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Ezeoke OM, Williams J, Ogueri V, Hills BK. The Heart of the Matter: A Path to Building Diversity in Pediatric Cardiology. Pediatr Cardiol 2024; 45:1364-1371. [PMID: 36961540 DOI: 10.1007/s00246-023-03144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Our essay discusses the impact of underrepresentation in medical training, with a focus on pediatric cardiology. We use the perspective of a physician who is underrepresented in medicine (URiM), and has chosen to pursue a career in pediatric cardiology, to initiate an analysis of the current path toward pediatric cardiology and the factors in undergraduate and graduate medical education which could currently be optimized to improve diversity in training. We argue that a lack of diversity among physicians leads to worse patient outcomes, and we describe steps to improve representation in the field. In order to improve representation in pediatric cardiology, we must reflect upon our current practices and implement systemic changes within cardiology training program recruitment and retention practices. These changes should include continuous mentorship of URiM trainees interested in cardiology and prioritization of research that investigates social determinants of health which may disproportionally affect minority patients.
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Affiliation(s)
- Ogochukwu M Ezeoke
- Division of Pediatric Cardiology, Congenital Heart Center - C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Drive, Ann Arbor, MI, 48109, USA.
| | - Jason Williams
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Vanessa Ogueri
- Division of Pediatric Cardiology, Children's National Hospital, Washington, DC, USA
| | - Brittney K Hills
- Department of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
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2
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Huang JS, Bialostozky M. Electronic medical record clinical workload metrics from 10,210 gastroenterologists in North America. J Pediatr Gastroenterol Nutr 2024. [PMID: 39034484 DOI: 10.1002/jpn3.12313] [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: 02/22/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024]
Abstract
In the United States, clinical work had been primarily compensated via a relative value unit (RVU) system reliant on professional surveys estimating the value of clinical care events. However, with the advent of time-based billing in 2021, time accounting has become an important work compensation metric. The Signal functionality within Epic, the most widely used electronic medical record (EMR) system in North America, tracks clinician time within the system. We extracted Epic Signal data from 10,200 gastroenterologists at 356 North American institutions for analysis. Workload metrics were reported as group median (interquartile range) per month and comparisons were performed using nonparametric testing. Gastroenterologists exhibit different EMR time patterns based on clientele and practice arenas. Compared with counterparts, pediatric and academic gastroenterologists spend more time at each encounter which had not been compensated under prior RVU valuations. Clinical compensation benchmarks should be driven by time-based workload metrics to ensure appropriate compensation.
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Affiliation(s)
- Jeannie S Huang
- University of California San Diego School of Medicine, La Jolla, California, USA
- Rady Children's Hospital, San Diego, California, USA
| | - Mario Bialostozky
- University of California San Diego School of Medicine, La Jolla, California, USA
- Rady Children's Hospital, San Diego, California, USA
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3
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Soranno DE, Amaral S, Ashoor I, Atkinson MA, Barletta GM, Braun MC, Carlson J, Carter C, Chua A, Dharnidharka VR, Drake K, Erkan E, Feig D, Goldstein SL, Hains D, Harshman LA, Ingulli E, Kula AJ, Leonard M, Mannemuddhu S, Menon S, Modi ZJ, Moxey-Mims M, Nada A, Norwood V, Starr MC, Verghese PS, Weidemann D, Weinstein A, Smith J. Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology. Pediatr Nephrol 2024:10.1007/s00467-024-06410-9. [PMID: 38976042 DOI: 10.1007/s00467-024-06410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 07/09/2024]
Abstract
IMPORTANCE Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care. OBJECTIVE To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce. EVIDENCE REVIEW Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions. FINDINGS A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology. CONCLUSIONS AND RELEVANCE The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients.
