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Frintner MP, Leslie LK, Gottschlich EA, Starmer AJ, Byrne BJ, Freed GL. Pediatricians' Career Satisfaction and Wellbeing by Sex Before and During the COVID-19 Pandemic. Pediatrics 2024; 153:e2023063345. [PMID: 38384232 DOI: 10.1542/peds.2023-063345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To compare pediatrician career satisfaction and wellbeing by sex during the coronavirus disease 2019 pandemic with prepandemic years using longitudinal survey data. METHODS Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine career satisfaction and wellbeing from 2012 to 2021 among 2002-2004 and 2009-2011 residency graduates (n = 1760). Mixed effects logistic regression, including key pediatrician characteristics, examined career satisfaction and wellbeing measures for sex (female vs male), pandemic year (2012-2019 vs 2020-2021), and their interaction effect. Adjusted predicted percentage values (PVs) were determined. RESULTS In total, 73.4% of participants identified as female. Adjusting for key pediatrician characteristics, differences were found by sex for satisfaction and 4 of 5 wellbeing measures, by pandemic year for 2 wellbeing measures, and the interaction of sex and pandemic year for 3 wellbeing measures. Female pediatricians reported higher levels of anxiety, sadness, and work stress, with greater differences during the pandemic. For example, female pediatricians (PV = 22.6, confidence interval [CI] = 21.0-24.3) were more likely than male pediatricians (PV = 14.2, CI = 12.0-16.4) to report anxiety during pre-pandemic years, and the difference between female pediatricians (PV = 29.3, CI = 26.7-32.0) and male pediatricians (PV = 12.4, CI = 9.3-15.5) increased during pandemic years (sex by pandemic year interaction, P < .001). CONCLUSIONS Compared with male pediatricians, female pediatricians reported worse anxiety, sadness, and stress at work, and the differences were more pronounced during the pandemic.
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Affiliation(s)
| | | | | | - Amy J Starmer
- Baystate Children's Hospital, Springfield, Massachusetts
| | - Bobbi J Byrne
- Indiana University School of Medicine, Indianapolis, Indiana
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Gottschlich EA, Frintner MP, Kist TW, Haftel HM. Pediatric Residents' Preparedness and Training Satisfaction: 2015 to 2022. Pediatrics 2024; 153:e2023063764. [PMID: 38258395 DOI: 10.1542/peds.2023-063764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
| | | | - Tylar W Kist
- American Academy of Pediatrics, Itasca, Illinois
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Green C, Gottschlich EA, Burr WH. A National Survey of Pediatricians' Experiences and Practices With Suicide Prevention. Acad Pediatr 2023; 23:1403-1410. [PMID: 36731651 DOI: 10.1016/j.acap.2023.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Describe pediatricians' experiences, attitudes, and practices around suicide prevention within primary care, and examine associations between pediatricians' experiences and practices. METHODS The nationally representative Periodic Survey of American Academy of Pediatrics members provided data on pediatricians' patient experience with suicide risk, perceived barriers to screening for suicidal ideation (SI), preparedness to counsel about suicide prevention, interest in learning more about suicide prevention strategies, and frequency of screening for and managing suicidal ideation. Multivariable analyses examined the effect of having a patient die by or attempt suicide on screening practices. RESULTS A total of 41% responded to the survey with 377 respondents in the analytic sample. A total of 93% of pediatricians had a patient screen positive for SI and 81% had a patient attempt or die by suicide. A total of 61% always screened for SI and 63% reported using a standardized depression screening tool and 9% a suicide-specific tool. Respondents who had a patient attempt or die by suicide were more likely to screen for SI (OR, 2.05, 95% CI, 1.16-3.63) and use a standardized depression screening instrument (OR, 2.34, 95% CI, 1.29-4.24). Patient reluctance to discuss mental health was the most frequently cited barrier (51%) followed by lack of time (49%) and lack of treatment options (43%). Over 90% of respondents assessed for a plan and referred to mental health services when suicidal ideation was identified. CONCLUSION Although pediatricians frequently see patients with suicide risk, 39% do not always screen for SI. Educational efforts are needed to improve pediatricians' assessment and management of suicide risk given new guidelines.
