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Forster CS, Polak CA, Chen C, Kim JL, Allan JM, Gold JM, Ruch-Ross HS, Fromme HB, Huang B, Schondelmeyer AC. Association Between Gender and Salary Among Pediatric Hospital Medicine Physicians. Hosp Pediatr 2024; 14:507-513. [PMID: 38832448 DOI: 10.1542/hpeds.2023-007567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/20/2024] [Accepted: 01/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Gender-based disparities in salary exist in multiple fields of medicine. However, there is limited data examining gender inequities in salary in pediatric hospital medicine (PHM). Our primary objective was to assess whether gender-based salary differences exist in PHM. The secondary objective was to assess if, among women, the differences in salary varied on the basis of leadership positions or self-identified race and ethnicity. METHODS We conducted a survey-based, cross-sectional study of pediatric hospitalists in December 2021. Our primary outcomes were base and total salary, adjusted for the reported number of average weekly work hours. We performed subanalyses by presence of a leadership position, as well as race. We used a weighted t test using inverse probability weighting to compare the outcomes between genders. RESULTS A total of 559 eligible people responded to our survey (51.0%). After propensity score weighting, women's mean base salary was 87.7% of men's base (95% confidence interval [CI] 79.8%-96.4%, P < .01), and women's total salary was 85.6% of men's total (95% CI 73.2%-100.0%, P = .05) salary. On subgroup analysis of respondents with a leadership position, women's total salary was 80.6% of men's total salary (95% CI 68.7%-94.4%, P < .01). Although women who identified as white had base salaries that were 86.6% of white men's base salary (95% CI 78.5%-95.5%, P < .01), there was no gender-based difference noted between respondents that identified as nonwhite (88.4% [69.9%-111.7%] for base salary, 80.3% [57.2% to 112.7%]). CONCLUSIONS Gender-based discrepancies in salary exists in PHM, which were increased among those with leadership roles. Continued work and advocacy are required to achieve salary equity within PHM.
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Affiliation(s)
- Catherine S Forster
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catherine A Polak
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chen Chen
- Department of Biostatistics & Epidemiology
| | - Juliann L Kim
- Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, California
| | - Jessica M Allan
- Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, California
| | - Jessica M Gold
- Department of Pediatrics, Stanford University, Palo Alto, California
| | | | - H Barrett Fromme
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Bin Huang
- Department of Biostatistics & Epidemiology
| | - Amanda C Schondelmeyer
- Division of Pediatric Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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2
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Nestander M, Day C, Lucke A, Gautam S, Horowitz E, Bernstein SM, Bhatia A. Workforce Characteristics of Early Career Neonatologists and Comparison of Practice Sites. Am J Perinatol 2024; 41:e1126-e1134. [PMID: 36649732 DOI: 10.1055/s-0042-1760430] [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: 01/19/2023]
Abstract
OBJECTIVE Transitioning into the early career physician workforce is a uniquely challenging period in a neonatologist's career. There are limited educational opportunities in fellowship regarding career progression, practice models, and benefits. Understanding these factors are key when searching for employment. This study evaluates the early career neonatologist (ECN) workforce and employment characteristics to improve identification of professional needs. STUDY DESIGN An anonymous 59-question cross-sectional survey was distributed in July 2020 to members of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine Trainees and Early Career Neonatologists (TECaN). The survey instrument was designed using SurveyMonkey and assessed search methods for identifying employers, employment contract details, and professional duties. Questions addressed clinical service time, level of acuity, protected research time, financial compensation, benefits, job search methods, and promotion requirements. Comparisons were drawn between respondents exclusively working in a university-based setting and respondents employed in nonuniversity locations. Responses were collected using SurveyMonkey and then extracted to a Microsoft Excel Workbook for analysis. Statistical analysis was performed using SAS version 9.4. RESULTS Of 1,302 eligible members, 348 people responded (26.7%). Forty-six percent of respondents worked in a university setting and 54% worked in a nonuniversity setting. Using employment site as a discriminator, significant differences were noted in scheduling models. University-located respondents were more likely to work 2-week block schedules, fewer weekend/weeknight call, less clinical weeks per year, and more research/administrative weeks per year. Between university and nonuniversity located positions, benefits were largely comparable, while factors perceived as influential toward promotion varied depending on practice site. CONCLUSION This study provides ECNs with a contemporary workforce description vital to graduating TECaN seeking employment or renegotiating professional obligations. While benefits were largely similar based on practice site, promotion factors and scheduling models may vary depending on location. KEY POINTS · Data specific to informing employment decisions for graduating Trainees and Early Career Neonatologists are limited.. · This study provides benchmarks for evaluating employment opportunities presented to early career neonatologists.. · Practice site can influence promotion factors..