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Affiliation(s)
- Danielle E Soranno
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Bioengineering, Purdue University Weldon School of Engineering, 1044 W. Walnut Street, West Lafayette, IN, R4-42146202, USA.
| | - Sandra Amaral
- Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Isa Ashoor
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gina-Marie Barletta
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Michael C Braun
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Joann Carlson
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Caitlin Carter
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | - Annabelle Chua
- Duke Children's Hospital and Health Center, Durham, NC, USA
| | | | - Keri Drake
- University of Texas Southwestern Medical Center, St. Louis, MO, USA
| | - Elif Erkan
- Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA
| | - Dan Feig
- Department of Pediatrics, University of Alabama, Heersink School of Medicine, Birmingham, AL, USA
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA
| | - David Hains
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Elizabeth Ingulli
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | | | - Mary Leonard
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Shina Menon
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Zubin J Modi
- Department of Pediatrics and Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Marva Moxey-Mims
- Department of Pediatrics, Children's National Hospital/George Washington University SOM, Washington, D.C, USA
| | - Arwa Nada
- Department of Pediatrics, Le Bonheur Children's Hospital, UTHSC, Memphis, TN, USA
| | - Victoria Norwood
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Michelle C Starr
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Darcy Weidemann
- Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Adam Weinstein
- Department of Medical Sciences and Pediatrics, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jodi Smith
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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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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Orr CJ, Leslie LK, Schaechter J, Williams XJ, Montez KG, Deen JF, Evans YN, Russell CJ, Webb J, Gaona AR, Mendoza FS. Diversity, Equity, and Inclusion, Child Health, and the Pediatric Subspecialty Workforce. Pediatrics 2024; 153:e2023063678S. [PMID: 38300010 PMCID: PMC10852199 DOI: 10.1542/peds.2023-063678s] [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
Using multiple metrics, the diversity of the pediatric population in the United States is increasing. However, recent data suggest significant disparities in both the prevalence and management of child health conditions cared for by pediatric subspecialists. These inequities occur across multiple dimensions of diversity, including race and ethnicity, country of origin, socioeconomic status, sex and gender, and disability. Research also suggests that attending to diversity, equity, and inclusion in the medical workforce may positively affect health outcomes. High-quality pediatric subspecialty care thus requires knowledge of these data, attention to the effects of social drivers, including racism and discrimination, on health and wellbeing, and interventions to improve pediatric health equity through educational, practice, policy, and research innovations. In this article, we review data on the diversity of the pediatric population and pediatric subspecialty workforce, suggest potential strengths, weaknesses, opportunities, and threats of current diversity, equity, and inclusion initiatives in academic pediatrics, and provide recommendations across 4 domains: education and training, practice, policy, and future research. The ultimate goal of pediatrics is to improve health equity for all infants, children, adolescents, and young adults cared for in the United States by pediatric subspecialists.
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Affiliation(s)
- Colin J. Orr
- Department of Pediatrics
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Kimberly G. Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jason F. Deen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yolanda N. Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Jonathan Webb
- American Board of Pediatrics, Chapel Hill, North Carolina
- Association of Women’s Health Obstetric and Neonatal Nurses, Washington, District of Columbia
| | | | - Fernando S. Mendoza
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
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Weidemann DK, Orr CJ, Norwood V, Brophy P, Leonard MB, Ashoor I. Child Health Needs and the Pediatric Nephrology Subspecialty Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678P. [PMID: 38300004 DOI: 10.1542/peds.2023-063678p] [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 nephrology is dedicated to caring for children with kidney disease, a unique blend of acute care and chronic longitudinal patient relationships. Though historically a small field, trainee interest has declined over the past 2 decades. This has led to growing alarm about the health of the pediatric nephrology workforce, although concerns have been hampered by a lack of available data to enable feasible projections. This article is part of a supplement that anticipates the future pediatric subspecialty workforce supply. It draws on existing literature, data from the American Board of Pediatrics, and findings from a model that estimates the future supply of pediatric subspecialists developed by the Carolina Health Workforce Research Center at the University of North Carolina Chapel Hill's Cecil G. Sheps Center for Health Services Research and Strategic Modeling Analytics & Planning Ltd. The workforce projections from 2020 to 2040 incorporate population growth, clinical effort, and geographic trends and model alternate scenarios adjusting for changes in trainee interest, clinical efforts, and workforce attrition. The baseline model predicts growth of clinical work equivalents by 26% by 2040, but further widening geographic disparities worsen the existing mismatch between supply, clinical need, and market demand. The worst-case scenario projects 13% growth by 2040 which, at best, maintains the status quo of an already strained workforce. The models do not account for many factors expected to heighten demand over the coming decades. Urgent reforms are necessary now. Proposed solutions require multipronged changes in education and training pathways, remuneration, clinical practice models, and government policy.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri, Kansas City, Kansas City, Missouri