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Affiliation(s)
- Cori Green
- Department of Pediatrics (C Green), New York Presbyterian/Weill Cornell Medicine, New York, NY.
| | | | - William H Burr
- American Academy of Pediatrics (EA Gottschlich, WH Burr), Itasca, Ill
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Byrne BJ, Frintner MP, Starmer AJ, Gottschlich EA, Freed GL. Different Measures and Ways to Categorize Pediatrician Burnout and the Association with Satisfaction. J Pediatr 2022; 249:84-91. [PMID: 35660489 DOI: 10.1016/j.jpeds.2022.05.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/27/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Compare pediatrician burnout when measured and categorized in different ways to better understand burnout and the association with satisfaction. STUDY DESIGN We analyzed national survey data from a cohort study of early to midcareer pediatricians. In 2017, participants randomly received 1 of 3 question sets measuring burnout components (emotional exhaustion, depersonalization, and personal accomplishment): group A received the Maslach Burnout Inventory, group B received a previously used measure, and group C received a new severe measure. Repeated measures ANOVA tested differences across burnout categorizations: high emotional exhaustion and high depersonalization and low personal accomplishment; high emotional exhaustion and high depersonalization; and high emotional exhaustion or high depersonalization. Logistic regression tested relationships between burnout profiles (engaged, intermediate, and burnout) and satisfaction. Seventy-one percent of participants completed the survey (1279/1800). RESULTS Burnout varied depending on measurement (groups A, B, and C) and categorization. For example, for group A, when categorized as high emotional exhaustion, high depersonalization, and low personal accomplishment, burnout was lower (4.8%) than categorized as high emotional exhaustion and depersonalization (15.2%) (P < .001) or categorized as high emotional exhaustion or depersonalization (44.6%) (P < .001). Most participants were satisfied with their career (83.6%). Using burnout profiles, 38.4%-85.1% fell in the engaged profile. For each group, burnout profiles were associated with satisfaction. For example, group A participants in the burnout or intermediate profile were less likely than those engaged to be satisfied with their careers (aOR, 0.08 [95% CI, 0.03-0.24]; and aOR, 0.23 [95% CI, 0.10-0.56], respectively). CONCLUSIONS The way burnout is measured and categorized affects burnout prevalence and its association with satisfaction. Transparency in methodology used is critical to interpreting results.
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Affiliation(s)
- Bobbi J Byrne
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Amy J Starmer
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | | | - Gary L Freed
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
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Frintner MP, Leslie LK, Gottschlich EA, Starmer AJ, Cull WL. Changes in Work Characteristics and Pediatrician Satisfaction: 2012-2020. Pediatrics 2022; 150:188261. [PMID: 35686476 DOI: 10.1542/peds.2021-055146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the association of changes in pediatricians' work characteristics with their satisfaction using longitudinal data. METHODS Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES), were used to examine self-reported work satisfaction from 2012 to 2020 among 2002-2004 and 2009-2011 residency graduates (N = 1794). Drawing from the Physician Worklife Study, work satisfaction was measured as a 4-item scale score and averaged [range, 1 (low)-5 (high)]. Mixed effects linear regression for longitudinal analysis examined work satisfaction with year as the lone explanatory variable and then with 11 variables that might change over time (time variant) to assess how changes in work might be linked to increased or decreased satisfaction. RESULTS In total, 85.9% of pediatricians in 2020 (September-December) thought their work was personally rewarding. Overall mean work satisfaction scale score displayed a small but significant (P < .001) decrease over time (3.80 in 2012 to 3.69 in 2020). Mixed effects modeling identified several changes associated with increasing work satisfaction over time: increased flexibility in work hours (B = 0.23; 95% confidence interval, 0.20 to 0.25) and personal support from physician colleagues (B = 0.18; 95% confidence interval, 0.15 to 0.21) had the largest associations. Pediatricians reporting increased stress balancing work and personal responsibilities and increased work hours had decreased satisfaction scores. CONCLUSIONS Early- to midcareer pediatricians expressed high levels of work satisfaction, though, satisfaction scale scores decreased slightly over time for the sample overall, including during 2020 (year 1 of the coronavirus disease 2019 pandemic). Pediatricians reporting increases in flexibility with work hours and colleague support showed the strongest increase in work satisfaction.