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Affiliation(s)
- Matt Nestander
- Division of Newborn Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Colby Day
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Ashley Lucke
- Department of Pediatrics, Dell Children's Medical Center, Austin, Texas
| | - Shiva Gautam
- Department of Biostatistics, University of Florida, Jacksonville, Florida
| | - Eric Horowitz
- Division of Neonatology, Boston Children's Hospital, Boston, Massachusetts
| | - Sarah M Bernstein
- Division of Neonatology, The University of Utah, Salt Lake City, Utah
| | - Anisha Bhatia
- Division of Neonatology, Rush University Medical Center, Chicago, Illinois
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3
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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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4
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Noah TL, Boyer D, Davis SD, Vinci RJ, Oermann CM. Child Health and the Pediatric Pulmonology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678Q. [PMID: 38300006 DOI: 10.1542/peds.2023-063678q] [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
There is concern as to whether the supply of pediatric pulmonology (PULM) subspecialists will be adequate to meet future demand. As part of an American Board of Pediatrics (ABP) Foundation-sponsored supplement investigating the future of the pediatric subspecialty workforce, this article assesses the current PULM clinical workforce and estimates the clinical workforce supply in the United States through 2040. The current workforce was assessed using ABP certification and Maintenance of Certification data, and a workforce supply model evaluating population growth, clinical effort, and geographic trends was developed after incorporating ABP data. Findings demonstrate that the number of pediatric pulmonologists has gradually increased over the past decade, and the ratio of subspecialists to children is likely to increase another 20% to 40% over the next 2 decades, although absolute numbers remain small. Geographic variation in access will persist in some regions. The proportion of women in the discipline has increased, but the proportion of pediatric pulmonologists from underrepresented in medicine backgrounds still lags behind the general population. Based on current trends, the PULM clinical workforce appears equipped to meet both population growth and the modest increase in demand for clinical services speculated to occur because of changes in the subspecialty's clinical portfolio. However, several factors could inhibit growth, and geographic maldistribution may continue to impact care access. Efforts to address variation in access and demographic diversity in the field are warranted. This article concludes by discussing the training, clinical practice, policy, and future workforce research implications of the data presented.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Debra Boyer
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert J Vinci
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christopher M Oermann
- University of Missouri-Kansas City School of Medicine; Children's Mercy Kansas City, Kansas City, Missouri
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5
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Venkatesan C, Cortezzo D, Habli M, Agarwal S. Interdisciplinary fetal neurology care: Current practice, challenges, and future directions. Semin Fetal Neonatal Med 2024; 29:101523. [PMID: 38604916 DOI: 10.1016/j.siny.2024.101523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
As the field of fetal-neonatal neurology has expanded over the past 2 decades with increasingly complex diagnoses, multidisciplinary collaboration with many subspecialties including genetics, neonatology, obstetrics, maternal fetal medicine, surgical sub-specialties, cardiology, radiology, palliative care, and ethics has needed to evolve to strive to offer optimal patient care. While comprehensive care delivery with an inter-disciplinary approach is preferred, there are often barriers based on numerous health disparities especially in resource limited settings. Even in the context of comprehensive care, diagnostic and prognostic uncertainty lead to challenges for providers during fetal neurology consultations. We present a case that highlights advantages of a comprehensive multi-disciplinary team in caring for the medical and social challenges of patients faced with a fetal neurologic diagnosis. Inter-disciplinary training focusing on maternal, fetal, neonatal, and childhood neurodevelopmental course and collaboration among the numerous stakeholders that contribute to fetal neurology practice is needed to provide optimal counseling and care for families faced with a fetal neurological diagnosis.
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Affiliation(s)
- Charu Venkatesan
- Pediatrics and Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, United States.
| | - DonnaMaria Cortezzo
- Pediatrics and Neonatology, Divisions of Neonatal Pulmonary Biology and Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, United States
| | - Mounira Habli
- Trihealth Fetal Care Center. Maternal Fetal Medicine Division, Co-Chair of Perinatal Research Committee at Good Samaritan Hospital, Principal Investigator of the NICHD MFMU Satellite Unit, Department of Pediatric Surgery, Fetal Care Center of Cincinnati, Cincinnati Children's Hospital Medical Center, University of Cincinnati, United States
| | - Sonika Agarwal
- Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States.
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6
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Kline S, Reed AM, McCarty L, Brown D, Fuste A, Kirstein K, Pak G, Jain L, Gessouroun M. Two Steps Forward, One Step Back: The Complexity of Accurately Defining and Measuring Clinical Activity in Academic Pediatrics. J Pediatr 2023; 259:113446. [PMID: 37120130 DOI: 10.1016/j.jpeds.2023.113446] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Susan Kline
- Department of Pediatrics, Duke University, Durham, NC
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC.
