Pediatric subspecialty workforce: what is needed to secure its vitality and survival?


Journal

Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714

Informations de publication

Date de publication:
25 Oct 2024
Historique:
received: 29 08 2024
accepted: 07 09 2024
medline: 26 10 2024
pubmed: 26 10 2024
entrez: 25 10 2024
Statut: aheadofprint

Résumé

The pediatric subspecialty workforce is challenged by shortages and geographic maldistribution of subspecialists. We invited leaders in pediatrics to discuss how the field's vitality and survival can be secured. These leaders presented their own opinions and not the opinion of the society or organization that they are presenting. Early exposure of future trainees to pediatrics and advocacy for improved reimbursement structures, loan repayment, and funded programs for physician scientists will enhance the recruitment and retention of pediatric subspecialists to guarantee advancement of knowledge and the appropriate care of children with chronic and complex diseases.

Identifiants

pubmed: 39455858
doi: 10.1038/s41390-024-03607-4
pii: 10.1038/s41390-024-03607-4
doi:

Types de publication

Letter

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

Références

Myers, A. L. et al. The importance of subspecialty pediatricians to the health and well-being of the nation’s children. J. Pediatr. 257, 113365 (2023).
doi: 10.1016/j.jpeds.2023.02.011 pubmed: 36894130
ABP. Estimated Driving Distance to Visit a Pediatric Subspecialist, https://www.abp.org/content/estimated-driving-distance-visit-pediatric-subspecialist (2022).
Pediatric Subspecialty Shortage Fact Sheets, https://www.aap.org/en/advocacy/pediatric-subspecialty-shortages-fact-sheets/ (2021).
Interactive Abp Workforce Data, https://www.abp.org/content/data-and-workforce (2024).
Orr, C. J. et al. Projecting the Future Pediatric Subspecialty Workforce: Summary and Recommendations. Pediatrics 153 (2024).
The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being, https://www.nationalacademies.org/our-work/the-pediatric-subspecialty-workforce-and-its-impact-on-child-health-and-well-being (2023).
Catenaccio, E., Rochlin, J. M. & Simon, H. K. Differences in Lifetime Earning Potential between Pediatric and Adult Physicians. Pediatrics 148 (2021).
Orr, C. J., Turner, A. L., Ritter, V. S., Gutierrez-Wu, J. & Leslie, L. K. Pursuing a career in pediatrics: intersection of educational debt and race/ethnicity. J. Pediatr. 252, 162–170 (2023).
doi: 10.1016/j.jpeds.2022.08.014 pubmed: 35973445
Orr, C. J., Turner, A. L., Ritter, V. S., Gutierrez-Wu, J. C. & Leslie, L. K. Educational Debt and Subspecialty Fellowship Type. Pediatrics 152 (2023).
Physiscian Specialty Data Report, https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-specialty-2021 (2021).
Catenaccio, E., Rochlin, J. M. & Simon, H. K. Addressing gender-based disparities in earning potential in academic medicine. JAMA Netw. Open 5, e220067–e220067 (2022).
doi: 10.1001/jamanetworkopen.2022.0067 pubmed: 35179582 pmcid: 8857688
Catenaccio, E., Rochlin, J. M. & Simon, H. K. Association between workforce gender distribution and lifetime earning potential in the pediatric subspecialties. Academic Pediatrics 22, 1153–1157 (2022).
doi: 10.1016/j.acap.2022.02.012 pubmed: 35219852
Committee on Pediatric Workforce. Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making. Pediatrics 132, e1105–e1116 (2013).
doi: 10.1542/peds.2013-2268
The Match: Results and Data 2024 Main Residency Match https://www.nrmp.org/match-data/2024/06/results-and-data-2024-main-residency-match/ (2024).
Shanafelt, T. D. & Noseworthy, J. H. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin. Proc. 92, 129–146 (2017).
doi: 10.1016/j.mayocp.2016.10.004 pubmed: 27871627
Lakshminrusimha, S. & Lubarsky, D. A. The Salary Problem in Pediatric Subspecialties, https://www.doximity.com/articles/b25beb9a-27dc-44ae-9ca5-dd03bb935341 (2024).