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Affiliation(s)
| | | | | | - Amy Jost Starmer
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William L Cull
- Research, American Academy of Pediatrics, Itasca, Illinois
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Larson K, Gottschlich EA, Cull WL, Olson LM. High-Deductible Health Plans for US Children: Trends, Health Service Use, and Financial Barriers to Care. Acad Pediatr 2021; 21:1345-1354. [PMID: 33713837 DOI: 10.1016/j.acap.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/08/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. METHODS Trend data on HDHP enrollment were available for 58,910 children ages 0 to 17 with private insurance from the 2007 to 2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. RESULTS The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007 to 2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs 5.7%), had problems paying medical bills (15.7% vs 10.3%), and had family medical debt (34.1% vs 25.8%). CONCLUSIONS Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care.
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Lipkin PH, Macias MM, Baer Chen B, Coury D, Gottschlich EA, Hyman SL, Sisk B, Wolfe A, Levy SE. Trends in Pediatricians' Developmental Screening: 2002-2016. Pediatrics 2020; 145:peds.2019-0851. [PMID: 32123018 DOI: 10.1542/peds.2019-0851] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Current guidelines from the American Academy of Pediatrics recommend screening children for developmental problems by using a standardized screening tool and referring at-risk patients to early intervention (EI) or subspecialists. Adoption of guidelines has been gradual, with research showing many children still not being screened and referred. METHODS We analyzed American Academy of Pediatrics Periodic Survey data from 2002 (response rate = 58%; N = 562), 2009 (response rate = 57%; N = 532), and 2016 (response rate = 47%, N = 469). Surveys included items on pediatricians' knowledge, attitudes, and practices regarding screening and referring children for developmental problems. We used descriptive statistics and a multivariable logistic regression model to examine trends in screening and referral practices and attitudes. RESULTS Pediatricians' reported use of developmental screening tools increased from 21% in 2002 to 63% in 2016 (P < .001). In 2016, on average pediatricians reported referring 59% of their at-risk patients to EI, up from 41% in 2002 (P < .001), and pediatricians in 2016 were more likely than in 2002 to report being "very likely" to refer a patient with global developmental delay, milestone loss, language delay, sensory impairment, motor delays, and family concern to EI. CONCLUSIONS Pediatricians' reported use of a standardized developmental screening tool has tripled from 2002 to 2016, and more pediatricians are self-reporting making referrals for children with concerns in developmental screening. To sustain this progress, additional efforts are needed to enhance referral systems, improve EI programs, and provide better tracking of child outcomes.