| | - Liz McCarty
- Department of Pediatrics, Emory University, Atlanta, GA
| | - Desiree Brown
- Department of Pediatrics, University of South Florida, Tampa, FL
| | - Angela Fuste
- Department of Pediatrics, University of Miami, Miami, FL
| | - Kristine Kirstein
- Department of Pediatrics. All Children's Hospital, St Petersburg, FL
| | - Gil Pak
- Department of Pediatrics, Penn State, Hershey, PA
| | - Lucky Jain
- Department of Pediatrics, Emory University, Atlanta, GA
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7
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Govil-Dalela T, Thomas R, Weber A, Kamat D, Williams MT, Przyklenk K, Sivaswamy L. Pediatric Resident Confidence in Assessing Neurological Cases: A Nationwide Survey. Pediatr Neurol 2023; 145:57-66. [PMID: 37279616 DOI: 10.1016/j.pediatrneurol.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/16/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND A relative shortage of pediatric neurologists in proportion to estimated neurological disorders often results in general pediatricians evaluating and treating children with complex neurological conditions. Dedicated rotations in pediatric neurology are not mandated during medical school or pediatric residency. We evaluated the perceptions of a large cohort of pediatric residents and program directors (PDs) regarding child neurology training. METHODS Using an online tool, surveys were sent to pediatric residents and pediatric and pediatric neurology PDs. RESULTS Response rates were 41% from pediatric residency programs, yielding 538 resident responses; 31% from pediatric PDs; and 62% from pediatric neurology PDs. Only 27% of the surveyed residents reported completing a neurology rotation during residency, 89% of whom expressed a subjective improvement in confidence with neurological assessments. Factors affecting comfort with eliciting a neurological history included exposure to a neurology rotation during residency, year of training, duration of neurology rotation in medical school, and inpatient exposure to neurological patients, whereas those associated with examination additionally included program size and postresidency plans. Overall, 80% of surveyed residents, 78% of pediatric PDs, and 96% of pediatric neurology PDs acknowledged the potential value of a mandatory pediatric neurology rotation during residency. CONCLUSION We suggest that a mandatory pediatric neurology rotation will boost the confidence of current and future pediatric trainees in assessing common neurological conditions of childhood.
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Affiliation(s)
- Tuhina Govil-Dalela
- Chief Resident in the Department of Pediatrics, Division of Neurology, Children's Hospital of Michigan, Detroit, Michigan
| | - Ronald Thomas
- Senior Biostatistician in the Department of Pediatrics, Central Michigan University and Clinical Research Institute, Children's Hospital of Michigan, Detroit, Michigan
| | - Amanda Weber
- Assistant Professor in the Department of Pediatrics, Division of Neurology, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan
| | - Deepak Kamat
- Professor and Vice-Chair for Academic Affairs in the Department of Pediatrics, UT Health San Antonio, San Antonio, Texas
| | - Mitchel T Williams
- Assistant Professor in the Department of Pediatrics, Division of Neurology, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan
| | - Karin Przyklenk
- Professor and Carman and Ann Adams Endowed Chair in Pediatric Research, Department of Pediatrics, Central Michigan University and Clinical Research Institute, Children's Hospital of Michigan, Detroit, Michigan
| | - Lalitha Sivaswamy
- Professor and Division Chief in the Department of Pediatrics, Division of Neurology, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan.
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8
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Russ CM, Gao Y, Karpowicz K, Lee S, Stephens TN, Trimm F, Yu H, Jiang F, Palfrey J. The Pediatrician Workforce in the United States and China. Pediatrics 2023:191246. [PMID: 37158018 DOI: 10.1542/peds.2022-059143] [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] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.
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Affiliation(s)
- Christiana M Russ
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | - Shoo Lee
- Mount Sinai Hospital, New York City, New York
- University of Toronto, Toronto, Canada
| | - Timothy Noel Stephens
- Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, China
| | - Franklin Trimm
- University of South Alabama College of Medicine, Mobile, Alabama; and
| | - Hao Yu
- Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Judith Palfrey
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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9
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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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10
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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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11
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Roy-Lavallée J, Findlay SM, Chen A, Katzman DK. Adolescent medicine subspecialty workforce: Insights from Canada. Paediatr Child Health 2022; 27:278-284. [DOI: 10.1093/pch/pxac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/18/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Adolescent Medicine (AM) in Canada has undergone significant growth since being accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) in May 2007. A deeper understanding of the workforce is needed in order to identify current gaps, to improve clinical care and scholarly endeavors, and to inform future developments.
Methods
This is the first AM workforce survey administered in Canada and included 39 multiple-choice and 3 open-ended questions. Descriptive statistics were calculated, and thematic analysis was used for open-ended questions.
Results
We identified 62 AM specialists from across Canada. The overall response was 97% (60/62). Most AM specialists were women (39/53, 74%), Caucasian (38/53, 72%), between 30 and 39 years old (22/53, 42%), and completed their subspecialty training in either Toronto (24/48, 50%) or Montreal (12/48, 25%). Nearly half of participants worked in either the Toronto, Ontario (13/49, 27%) or Montreal, Quebec (10/49, 20%). Nearly all participants (46/49, 94%) practiced in large urban population centres and were based in academic health science centres. The primary clinical areas of focus included eating disorders (25/51, 49%) and mental health (9/51, 18%). Almost all participants were satisfied with their career choice (41/50, 82%). Two-thirds of the participants (31/48, 65%) believed that there was an insufficient number of AM specialists in Canada.
Conclusions
Highlighting current characteristics of the AM subspecialty will help government and academic policymakers in understanding the workforce available to care for Canadian adolescents and the need to develop training programs and policies to address gaps and shortages.