| | - Colin J Orr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Victoria Norwood
- Division of Nephrology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Patrick Brophy
- Division of Nephrology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Mary B Leonard
- Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Isa Ashoor
- Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts
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Harrison WN, Mittal VS, O'Toole JK, Quinonez RA, Mink R, Leyenaar JK. Child Health Needs and the Pediatric Hospital Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678M. [PMID: 38300016 DOI: 10.1542/peds.2023-063678m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric hospital medicine (PHM) established a new model of care for hospitalized children in the United States nearly 3 decades ago. In that time, the field experienced rapid growth while distinguishing itself through contributions to medical education, quality improvement, clinical and health services research, patient safety, and health system leadership. Hospital systems have also invested in using in-house pediatricians to manage various inpatient care settings as patient acuity has accelerated. National PHM leaders advocated for board certification in 2014, and the first certification examination was administered by the American Board of Pediatrics in 2019. In this article, we describe the development of the subspecialty, including evolving definitions and responsibilities of pediatric hospitalists. Although PHM was not included in the model forecasting future pediatric subspecialties through 2040 in this supplement because of limited historical data, in this article, we consider the current and future states of the workforce in relation to children's health needs. Expected challenges include potential alterations to residency curriculum, changes in the number of fellowship positions, expanding professional roles, concerns related to job sustainability and burnout, and closures of pediatric inpatient units in community hospitals. We simultaneously forecast growing demand in the PHM workforce arising from the increasing prevalence of children with medical complexity and increasing comanagement of hospitalized children between pediatric hospitalists and other subspecialists. As such, our forecast incorporates a degree of uncertainty and points to the need for ongoing investments in future research to monitor and evaluate the size, scope, and needs of pediatric hospitalists and the PHM workforce.
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Affiliation(s)
- Wade N Harrison
- Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vineeta S Mittal
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas
| | - Jennifer K O'Toole
- Division of Hospital Medicine, Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ricardo A Quinonez
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Mink
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center and the David Geffen School of Medicine at University of California Los Angeles, Torrance, California
| | - JoAnna K Leyenaar
- Department of Pediatrics and the Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Health, Lebanon, New Hampshire
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Frank LH, Glickstein J, Brown DW, Mink RB, Ross RD. Child Health Needs and the Pediatric Cardiology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678E. [PMID: 38300014 PMCID: PMC10852197 DOI: 10.1542/peds.2023-063678e] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article evaluates the pediatric cardiology (PC) workforce and forecasts its future supply. Produced as part of a supplement in Pediatrics, this effort represents a collaboration among the American Board of Pediatrics Foundation, the University of North Carolina at Chapel Hill's Carolina Health Workforce Research Center, the Strategic Modeling and Analysis Ltd., and members of the pediatric subspecialty community. PC is a complex subspecialty including care from fetal life through adulthood and in practice settings that range from the outpatient clinic to procedural settings to the cardiac ICU. Complex subdisciplines include imaging, electrophysiology, heart failure, and interventional and critical care. Using American Board of Pediatrics data, US Census Bureau data, and data from the modeling project, projections were created to model the subspecialty workforce through 2040. Across all modeling scenarios considered, there is considerable projected growth in the supply of pediatric cardiologists by 2040. However, there is significant regional variation in the projected supply of trainees relative to demand in terms of local population growth, with evidence of a likely mismatch between areas surrounding training centers versus areas of greatest workforce need. In addition, this article highlights areas for future focus, including efforts to attract more residents to the subspecialty in general, particularly underrepresented minority members; increased support, more part-time career options, and improved academic career advancement for women in PC; and the development of better "real-time" workforce data to guide trainees and training programs in decisions regarding sub-subspecialty job availability.