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Affiliation(s)
- Paul H Lipkin
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland;
| | - Michelle M Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Briella Baer Chen
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
| | | | | | - Susan L Hyman
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Blake Sisk
- Research, American Academy of Pediatrics, Itasca, Illinois
| | - Audrey Wolfe
- Massachusetts General Hospital, Boston, Massachusetts; and
| | - Susan E Levy
- Division of Developmental Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Holman DM, Qin J, Gottschlich EA, Balk SJ. Clinical counseling on sun protection and indoor tanning avoidance: A survey of current practices among U.S. health care providers. Prev Med 2019; 126:105783. [PMID: 31325525 PMCID: PMC6697604 DOI: 10.1016/j.ypmed.2019.105783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
Clinicians can play a role in skin cancer prevention by counseling their patients on use of sun protection and indoor tanning avoidance. We used data from the 2016 DocStyles, a web-based survey of U.S. primary care providers, to examine skin cancer prevention counseling practices among 1506 providers. In 2018, we conducted logistic regression analyses to examine factors associated with regularly providing counseling. Almost half (48.5%) of all providers reported regularly counseling on sun protection, and 27.4% reported regularly counseling on indoor tanning. Provider characteristics associated with regular counseling included having practiced medicine for at least 16 years (sun protection: adjusted prevalence ratio [aPR] = 1.27, 95% confidence interval [CI] = 1.15, 1.41; indoor tanning: aPR = 1.38, 95% CI = 1.17, 1.63), having treated sunburn in the past year (sun protection: aPR = 1.78, 95% CI = 1.46, 2.17; indoor tanning: aPR = 2.42, 95% CI = 1.73, 3.39), and awareness of U.S. Preventive Services Task Force recommendations (sun protection: aPR = 1.73, 95% CI = 1.51, 2.00; indoor tanning: aPR = 2.70, 95% CI = 2.09, 3.48). Reporting barriers to counseling was associated with a lower likelihood of regularly counseling on sun protection (1-3 barriers: aPR = 0.82, 95% CI = 0.71, 0.94; 4+ barriers: aPR = 0.80, 95% CI = 0.69, 0.93) and indoor tanning (1-3 barriers: aPR = 0.72, 95% CI = 0.57, 0.91; 4+ barriers: aPR = 0.61, 95% CI = 0.47, 0.78). Barriers to counseling included lack of time (58.1%), more urgent health concerns (49.1%), and patient disinterest (46.3%). Although many providers report regularly counseling patients on skin cancer prevention, most report serious barriers to providing such counseling. Additional research could explore strategies to integrate compelling and informative skin cancer prevention counseling into current provider practices.
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Affiliation(s)
- Dawn M Holman
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, GA, United States of America.
| | - Jin Qin
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, GA, United States of America
| | - Elizabeth A Gottschlich
- Department of Research, American Academy of Pediatrics, Itasca, IL, United States of America
| | - Sophie J Balk
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States of America
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Gottschlich EA, Larson K, Sisk B, Pat Frintner M. Sleep, Physical Activity, and General Health Status: US Pediatricians and the General US Adult Population. Acad Pediatr 2019; 19:269-277. [PMID: 30103049 DOI: 10.1016/j.acap.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/24/2018] [Accepted: 08/05/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine US pediatricians and US adults on 3 self-reported health measures (sleep, physical activity, and general health status) and to assess factors related to these measures for each group. METHODS Pediatrician data were collected through a 2012 American Academy of Pediatrics Periodic Survey (response rate = 64.0%). US population data originated from the 2012 National Health Interview Survey (response rate = 61.2%). Analytic samples included those currently working and ≥30 years old and were restricted to post-trainees (pediatricians; n = 854) and US adults with at least a bachelor's degree (n = 5447). Accounting for sample demographic differences, predicted probabilities compared the proportions reporting ≥7 hours of sleep, meeting physical activity recommendations, and reporting very good or excellent health. Multivariable logistic regression examined characteristics associated with health measures for pediatricians and US adults separately. RESULTS When the US population demographic profile was adjusted to resemble the pediatrician sample, 7 in 10 pediatricians (71.2%; confidence interval [CI], 68.0-74.5) and US adults (69.9%; CI, 67.8-72.0) reported ≥7 hours of sleep. Pediatricians were more likely than US adults to meet physical activity recommendations (71.4%; CI, 68.0-74.8 vs. 62.9%; CI, 60.6-65.2) and less likely to report very good or excellent health (74.3%; CI, 71.2-77.3 vs. 80.2%; CI, 78.3-82.1). In pediatrician and US population multivariable models, self-identified Asians and those working ≥50 hours were less likely to get ≥7 hours of sleep (P < .05). CONCLUSIONS Most US pediatricians and US adults reported getting the recommended amounts of sleep and physical activity and rated their health as very good or excellent. Those working fewer hours reported more sleep. Organization-directed approaches may be needed to help physicians maintain and improve their health.