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Affiliation(s)
| | - Sheri M Findlay
- Department of Pediatrics, McMaster Children’s Hospital , Ottawa, Ontario , Canada
| | - Allison Chen
- University of Toronto Faculty of Medicine , Toronto, Ontario , Canada
| | - Debra K Katzman
- Department of Pediatrics, The Hospital for Sick Children , Toronto, Ontario , Canada
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12
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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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13
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Fromme HB, Ruch-Ross HS, Marks M, Barone L, Shaugnessy E. The 2021 Pediatric Hospital Medicine Workforce: Results of a National Survey of Program Leaders. Hosp Pediatr 2022; 12:456-463. [PMID: 35445252 DOI: 10.1542/hpeds.2021-006434] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Pediatric Hospital Medicine (PHM) is a young subspecialty with practice models that continue to evolve. To inform program and workforce planning, it is essential to understand the current state. This study sought to delineate current work models for PHM. METHODS In the spring of 2021, we conducted a survey-based cohort study of individuals identifying as PHM program leaders. Individuals were invited based on membership in the 3 PHM sponsoring societies. Additional respondents were recruited through society listservs. RESULTS One hundred ninety-eight program leaders responded to the program model survey. One-half covered only community sites, 21.2% covered only university sites, and 21.2% covered both university and community sites. Programs provided a diverse set of services, with community sites covering more services, including newborn nurseries, emergency department consultation, and delivery room care. Median total hours for 1.0 clinical full time equivalent were 1849 across all sites, 1800 at university-only sites, and 1900 at community-only sites. Inpatient floor patient caps, when present, were higher for resident covered versus noncovered teams (16 vs 13). Similarly, back-up activation was higher for resident-covered teams (15-16) than noncovered teams (12-13.5). CONCLUSIONS Current data on clinical work hours for pediatric hospitalists are consistent with recent, smaller studies, suggesting that the current national median for a 1.0 FTE clinical position at university-based sites is 1800 annual hours. Community hospitalists often work more clinical hours than university sites and more commonly provide a broader range of service lines. More studies are needed to explore the differences between community and university site work models.
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Affiliation(s)
- H Barrett Fromme
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Michelle Marks
- Cleveland Clinic, Lerner College of Medicine, Cleveland, Ohio
| | - Lauren Barone
- Primary Care and Pediatrics.,American Academy of Pediatrics, Itasca, Illinois
| | - Erin Shaugnessy
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Powell WT, Dundon KMW, Frintner MP, Kornfeind K, Haftel HM. Parenthood, Parental Benefits, and Career Goals Among Pediatric Residents: 2008 and 2019. Pediatrics 2021; 148:183447. [PMID: 34814184 DOI: 10.1542/peds.2021-052931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Examine reported availability of parental benefits for pediatric residents and impact of parenthood on reported importance of characteristics of post-training positions and career goals in 2008 and 2019. METHODS We analyzed data from American Academy of Pediatrics surveys of graduating residents in 2008 and 2019 querying (1) parenthood, (2) benefits during residency, (3) importance of parental benefits and job characteristics in post-training position, and (4) subspecialty career goal. Logistic regression was used to estimate independent effects of gender, partner status, and parenthood via derived predicted values (PVs). RESULTS Of 1021 respondents, three-fourths were women. Respondents in 2019 were less likely than in 2008 to have children (24.5% vs 33.8%, P < .01). In 2019, respondents were less likely to report availability of maternity (PV = 78.5% vs 89.5%, P < .001) or parental leave (PV = 42.5% vs 59.2%, P < .001) and more likely to report availability of lactation space (PV = 77.8% vs 56.1%, P < .001.). Most residents reported control over work hours, family considerations, and number of overnight calls per month as essential or very important characteristics in post-training positions. Controlling for resident characteristics, parenthood was associated with importance of family considerations and overnight calls in post-training position. Parenthood did not associate with subspecialty career goals, but gender did. CONCLUSIONS Residents are less likely to report availability of parental benefits during residency training in 2019. Most residents, both those with children and those without, consider parent friendly characteristics important in post-training positions. Parenthood does not correlate with subspecialty career goals independent from gender.
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Affiliation(s)
- Weston T Powell
- Division of Pediatric Pulmonology and Sleep Medicine, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kelly M W Dundon
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
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15
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Catenaccio E, Rochlin JM, Simon HK. Differences in Lifetime Earning Potential Between Pediatric and Adult Physicians. Pediatrics 2021; 148:peds.2021-051194. [PMID: 34330865 DOI: 10.1542/peds.2021-051194] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Compare lifetime earning potential between academic pediatric and adult medicine generalists and subspecialists. Evaluate the effect of decreasing the length of training for pediatric subspecialties whose length of training is longer than that for the adult medicine counterpart. METHODS Using compensation and debt data from national physician surveys for 2019-2020, we estimated and compared the lifetime earning potential for academic pediatric and adult physicians. RESULTS Lifetime earning potential was higher for adult physicians than for pediatric physicians across all comparable areas of both general and subspecialty academic practice. The lifetime earning potentials for adult physicians averaged 25% more, or $1.2 million higher, than those of the corresponding pediatric physicians. These differences predominantly were not attributable to unequal training length: when we modeled a shortened length of training for pediatric subspecialists, lifetime earning potential for adult subspecialists still averaged 19% more than that for pediatric subspecialists. For both pediatric and adult medicine, the primarily inpatient, procedure-oriented subspecialties had higher lifetime earning potential than the outpatient, less procedure-oriented subspecialties. CONCLUSIONS Wide differences in lifetime earning potential between pediatric and adult physicians reflected lower compensation in pediatrics, rather than any differences in training length. Inpatient-based, more procedure-oriented subspecialties had higher lifetime earning potential than outpatient-based, less procedure-oriented subspecialties. Interventions that improve the lifetime earning potential of general pediatrics and the pediatric subspecialties, as well as the less procedure-oriented subspecialties across both pediatric and adult medicine, have the potential to impact both clinical practice and access to care.