Hansen, M. Average Medical School Debt, https://educationdata.org/average-medical-school-debt (2023).
Lakshminrusimha, S., Murin, S. & Lubarsky, D. A. Low compensation for academic pediatric medical specialists: role of medicaid, productivity, work hours, and sex. J. pediatrics 255, 1–6 (2023).
doi: 10.1016/j.jpeds.2023.01.013
Lakshminrusimha, S., Lubarsky, D. A., Gamber, R. A. & Devaskar, S. U. The National Academies of Sciences, Engineering, and Medicine Recommendations on Medicaid Parity and Future of Pediatric Subspecialty Workforce. Journal of perinatology : official journal of the California Perinatal Association (2024).
Income in the United States: 2021 Current Population Report, https://www.americanprogress.org/article/what-to-know-about-the-gender-wage-gap-as-the-equal-pay-act-turns-60/ (2021).
Gender Pay Gap Persists in 2023 https://www.epi.org/blog/gender-wage-gap-persists-in-2023-women-are-paid-roughly-22-less-than-men-on-average/ (2024).
Lautenberger, D. M. & Dandar, V. M. The State of Women in Academic Medicine 2018-2019. Exploring Pathways to Equity https://store.aamc.org/downloadable/download/sample/sample_id/330/ (2020).
Levanon, A., England, P. & Allison, P. Occupational feminization and pay: assessing causal dynamics using 1950–2000 U.S. census data. Soc. Forces 88, 865–891 (2009).
doi: 10.1353/sof.0.0264
Carr, P. L. et al. Gender differences in academic medicine: retention, rank, and leadership comparisons from the national faculty survey. Acad. Med 93, 1694–1699 (2018).
doi: 10.1097/ACM.0000000000002146 pubmed: 29384751 pmcid: 6066448
Starmer, A. J. et al. Gender discrepancies related to pediatrician work-life balance and household responsibilities. Pediatrics 144 (2019).
Jolly, S. et al. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann. Intern. Med. 160, 344-353 (2014).
doi: 10.7326/M13-0974 pubmed: 24737273 pmcid: 4131769
Jagsi, R. et al. Workplace harassment, cyber incivility, and climate in academic medicine. Jama 329, 1848–1858 (2023).
doi: 10.1001/jama.2023.7232 pubmed: 37278814 pmcid: 10245188
Jagsi, R. et al. Sexual harassment and discrimination experiences of academic medical faculty. JAMA 315, 2120–2121 (2016).
doi: 10.1001/jama.2016.2188 pubmed: 27187307 pmcid: 5526590
Rotenstein, L. S. & Jena, A. B. Lost Taussigs — the consequences of gender discrimination in medicine. N. Engl. J. Med. 378, 2255–2257 (2018).
doi: 10.1056/NEJMp1801164 pubmed: 29897850
Lee, M. O., Flores, B., Fassiotto, M. & Hobgood, C. Career advancement among women physicians in nine academic medicine specialties. J. Women’s Health (Larchmt.) 32, 1073–1079 (2023).
doi: 10.1089/jwh.2022.0464
Lewiss, R. E. et al. Is academic medicine making mid-career women physicians invisible? J. Women’s Health 29, 187–192 (2019).
doi: 10.1089/jwh.2019.7732
Faculty Roster: U.S. Medical School Faculty, https://www.aamc.org/data-reports/faculty-institutions/data/2022-us-medical-school-faculty (2023).
Brotherton, S. E. & Etzel, S. I. Graduate medical education, 2022-2023. JAMA 330, 988–1011 (2023).
doi: 10.1001/jama.2023.15520 pubmed: 37698579
The State of Womenin Academic Medicine 2023-2024, https://store.aamc.org/downloadable/download/sample/sample_id/626/ (2024).
Dammann, C. E. L. et al. Female excellence and leadership in pediatrics subspecialties (flexpeds): creating a network for women across academic pediatrics. J. Pediatr. 263, 113512 (2023).
doi: 10.1016/j.jpeds.2023.113512 pubmed: 37244585
Freed, G. L., Moran, L. M., Van, K. D. & Leslie, L. K. Current Workforce of Pediatric Subspecialists in the United States. Pediatrics 139 (2017).
Nivet, M. A., Castillo-Page, L. & Schoolcraft Conrad, S. A Diversity and Inclusion Framework for Medical Education. Academic Medicine 91 (2016).
Page, S. E. The Diversity Bonus: How Great Teams Pay Off in the Knowledge Economy. Princeton University Press (2017).
Diversity Wins: How Inclusion Matters. (2020).