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Affiliation(s)
| | - Kandyce Larson
- Department of Research, American Academy of Pediatrics, Itasca, Ill
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics, Itasca, Ill
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Abstract
BACKGROUND The US Preventive Services Task Force recommends clinical counseling for individuals ages 10 to 24 years to decrease skin cancer risk. METHODS A national, random sample of US American Academy of Pediatrics members practicing primary care in 2002 (response rate 55%) and 2015 (response rate 43%). Surveys explored attitudes and experiences regarding sun protection counseling; indoor tanning questions were added in 2015. χ2 tests compared demographics and counseling responses across years, and multivariable logistic regression models examined counseling predictors. RESULTS More pediatricians in 2015 (34%) than in 2002 (23%) reported discussing sun protection during recent summer months with ≥75% of patients. This pattern held across all patient age groups (each P <.001). Female and suburban pediatricians counseled more; those in the South and West counseled less. More pediatricians in 2015 than in 2002 named time as a barrier. Sun protection ranked lowest among preventive topics in both years. In 2015, approximately one-third of pediatricians reported discussing indoor tanning at least once with 10 to 13 year-old patients; approximately half discussed this with older adolescents. Most (70%) did not know if their states had laws on minors' indoor tanning access; those stating they knew whether a law existed counseled more. CONCLUSIONS Although improved, sun protection counseling rates remain low. Indoor tanning counseling can be improved. Because early-life exposure to UV radiation increases risk and clinician counseling can positively impact prevention behaviors, pediatricians have an important role in skin cancer prevention; counseling may save lives. Time constraints remain a barrier.
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Affiliation(s)
- Sophie J. Balk
- Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | | | - Dawn M. Holman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Cull WL, Katakam SK, Starmer AJ, Gottschlich EA, Miller AA, Frintner MP. A Study of Pediatricians' Debt Repayment a Decade After Completing Residency. Acad Med 2017; 92:1595-1600. [PMID: 28445218 DOI: 10.1097/acm.0000000000001721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Pediatricians' education debt has been increasing. Less is known about the pace of their debt repayment. The authors examined patterns of debt repayment for pediatricians who completed residency from 2002-2004. METHOD The authors analyzed weighted 2013 survey data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study. They categorized participants based on education debt level at residency completion ($0; $1-$49,999; $50,000-$99,999; $100,000-$149,999; ≥ $150,000) and explored debt repayment and well-being by starting debt group using multivariable logistic regression. RESULTS Of 830 pediatricians surveyed, 266 (32%) had no starting debt and 166 (20%) had ≥ $150,000 in starting debt. A decade after residency, the percentage of participants who completely repaid their debt varied from 76% (68/89) of those with $1-$49,999 of starting debt to 15% (25/164) of those with ≥ $150,000 of starting debt. The percentage of participants concerned about their debt increased with starting debt level, with over half of those in the highest group concerned. Starting debt was associated with all examined measures of debt repayment and with recent financial difficulties among those in the two highest debt groups ($100,000-$149,999: adjusted odds ratio = 3.82, confidence interval = 1.17-12.43; ≥ $150,000: adjusted odds ratio = 4.55, confidence interval = 1.47-14.14). CONCLUSIONS A decade after completing residency, pediatricians had made progress repaying their debt, yet many still expressed concern, especially those with the greatest amount of starting debt. As debt levels continue to increase, these issues could worsen.
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Affiliation(s)
- William L Cull
- W.L. Cull is director, Division of Health Services Research, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois. S.K. Katakam is vice chair, Department of Pediatrics, Laporte Hospital, Laporte, Indiana. A.J. Starmer is assistant professor of pediatrics, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. E.A. Gottschlich is research associate, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois. A.A. Miller is clinical assistant professor, Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire. M.P. Frintner is senior research associate, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
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