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Affiliation(s)
- Eva Catenaccio
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan M Rochlin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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16
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Levy VY, Bhombal S, Villafane J, McBride ME, Chung S, Figueroa M, Hopper A, Johnson JN, Costello JM. Status of Multidisciplinary Collaboration in Neonatal Cardiac Care in the United States. Pediatr Cardiol 2021; 42:1088-1101. [PMID: 33870440 DOI: 10.1007/s00246-021-02586-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
While outcomes for neonates with congenital heart disease have improved, it is apparent that substantial variability exists among centers with regard to the multidisciplinary approach to care for this medically fragile patient population. We endeavored to understand the landscape of neonatal cardiac care in the United States. A survey was distributed to physicians who provide neonatal cardiac care in the United States regarding (1) collaborative efforts in care of neonates with congenital heart disease (CHD); (2) access to neonatal cardiac training; and (3) barriers to the implementation of protocols for neonatal cardiac care. Responses were collected from 10/2018 to 6/2019. We received responses from 172 of 608 physicians (28% response rate) from 89 centers. When compared to responses received from physicians at low-volume centers (< 300 annual bypass cases), those at high-volume centers reported more involvement from the neurodevelopmental teams (58% vs. 29%; P = 0.012) and a standardized transition to outpatient care (68% vs. 52%; P = 0.038). While a majority of cardiothoracic surgery and anesthesiology respondents reported multidisciplinary involvement, less than half of cardiology and neonatology supported this statement. The most commonly reported obstacles to multidisciplinary engagement were culture (61.6%) and logistics (47.1%). Having a standardized neonatal cardiac curriculum for neonatal fellows was positively associated with the perception that multidisciplinary collaboration was "always" in place (53% vs. 40%; P = 0.09). There is considerable variation among centers in regard to personnel involved in neonatal cardiac care, related education, and perceived multidisciplinary collaboration among team members. The survey findings suggest the need to establish concrete standards for neonatal cardiac surgical programs, with ongoing quality improvement processes.
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Affiliation(s)
- Victor Y Levy
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA. .,Department of Pediatrics, Texas Tech University Health Science Center School of Medicine, 701 West 5th Street, Odessa, TX, 79763, USA.
| | - Shazia Bhombal
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Juan Villafane
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Mary E McBride
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sukyung Chung
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Mayte Figueroa
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew Hopper
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic Children's Center Rochester, Rochester, MN, USA
| | - John M Costello
- Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
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17
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Vinci RJ. The Pediatric Workforce: Recent Data Trends, Questions, and Challenges for the Future. Pediatrics 2021; 147:peds.2020-013292. [PMID: 33692163 DOI: 10.1542/peds.2020-013292] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
The future of the pediatric workforce has been the subject of significant dialogue in the pediatric community and generated much discussion in the academic literature. There are significant concerns regarding the ability of pediatricians to meet the growing demands of our pediatric population. Over the past 5 years, there has been a decline in the percentage of doctor of osteopathic medicine students who pursue a career in pediatrics but an equally important increase in the number of pediatric positions that are filled by doctor of osteopathic medicine students and international medical graduates. Although there has been an increase in the number of pediatric positions offered in the National Resident Matching Program, the last 4 years have seen a significant increase in the number of unfilled pediatric positions. A number of pediatric subspecialties struggle to fill their training positions, and those with low match rates may have 20% to 40% fewer applicants than positions. The pediatric vision for the future must include a commitment to a comprehensive strategic planning process with the many organizations involved across the multiple stages of the educational continuum. It is time to elucidate and address the questions raised by the workforce data. Developing solutions to these questions will require a careful planning process and a thoughtful analysis of the pediatric workforce data. Establishing this as an important priority will require a major collaborative effort between pediatric academic and professional organizations, but the future benefit to the nation's children will be significant.
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Affiliation(s)
- Robert J Vinci
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
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18
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Catenaccio E, Rochlin JM, Simon HK. Differences in Lifetime Earning Potential for Pediatric Subspecialists. Pediatrics 2021; 147:peds.2020-027771. [PMID: 33685988 DOI: 10.1542/peds.2020-027771] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our 2011 report, reflecting data from 2007-2008, demonstrated that, for many pediatric subspecialties, pursuing fellowship training was a negative financial decision when compared with practicing as a general pediatrician. We provide an updated analysis on the financial impact of pediatric fellowship training and model interventions that can influence the results. METHODS We estimated the financial returns a graduating pediatric resident might anticipate from fellowship training followed by a career as a pediatric subspecialist and compared them with the returns expected from starting a career as a general pediatrician immediately after residency. We evaluated the potential effects of eliminating medical school debt, shortening the length of fellowship training, and implementing a federal loan repayment program for pediatric subspecialists. We compared the financial returns of subspecialty training in 2018-2019 to those from our previous report. RESULTS Pursuing fellowship training generated widely variable financial returns when compared with general pediatrics that ranged from +$852 129 for cardiology to -$1 594 366 for adolescent medicine. Twelve of 15 subspecialties analyzed yielded negative financial returns. The differences have become more pronounced over time: the spread between the highest and lowest earning subspecialties widened from >$1.4 million in 2007-2008 to >$2.3 million in 2018-2019. The negative financial impact of fellowship training could be partially ameliorated by shortening the length of training or by implementing pediatric subspecialist specific loan repayment programs. CONCLUSIONS This report can be used to help guide trainees, educators, and policy makers. The interventions discussed could help maintain an adequate and balanced pediatric workforce.