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Affiliation(s)
- Lowell H. Frank
- Division of Cardiology, Children’s National Hospital, Washington, District of Columbia
| | - Julie Glickstein
- Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, New York
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Richard B. Mink
- David Geffen School of Medicine at the University of California Los Angeles, The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, Torrance
| | - Robert D. Ross
- Division of Cardiology, Children’s Hospital of Michigan, Detroit, Michigan
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Slingsby B, Bachim A, Leslie LK, Moffatt ME. Child Health Needs and the Child Abuse Pediatrics Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678F. [PMID: 38300005 DOI: 10.1542/peds.2023-063678f] [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
Child abuse pediatrics (CAP) subspecialists evaluate, diagnose, and treat children when abuse or neglect is suspected. Despite the high rates of child maltreatment across the United States, CAP remains the smallest pediatric subspecialty. The CAP workforce faces numerous challenges, including few fellows entering the field, decreased financial compensation compared with other fields of medicine, and threats to workforce retention, including secondary trauma and harmful exposure in the media. A microsimulation model that estimates the future of the US CAP workforce over the next 20 years shows that, although the number of child abuse pediatricians in the field is expected to increase, the growth is smaller than that of every other pediatric subspecialty. In addition to the low overall CAP workforce in the United States, other workforce issues include the need to increase CAP subspecialists who are underrepresented in medicine and unequal geographic distribution across the country. To meet the medical needs of suspected victims of maltreatment, especially in CAP-underserved areas, many children are evaluated by providers who are not board-certified in CAP, such as general pediatricians, family medicine physicians, emergency medicine physicians, and advanced practice providers, whose CAP experience and training may vary. Current child abuse pediatricians should continue introducing the field to medical students and residents, especially those who identify as underrepresented in medicine or are from CAP-underserved areas, and offer mentorship, continuing education, and oversight to non-CAP physicians meeting this population's medical needs.
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Affiliation(s)
- Brett Slingsby
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Angela Bachim
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
| | - Mary E Moffatt
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
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Aye T, Boney CM, Orr CJ, Leonard MB, Leslie LK, Allen DB. Child Health Needs and the Pediatric Endocrinology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678J. [PMID: 38300000 DOI: 10.1542/peds.2023-063678j] [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
The pediatric endocrinology (PE) workforce in the United States is struggling to sustain an adequate, let alone optimal, workforce capacity. This article, one of a series of articles in a supplement to Pediatrics, focuses on the pediatric subspecialty workforce and furthers previous evaluations of the US PE workforce to model the current and future clinical PE workforce and its geographic distribution. The article first discusses the children presenting to PE care teams, reviews the current state of the PE subspecialty workforce, and presents projected headcount and clinical workforce equivalents at the national, census region, and census division level on the basis of a subspecialty workforce supply model through 2040. It concludes by discussing the educational and training, clinical practice, policy, and future workforce research implications of the data presented. Data presented in this article are available from the American Board of Pediatrics, the National Resident Matching Program, and the subspecialty workforce supply model. Aging, part-time appointments, and unbalanced geographic distribution of providers diminish the PE workforce capacity. In addition, limited exposure, financial concerns, and lifestyle perceptions may impact trainees. Additional workforce challenges are the subspecialty's increasingly complex cases and breadth of conditions treated, reliance on international medical graduates to fill fellowship slots, and high relative proportion of research careers. The recent limitations on pediatric endocrinologists providing gender-affirming care may also impact the geographic distribution of the subspecialty's workforce. Deliberate actions need to be taken now to continue serving the needs of children.
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Affiliation(s)
- Tandy Aye
- Division of Pediatric Endocrinology
- Stanford University School of Medicine, Stanford, California
| | - Charlotte M Boney
- Division of Pediatric Endocrinology, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, California
| | | | - David B Allen
- Division of Pediatric Endocrinology and Diabetes, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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11
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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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12
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Sauer CG, Barnard JA, Vinci RJ, Strople JA. Child Health Needs and the Pediatric Gastroenterology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678K. [PMID: 38300013 DOI: 10.1542/peds.2023-063678k] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article is part of an American Board of Pediatrics Foundation-sponsored effort to analyze and forecast the pediatric subspecialty workforce between 2020 and 2040. Herein, an overview of the current pediatric gastroenterology workforce is provided, including demographics, work characteristics, and geographic distribution of practitioners. Brief context is provided on the changing nature of current practice models and the increasing prevalence of some commonly seen disorders. On the basis of a rigorous microsimulation workforce projection model, projected changes from 2020 to 2040 in the number of pediatric gastroenterologists and clinical workforce equivalents in the United States are presented. The article closes with a brief discussion of training, clinical practice, policy, and future workforce research implications of the data presented. This data-driven analysis suggests that the field of pediatric gastroenterology will continue to grow in scope and complexity, propelled by scientific advances and the increasing prevalence of many disorders relevant to the discipline. The workforce is projected to double by 2040, a growth rate faster than most other pediatric subspecialties. Disparities in care related to geography, race, and ethnicity are among the most significant challenges for the years ahead. Changes to training and education, incentives to meet the needs of underserved populations, and new multidisciplinary models for health care delivery will be necessary to optimally meet the volume, diversity, and complexity of children with gastroenterological diseases in the years ahead.
