicago, Chicago, IL
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA
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