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Affiliation(s)
- Eva Catenaccio
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
| | - Jonathan M Rochlin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York; and
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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19
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Macy ML, Leslie LK, Turner A, Freed GL. Growth and changes in the pediatric medical subspecialty workforce pipeline. Pediatr Res 2021; 89:1297-1303. [PMID: 33328583 PMCID: PMC7738773 DOI: 10.1038/s41390-020-01311-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To inform discussions of pediatric subspecialty workforce adequacy and characterize its pipeline, we examined trends in first-year fellows in the 14 American Board of Pediatrics (ABP)-certified pediatric medical subspecialties, 2001-2018. METHODS Data were obtained from the ABP Certification Management System. We determined, within each subspecialty, the annual number of first-year fellows. We assessed for changes in the population using variables available throughout the study period (gender, medical school location, program region, and program size). We fit linear trendlines and calculated χ2 statistics. RESULTS The number of first-year pediatric medical subspecialty fellows increased from 751 in 2001 to 1445 in 2018. Fields with the growth of 3 or more fellows per year were Cardiology, Critical Care, Emergency Medicine, Gastroenterology, Neonatology, and Hematology Oncology (P value <0.05 for all). The number of fellows entering Adolescent Medicine, Child Abuse, Infectious Disease, and Nephrology increased at a rate of 0.5 fellows or fewer per year. Female American Medical Graduates represented the largest and growing proportions of several subspecialties. Distribution of programs by region and size were relatively consistent over time, but varied across subspecialties. CONCLUSIONS The number of pediatricians entering medical subspecialty fellowship training is uneven and patterns of growth differ between subspecialties. IMPACT The number of individuals entering fellowship training has increased between 2001 and 2018. Growth in the number of first-year fellows is uneven. Fields with the greatest growth: Critical Care, Emergency Medicine, and Neonatology. Fields with limited growth: Adolescent Medicine, Child Abuse, Infectious Disease, and Nephrology. Concerns about the pediatric medical subspecialty workforce are not explained by the number of individuals entering the fellowship.
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Affiliation(s)
- Michelle L. Macy
- Child Health Evaluation and Research (CHEAR) Center, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Emergency Medicine, University of Michigan, Ann Arbor, MI USA ,grid.413808.60000 0004 0388 2248Present Address: Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine Northwestern University, Chicago, IL USA
| | - Laurel K. Leslie
- American Board of Pediatrics, Chapel Hill, NC USA ,grid.67033.310000 0000 8934 4045Tufts Medical Center/School of Medicine, Boston, MA USA
| | - Adam Turner
- American Board of Pediatrics, Chapel Hill, NC USA
| | - Gary L. Freed
- Child Health Evaluation and Research (CHEAR) Center, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of PediatricsDivision of General Pediatrics, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Health Management and Policy, University of Michigan, Ann Arbor, MI USA
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20
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Curtin M, Downs J, Hunt A, Coleman ER, Enneking BA, McNally Keehn R. INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees. Front Psychiatry 2021; 12:671442. [PMID: 34248708 PMCID: PMC8260937 DOI: 10.3389/fpsyt.2021.671442] [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: 02/23/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the "INteractive Virtual Expert-led Skills Training" (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities. Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality. Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality. Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.
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Affiliation(s)
- Michelle Curtin
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jennifer Downs
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amber Hunt
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Emily R Coleman
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brett A Enneking
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Rebecca McNally Keehn
- Division of Child Development, Department of Pediatrics, Riley Child Development Center, Indiana University School of Medicine, Indianapolis, IN, United States
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21
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Duvivier RJ, Gusic ME, Boulet JR. International Medical Graduates in the Pediatric Workforce in the United States. Pediatrics 2020; 146:peds.2020-003301. [PMID: 33154152 DOI: 10.1542/peds.2020-003301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in pediatrics who provide patient care in the United States. METHODS Cross-sectional study, combining data from the 2019 Physician Masterfile of the American Medical Association and the Educational Commission for Foreign Medical Graduates database. RESULTS In total, 92 806 pediatric physicians were identified, comprising 9.4% of the entire US physician workforce. Over half are general pediatricians. IMGs account for 23.2% of all general pediatricians and pediatric subspecialists. Of all IMGs in pediatrics, 22.1% or 4775 are US citizens who obtained their medical degree outside the United States or Canada, and 15.4% (3246) attended medical school in the Caribbean. Fifteen non-US medical schools account for 29.9% of IMGs currently in active practice in pediatrics in the United States. IMGs are less likely to work in group practice or hospital-based practice and are more likely to be employed in solo practice (compared with US medical school graduates). CONCLUSIONS With this study, we provide an overview of the pediatric workforce, quantifying the contribution of IMGs. Many IMGs are US citizens who attend medical school abroad and return to the United States for postgraduate training. Several factors, including the number of residency training positions, could affect future numbers of IMGs entering the United States. Longitudinal studies are needed to better understand the implications that workforce composition and distribution may have for the care of pediatric patients.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania.,Center for Educational Development and Research in Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Maryellen E Gusic
- Office of Medical Education, Center for Medical Education Research and Scholarly Innovation, School of Medicine, University of Virginia, Charlottesville, Virginia; and