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Affiliation(s)
- Cary G Sauer
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - John A Barnard
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio
| | - Robert J Vinci
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jennifer A Strople
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois
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13
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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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14
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Orr CJ, McCartha E, Vinci RJ, Mink RB, Leonard MB, Bissell M, Gaona AR, Leslie LK. Projecting the Future Pediatric Subspecialty Workforce: Summary and Recommendations. Pediatrics 2024; 153:e2023063678T. [PMID: 38300012 DOI: 10.1542/peds.2023-063678t] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
This article summarizes the findings of a Pediatrics supplement addressing the United States workforce for 15 pediatric subspecialties. It includes results from a microsimulation model projecting supply through 2040; growth is forecasted to be uneven across the subspecialties with worsening geographic maldistribution. Although each subspecialty has unique characteristics, commonalities include (1) the changing demographics and healthcare needs of children, including mental health; (2) poor outcomes for children experiencing adverse social drivers of health, including racism; and (3) dependence on other subspecialties. Common healthcare delivery challenges include (1) physician shortages for some subspecialties; (2) misalignment between locations of training programs and subspecialists and areas of projected child population growth; (3) tension between increasing subsubspecialization to address rare diseases and general subspecialty care; (4) the need to expand clinical reach through collaboration with other physicians and advanced practice providers; (5) the lack of parity between Medicare, which funds much of adult care, and Medicaid, which funds over half of pediatric subspecialty care; and (6) low compensation of pediatric subspecialists compared with adult subspecialists. Overall, subspecialists identified the lack of a central authority to monitor and inform child healthcare provided by pediatric subspecialists as a challenge. Future research on the pediatric subspecialty workforce and the children it serves will be necessary to ensure these children's needs are met. Together, these articles provide overarching and subspecialty-specific recommendations to improve training, recruitment, and retention of a diverse workforce, implement innovative models of care, drive policy changes, and advise future research.
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Affiliation(s)
- Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily McCartha
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert J Vinci
- Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, California
| | - Mary Bissell
- Child Focus, Washington, District of Columbia
- Georgetown University Law Center, Georgetown University, Washington, District of Columbia
| | - Adriana R Gaona
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina
- Tufts University School of Medicine, Boston, Massachusetts
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15
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Kelly MS, Cataldi JR, Schlaudecker EP, Shah SS, Vinci RJ, Myers AL. Child Health Needs and the Pediatric Infectious Diseases Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678N. [PMID: 38300015 PMCID: PMC10852198 DOI: 10.1542/peds.2023-063678n] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric infectious diseases (PID) physicians prevent and treat childhood infections through clinical care, research, public health, education, antimicrobial stewardship, and infection prevention. This article is part of an American Board of Pediatrics Foundation-sponsored supplement investigating the future of the pediatric subspecialty workforce. The article offers context to findings from a modeling analysis estimating the supply of PID subspecialists in the United States between 2020 and 2040. It provides an overview of children cared for by PID subspecialists, reviews the current state of the PID workforce, and discusses the projected headcount and clinical workforce equivalents of PID subspecialists at the national, census region, and census division levels over this 2-decade period. The article concludes by discussing the education and training, clinical practice, policy, and research implications of the data presented. Adjusting for population growth, the PID workforce is projected to grow more slowly than most other pediatric subspecialties and geographic disparities in access to PID care are expected to worsen. In models considering alternative scenarios, decreases in the number of fellows and time spent in clinical care significantly affect the PID workforce. Notably, model assumptions may not adequately account for potential threats to the PID workforce, including a declining number of fellows entering training and the unknown impact of the COVID-19 pandemic and future emerging infections on workforce attrition. Changes to education and training, clinical care, and policy are needed to ensure the PID workforce can meet the future needs of US children.