The State of Women in Academic Medicine, https://www.aamc.org/data-reports/faculty-institutions/report/state-women-academic-medicine (2023).
Aamc Stand Point Survey: 2023 State of Medical School Faculty Engagement, https://store.aamc.org/the-aamc-standpoint-survey-s-2023-state-of-medical-school-faculty-engagement.html (2023).
Page, S. E. The Diversity Bonus: How Great Teams Pay Off in the Knowledge Economy (Princton University Press, 2017).
Abp Data Compared to Nrmp Data, https://www.abp.org/dashboards/abp-data-compared-nrmp-data (2024).
Pfarrwaller, E. et al. An expanded conceptual framework of medical students’ primary care career choice. Acad. Med 92, 1536–1542 (2017).
doi: 10.1097/ACM.0000000000001676 pubmed: 28379931
Bennett, K. L. & Phillips, J. P. Finding, recruiting, and sustaining the future primary care physician workforce: a new theoretical model of specialty choice process. Academic Med. : J. Assoc. Am. Med. Coll. 85, S81–S88 (2010).
doi: 10.1097/ACM.0b013e3181ed4bae
Querido, S. J. et al. Dynamics of career choice among students in undergraduate medical courses. a Beme systematic review: Beme guide no. 33. Med Teach. 38, 18–29 (2016).
doi: 10.3109/0142159X.2015.1074990 pubmed: 26372112
Pfarrwaller, E. et al. Students’ intentions to practice primary care are associated with their motives to become doctors: a longitudinal study. BMC Med. Educ. 22, 30 (2022).
doi: 10.1186/s12909-021-03091-y pubmed: 35016672 pmcid: 8750802
Assuring the Qualification of Health Care Professionals, https://www.intealth.org/what-we-do/ .
Perrin, J. M., Flanagan, P., Katkin, J., Barabell, G. & Price, J. The Unique Value Proposition of Pediatric Health Care. Pediatrics 151 (2023).
Lakshminrusimha, S. et al. Raising the bar: the need for increased financial support to sustain and expand the community of pediatric subspecialists. J. Pediatr. 267, 113758 (2024).
doi: 10.1016/j.jpeds.2023.113758 pubmed: 37748730
Winer, K. K. et al. The child health research centers: twenty-one years of promoting the development of pediatrician scientists from 1990-2011. J. Pediatr. 161, 975–976 (2012).
doi: 10.1016/j.jpeds.2012.09.001 pubmed: 23171484
Wyngaarden, J. B. The clinical investigator as an endangered species. N. Engl. J. Med 301, 1254–1259 (1979).
doi: 10.1056/NEJM197912063012303 pubmed: 503128
Garrison, H. H. & Ley, T. J. Physician-scientists in the United States at 2020: trends and concerns. Faseb j. 36, e22253 (2022).
doi: 10.1096/fj.202200327 pubmed: 35349197
Heggeness, M. L., Gunsalus, K. T., Pacas, J. & McDowell, G. The new face of US science. Nature 541, 21–23 (2017).
doi: 10.1038/541021a pubmed: 28054625
Carr, P. L. et al. A summary report from the research partnership on women in science careers. J. Gen. Intern. Med. 34, 356–362 (2019).
doi: 10.1007/s11606-018-4547-y pubmed: 30003480

Auteurs

Christiane E Dammann (CE)

Division of Newborn Medicine, Tufts Medicine Pediatrics at Tufts University, Boston Children's Hospital, Boston, US. cdammann@tuftsmedicalcenter.org.

Cristina M Alvira (CM)

Division of Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, US.

Sherin U Devaskar (SU)

Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles, US.

Joseph W St Geme (JW)

Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, US.

W Christopher Golden (WC)

Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, US.

Catherine M Gordon (CM)

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, US.

Benjamin Hoffmann (B)

Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Baltimore, US.

Satyan Lakshminrusimha (S)

Department of Pediatrics, UC Davis Children's Hospital, Sacramento, US.

Laurel K Leslie (LK)

American Board of Pediatrics, Chapel Hill, US.

Maria Trent (M)

Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, US.

Karen K Winer (KK)

Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, US.

H Barrett Fromme (HB)

Department of Pediatrics, UChicago Medicine at the University of Chicago, Chicago, US.

Classifications MeSH