| | - John R Boulet
- Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania; .,Educational Commission for Foreign Medical Graduates, Philadelphia, Pennsylvania
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22
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Keller DM, Davis MM, Freed GL. Access to pediatric subspecialty care for children and youth: possible shortages and potential solutions. Pediatr Res 2020; 87:1151-1152. [PMID: 32294663 DOI: 10.1038/s41390-020-0889-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 01/21/2023]
Affiliation(s)
- David M Keller
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
| | - Matthew M Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gary L Freed
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
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23
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Association of Neonatologist Continuity of Care and Short-Term Patient Outcomes. J Pediatr 2019; 212:131-136.e1. [PMID: 31201026 DOI: 10.1016/j.jpeds.2019.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe neonatologist continuity of care and estimate the association between these transitions and selected patient outcomes. STUDY DESIGN We linked Children's Hospitals Neonatal Database records with masked neonatologist daily schedules at 4 centers, which use 2- and 3-week and 1-month "on service" blocks to provide care. After describing the neonatologist transitions, we estimated associations between these transitions and selected short-term patient outcomes using multivariable Poisson, logistic, and linear regression analyses, independent of length of stay (LOS) and case-mix. We also completed analyses after stratifying the cohort by LOS, birthweight, age at admission categories, and selected diagnoses. RESULTS Stratified by LOS, patient transitions varied between centers in both unadjusted (P < .001) and multivariable analyses (adjusted incidence rate ratio; 95% CI for center B = 3.98 (3.81-4.15), center C = 4.92 (4.71-5.13), center D = 4.2 (4.0-4.4), P < .001), independent of LOS, gestational age, birthweight, surgical intervention, ventilator duration, and mortality. Only central venous line duration (adjusted incidence rate ratio 1.015, 95% CI 1.01-1.02) was minimally and independently associated with the number of transitions. No differences were observed in ventilator duration, oxygen use at neonatal intensive care unit discharge, bloodstream infections, or urinary tract infections. Surviving infants with meconium aspiration, hypoxic ischemic encephalopathy, cerebral infarction, bronchopulmonary dysplasia, and diaphragmatic hernia demonstrated similar findings. CONCLUSIONS Transitions in neonatologists are frequent in regional neonatal intensive care units but appear unrelated to short-term patient outcomes. Future work to define continuity of care and develop effective strategies that promote longitudinal inpatient management is needed.
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Part-Time Pediatric Radiology: The Realities and Perceptions of Part-Time Employment in the Academic Setting. AJR Am J Roentgenol 2018; 211:971-977. [DOI: 10.2214/ajr.18.19922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Steinbach WJ, Benjamin DK, Sleasman JW. Funding Pediatric Subspecialty Training: Are T32 Grants the Future? J Pediatr 2018; 202:4-7.e1. [PMID: 30360878 DOI: 10.1016/j.jpeds.2018.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Affiliation(s)
- William J Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University, Durham, NC; Department of Molecular Genetics and Microbiology, Duke University, Durham, NC.
| | - Daniel K Benjamin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - John W Sleasman
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Duke University, Durham, NC
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26
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Alvira CM, Steinhorn RH, Balistreri WF, Fineman JR, Oishi PE, Padbury JF, Kinsella JP, Abman SH. Enhancing the Development and Retention of Physician-Scientists in Academic Pediatrics: Strategies for Success. J Pediatr 2018; 200:277-284. [PMID: 30055815 DOI: 10.1016/j.jpeds.2018.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Cristina M Alvira
- Division of Critical Care Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA.
| | - Robin H Steinhorn
- Hospital Based Specialties, Section of Neonatology, National Children's Hospital, Washington, DC
| | - William F Balistreri
- The Journal of Pediatrics, Section of Gastroenterology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH
| | - Jeffrey R Fineman
- Section of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Peter E Oishi
- Section of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - James F Padbury
- Division of Neonatology, Brown University Alpert School of Medicine, Providence, RI
| | - John P Kinsella
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Steven H Abman
- Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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27
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Rimsza ME, Ruch-Ross HS, Clemens CJ, Moskowitz WB, Mulvey HJ. Workforce Trends and Analysis of Selected Pediatric Subspecialties in the United States. Acad Pediatr 2018; 18:805-812. [PMID: 29709621 DOI: 10.1016/j.acap.2018.04.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/18/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To update pediatric subspecialty workforce data to support evidence-based legislation and public policy decisions by replicating the American Academy of Pediatrics' 1998 Future of Pediatric Education (FOPE II) workforce survey. METHODS A descriptive and comparative analysis of survey responses from 9950 US pediatric subspecialists who completed an electronic survey. RESULTS Pediatric subspecialists are working fewer hours and spending less of their time in direct patient care than they did in 1998 but the mean hours worked differs significantly according to subspecialty. Most subspecialists continue to be board-certified, white, non-Hispanic men, although the percentage who are women and from minority groups has increased. The proportion of subspecialists practicing in an academic medical center has increased since 1998. Thirty percent of pediatric subspecialists reported appointment wait times of >2 weeks and pediatric subspecialists in developmental pediatrics, endocrinology, and neurology identified much longer wait times than other subspecialists. CONCLUSION The demographic and practice characteristics of pediatric subspecialists have changed since the FOPE II survey and access to subspecialty care in a family's community remains a challenge. However, pediatric subspecialties are not monolithic and solutions to workforce shortages will need to take into account these differences to improve access to subspecialty care.