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Affiliation(s)
- Matthew S. Kelly
- Department of Pediatrics, Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jessica R. Cataldi
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samir S. Shah
- Division of Infectious Diseases
- Division of Hospital Medicine, Cincinnati Children’s Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert J. Vinci
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Angela L. Myers
- Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- University of Missouri – Kansas City
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16
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Fields EL, Louis-Jacques J, Kas-Osoka O, Holland-Hall C, Richardson LP, Ott M, Leslie LK, Pitts SAB. Child Health Needs and the Adolescent Medicine Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678D. [PMID: 38300009 DOI: 10.1542/peds.2023-063678d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Adolescent medicine (AM) subspecialists provide primary, subspecialty, and consultative care to adolescents and young adults (AYAs). Given insufficient numbers of AM subspecialists to care for all AYAs, the workforce supports AYAs health care capacity through education, research, advocacy, and the development of policies and programs sensitive to their unique needs. A modeling project funded by the American Board of Pediatrics Foundation was developed to forecast the pediatric subspecialty workforce in the United States from 2020 to 2040 on the basis of current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios, and reports results in headcount and headcount adjusted for percentage of time spent in clinical care, termed "clinical workforce equivalent." For the AM subspecialty, several scenarios were considered that modified the number of fellows and/or clinical time. The baseline model predicted low growth nationally (27% and 13% increase in total AM subspecialists and AM subspecialists per 100 000 children, respectively) and declines in AM workforce relative to population growth in census divisions with existing geographic workforce disparities. In the alternative scenarios, fellow number and clinical time changes did not significantly change predictions relative to the baseline model, but a 12.5% decrease in fellows predicted a 40% reduction in the workforce from baseline with a widening of geographic workforce disparities. On the basis of the expansive clinical and nonclinical roles of AM subspecialists and these forecasted workforce challenges, significant educational, practice, and policy changes will be necessary to bolster the supply of well-trained clinicians addressing the dynamic health care needs of AYAs.
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Affiliation(s)
| | | | - Oriaku Kas-Osoka
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cynthia Holland-Hall
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura P Richardson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Mary Ott
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Sarah A B Pitts
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Vinci RJ, Clapp DW, Reed A, Degnon L. A Flattening of the Curve: The Challenge of Disparate Growth Rates in the Pediatric Subspecialties. J Pediatr 2023; 261:113509. [PMID: 37301280 DOI: 10.1016/j.jpeds.2023.113509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Robert J Vinci
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - D Wade Clapp
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Ann Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Durham, NC
| | - Laura Degnon
- Association of Medical School Pediatric Department Chairs, McLean, VA
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18
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Weiss P. Recruitment into Pediatric Pulmonary Fellowship Programs: The Bigger the Better? ATS Sch 2023; 4:250-253. [PMID: 37795113 PMCID: PMC10547034 DOI: 10.34197/ats-scholar.2023-0091ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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19
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Heller RE, Joshi A, Sircar R, Hayatghaibi S. Medicaid and the Children's Health Insurance Program: an overview for the pediatric radiologist. Pediatr Radiol 2023; 53:1179-1187. [PMID: 36879048 PMCID: PMC9988602 DOI: 10.1007/s00247-023-05640-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid's structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP.
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Affiliation(s)
- Richard E Heller
- Radiology Partners, 2330 Utah Avenue, Suite 200, El Segundo, CA, 90245, USA.
| | - Aparna Joshi
- Section of Pediatric Radiology, University of Michigan C.S. Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4252, Ann Arbor, MI, 48109-4252, USA
| | - Robin Sircar
- Advocate Children's Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - Shireen Hayatghaibi
- Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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20
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Orr CJ, Turner AL, Ritter VS, Gutierrez-Wu J, Leslie LK. Pursuing a Career in Pediatrics: Intersection of Educational Debt and Race/Ethnicity. J Pediatr 2023; 252:162-170. [PMID: 35973445 DOI: 10.1016/j.jpeds.2022.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the associations among pediatric trainees' self-reported race/ethnicity, educational debt, and other factors for pursuing a pediatrics career. STUDY DESIGN Cross-sectional study using data from the American Board of Pediatrics In-training Examination Post-examination Survey years 2018-2020 of categorical pediatric interns. Independent variable of interest was race/ethnicity. Classifications used were White, Hispanic/Latinx, Black/African American, Asian, and other/multiracial. The primary dependent variable was educational debt; secondary dependent variables included the importance of personal, professional, and financial factors in selecting a pediatric career. Means with 95% CIs were computed to summarize scores regarding a factor's importance. Chi-square tests of homogeneity and one-way ANOVA F tests were used to compare proportions and means of dependent variables across levels of self-reported race/ethnicity. RESULTS A total of 11 150 (91.5%) completed the survey. Of the final analytical sample (7 943), approximately 6.3% self-identified as Black/African American, 8.2% as Hispanic/Latinx, 22% as Asian, and 55% as White; 44% reported >$200 000 of debt. Overall, 33% of those identifying as Black/African American had >$300 000 in educational debt. The highest ranked career factor was interest in a specific disease/patient population. The importance of educational debt in career choices was highest among those identifying as Black/African American, followed by Asians and Hispanic/Latinx. Among all races/ethnicities, the importance of mentorship decreased with higher educational debt. CONCLUSION Among individuals pursuing pediatrics, the intersection of race/ethnicity and debt may influence trainees' pursuit of pediatric careers. Educational debt negatively impacts the importance of mentorship.
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Affiliation(s)
- Colin J Orr
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Victor S Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Gutierrez-Wu
- Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, NC; Tufts School of Medicine, Boston, MA
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21
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Daily J, Palmer E, Mizell J. A Primer on Retirement Savings for Pediatricians. Clin Pediatr (Phila) 2022:99228221146449. [PMID: 36579855 DOI: 10.1177/00099228221146449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Joshua Daily
- Arkansas Children's Hospital, Little Rock, AR, USA.,University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Edwin Palmer
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jason Mizell
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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22
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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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23
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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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24
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Lakshminrusimha S, Olsen SL, Lubarsky DA. Behavioral economics in neonatology-balancing provider wellness and departmental finances. J Perinatol 2022; 42:683-688. [PMID: 35318428 PMCID: PMC8939884 DOI: 10.1038/s41372-022-01370-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022]
Abstract
High work relative value units (wRVU) per clinical full-time-equivalent (cFTE) productivity by Neonatologists have played a key role in enhancing departmental revenue in Pediatrics. However, such high productivity is not sustainable due to recent changes in trainee schedules and global daily codes and is likely to impact physician morale and wellness. Incentives based on wRVU benchmarks have the capacity to promote desirable behavior such as better documentation and in-person attendance in delivery room resuscitation and consults but comes at a cost of physician time providing care. An alternate method of funding academic Pediatric departments using time- or point-based staffing models, a reduction in productivity benchmarks for academic neonatologists through more accurate reporting of effort and physician leadership that promotes transparency and mutual respect are warranted to improve neonatologist well-being and morale.
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Affiliation(s)
| | - Steven L Olsen
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
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25
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Espinoza J, Shah P, Nagendra G, Bar-Cohen Y, Richmond F. Pediatric Medical Device Development and Regulation: Current State, Barriers, and Opportunities. Pediatrics 2022; 149:186768. [PMID: 35425971 DOI: 10.1542/peds.2021-053390] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Few medical devices are designed and marketed specifically for children. Instead, adult devices are often repurposed and used off-label in pediatrics. The innovation gap between pediatric and adult devices is complex and multifactorial. This review aims to summarize the medical device landscape, describe barriers to pediatric device development, and provide an update on current strategies to help overcome these limitations. Medical devices are regulated by the Food and Drug Administration. They are registered, cleared, or approved on the basis of a 3-tier risk classification system and a differentiated set of regulatory pathways. This includes some for products that receive special designations on the basis of specific aspects that warrant more rapid review and approval. Pediatric devices number only one-quarter of those developed for adults for multiple reasons. Clinically, innovators must adjust their products to address the smaller sizes, growth, and longer duration of use in children. Smaller sample sizes and population heterogeneity also challenge the ability to obtain sufficient safety data for regulatory submissions. Financial concerns stem from lower pediatric reimbursement rates coupled with a lack of nationally standardized coverage. There are a number of promising initiatives, including the Pediatric Device Consortia Program, Early Feasibility Studies, and the new System of Hospitals for Innovation in Pediatrics - Medical Devices. However, the gap will likely not be narrowed without broad cooperation across stakeholders from industry, academia, patient advocacy groups, health care providers, investors, payors, regulators, and Congress.
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Affiliation(s)
- Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Payal Shah
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Gautam Nagendra
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Yaniv Bar-Cohen
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Frances Richmond
- Department of Regulatory & Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, California
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Gold JM, Yemane L, Keppler H, Balasubramanian V, Rassbach CE. Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents. Acad Pediatr 2022; 22:698-704. [PMID: 35158087 DOI: 10.1016/j.acap.2022.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees. OBJECTIVE To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident. DESIGN/METHODS All faculty evaluations of residents in 3 consecutive intern classes from 2016 to 2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences to detect imbalances between genders. RESULTS A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory. CONCLUSIONS We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.