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Affiliation(s)
- Mary E Rimsza
- American Academy of Pediatrics, Division of Workforce & Medical Education Policy, Elk Grove Village, Ill.
| | - Holly S Ruch-Ross
- American Academy of Pediatrics, Division of Workforce & Medical Education Policy, Elk Grove Village, Ill
| | - Conrad J Clemens
- Department of Pediatrics & Public Health, University of Arizona College of Medicine, Tucson, Ariz
| | - William B Moskowitz
- The Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Va
| | - Holly J Mulvey
- American Academy of Pediatrics, Division of Workforce & Medical Education Policy, Elk Grove Village, Ill
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Freed GL, Boyer DM, Van KD, Macy ML, McCormick J, Leslie LK. Variation in Part-Time Work among Pediatric Subspecialties. J Pediatr 2018; 195:263-268. [PMID: 29395185 DOI: 10.1016/j.jpeds.2017.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/19/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the part-time workforce and average hours worked per week among pediatric subspecialists in the 15 medical subspecialties certified by the American Board of Pediatrics. STUDY DESIGN We examined data from pediatric subspecialists who enrolled in Maintenance of Certification with the American Board of Pediatrics from 2009 to 2015. Data were collected via an online survey. Providers indicated whether they worked full time or part time and estimated the average number of hours worked per week in clinical, research, education, and administrative tasks, excluding time on call. We calculated and compared the range of hours worked by those in full- and part-time positions overall, by demographic characteristics, and by subspecialty. RESULTS Overall, 9.6% of subspecialists worked part time. There was significant variation in part-time employment rates between subspecialties, ranging from 3.8% among critical care pediatricians to 22.9% among developmental-behavioral pediatricians. Women, American medical graduates, and physicians older than 70 years of age reported higher rates of part-time employment than men, international medical graduates, and younger physicians. There was marked variation in the number of hours worked across subspecialties. Most, but not all, full-time subspecialists reported working at least 40 hours per week. More than one-half of physicians working part time in hematology and oncology, pulmonology, and transplant hepatology reported working at least 40 hours per week. CONCLUSIONS There are unique patterns of part-time employment and hours worked per week among pediatric medical subspecialists that make simple head counts inadequate to determine the effective workforce. Our findings are limited to the 15 American Board of Pediatrics-certified medical subspecialties.
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Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
| | - Debra M Boyer
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kenton D Van
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Michelle L Macy
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Julie McCormick
- Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Laurel K Leslie
- American Board of Pediatrics Foundation, Chapel Hill, NC; Tufts University School of Medicine, Boston MA
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29
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Bridgemohan C, Bauer NS, Nielsen BA, DeBattista A, Ruch-Ross HS, Paul LB, Roizen N. A Workforce Survey on Developmental-Behavioral Pediatrics. Pediatrics 2018; 141:peds.2017-2164. [PMID: 29453235 DOI: 10.1542/peds.2017-2164] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Developmental-behavioral conditions are common, affecting ∼15% of US children. The prevalence and complexity of these conditions are increasing despite long wait times and a limited pipeline of new providers. We surveyed a convenience sample of the developmental-behavioral pediatric (DBP) workforce to determine current practices, workforce trends, and future needs. METHODS An electronic survey was e-mailed to 1568 members of the American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities, the Society for Developmental and Behavioral Pediatrics, and the National Association of Pediatric Nurse Practitioners Developmental and Behavioral Mental Health Special Interest Group. RESULTS The response rate was 48%. There were 411 fellowship-trained physicians, 147 nonfellowship-trained physicians, and 125 nurse practitioners; 61% were women, 79% were white, and 5% were Hispanic. Physicians had a mean of 29 years since medical school graduation, and one-third planned to retire in 3 to 5 years. Nurse practitioners were earlier in their careers. Respondents reported long wait times for new appointments, clinician burnout, increased patient complexity and up to 50% additional time spent per visit in nonreimbursed clinical-care activities. Female subspecialists spent more time per visit in billable and nonbillable components of clinical care. CONCLUSIONS The DBP workforce struggles to meet current service demands, with long waits for appointments, increased complexity, and high volumes of nonreimbursed care. Sex-based practice differences must be considered in future planning. The viability of the DBP subspecialty requires strategies to maintain and expand the workforce, improve clinical efficiency, and prevent burnout.
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Affiliation(s)
- Carolyn Bridgemohan
- Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
| | - Nerissa S Bauer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Britt A Nielsen
- Department of Psychiatry, MetroHealth Medical Center and Department of Psychiatry, Case Western Reserve School of Medicine
| | - Anne DeBattista
- Department of Developmental-Behavioral Pediatrics, Stanford Children's Health, Palo Alto, California; and
| | | | - Linda B Paul
- American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Nancy Roizen
- Department of Pediatrics, UH/Rainbow Babies and Children's Hospital and Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
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