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Affiliation(s)
- Jessica M Gold
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif
| | - Hannah Keppler
- Department of Pediatrics (H Keppler), Albert Einstein College of Medicine, Bronx, NY
| | | | - Caroline E Rassbach
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif
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Abstract
IMPORTANCE Gender-based disparities in compensation in academic medicine are recognized, but their estimated impacts on early career earning potential and strategies to mitigate them have not been well studied. OBJECTIVES To compare earning potential between female and male academic physicians in the first 10 years of posttraining employment and to evaluate the estimated impact of promotion timing, starting salary, and salary growth rate on earning potential. DESIGN, SETTING, AND PARTICIPANTS Using publicly available mean debt and compensation data for full-time employed academic physicians in the US from 2019 to 2020, starting salary, salary in year 10 of employment, annual salary growth rate, and overall earning potential in the first 10 years of employment were estimated for each gender by subspecialty. The estimated impacts of promotion timing and potential interventions, including equalizing starting salaries and annual salary growth rates, were modeled. Data analysis was performed from March to May 2021. EXPOSURES Gender and subspecialty. MAIN OUTCOMES AND MEASURES Starting salary, annual salary growth rate, year-10 salary, and earning potential in first 10 years of employment. RESULTS This cross-sectional study included compensation data from 24 593 female and 29 886 male academic physicians across 45 subspecialties. Women had lower starting salaries in 42 of 45 subspecialties (93%), year-10 salaries in 43 of 45 subspecialties (96%), mean annual salary growth rates in 22 of 45 subspecialties (49%), and earning potential in 43 of 45 subspecialties (96%) (median [IQR], $214 440 [$130 423-$384 954], or 10%, less). A 1-year delay in promotion from assistant to associate professor reduced women's earning potential by a median (IQR) of $26 042 ($19 672-$35 671), but failure to be promoted at all reduced it by a median (IQR) of $218 724 ($176 317-$284 466). Equalizing starting salaries could increase women's earning potential by a median (IQR) of $250 075 ($161 299-$381 799) in the subspecialties for which starting salaries for women were lower than those for men. Equalizing annual salary growth rates could increase women's earning potential by a median (IQR) of $53 661 ($24 258-$102 892) in the subspecialties for which mean annual salary growth rates were lower for women than for men. CONCLUSIONS AND RELEVANCE The findings of this study suggest that gender-based disparities in starting salary and early career earning potential are pervasive in academic medicine in the US. Equalizing starting salaries would address the majority of the differences in earning potential.
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Affiliation(s)
- Eva Catenaccio
- Division of Pediatric Neurology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan M. Rochlin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Harold K. Simon
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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Weidemann DK, Ashoor IA, Soranno DE, Sheth R, Carter C, Brophy PD. Moving the Needle Toward Fair Compensation in Pediatric Nephrology. Front Pediatr 2022; 10:849826. [PMID: 35359890 PMCID: PMC8960267 DOI: 10.3389/fped.2022.849826] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease is neither sufficiently valued, nor appropriately compensated. Current compensation models derived from the relative value unit (RVU) system contribute to the structural biases inherent in the current inequitable payment system. The perceived negative financial compensation is a significant driver of waning trainee interest in the field which is one of the least attractive specialties for students, with a significant proportion of training spots going unfilled each year and relatively stagnant growth rate as compared to the other pediatric subspecialties. This article reviews the current state of financial compensation issues plaguing the pediatric nephrology subspecialty. We further outline strategies for pediatric nephrologists, hospital administrators, and policy-makers to improve the landscape of financial reimbursement to pediatric subspecialists. A physician compensation model is proposed which aligns clinical activity with alternate metrics for current non-RVU producing activities that harmonizes hospital and personal mission statements.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, United States.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - I A Ashoor
- Division of Nephrology, LSU Health New Orleans and Children's Hospital, New Orleans, LA, United States
| | - D E Soranno
- Departments of Pediatrics, University of Colorado, Bioengineering, and Medicine, Anschutz Medical Campus, Aurora, CO, United States
| | - R Sheth
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - C Carter
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
| | - P D Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, United States
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