Changes in work hours for pediatric residents appear to have an impact on workforce planning within pediatric hospitals. Decreases in available resident work hours will create an increasing demand, primarily for nonresident physicians, PNPs, and NNPs.

There have been significant changes in the patterns of longer consultations provided to children by GPs. Efforts to ensure that children receive primary care for chronic conditions and preventive care must now take on a greater urgency for the health-care system.

BACKGROUND AND OBJECTIVES:A near vacuum exists for credible information regarding specialtyspecific demography, including gender, years since training completion, current employer, academic affiliation, and hours worked in specific tasks. Understanding the current status and changes to the medical workforce and its work patterns is essential to assessing whether the supply and distribution meets the needs of patients, institutions, society, and educational programs.

BACKGROUND: The proportion of the newly graduated pediatric workforce that becomes hospitalists has been increasing slightly over the past decade. However, it is unknown what proportion of those who accept hospitalist positions as their fi rst job intend to remain in the fi eld longer term. This is important to workforce projections regarding the magnitude of those who will function in this role. METHODS:The American Board of Pediatrics incorporated a structured questionnaire within the online application process to the General Pediatrics certifi cation application. Respondents identifi ed as residents or chief residents who selected "hospitalist position" as their immediate postresidency plan were the focus this study. We compared survey responses by gender and location of the medical school attended. RESULTS:Since the initiation of the general pediatrics certifi cation examination application survey, 6335 completed the questionnaire. 79% (n = 5001) were either in residency training or were a chief resident. Of those, 8% (n = 376) reported they planned to work as a pediatric hospitalist immediately after completing residency. Fewer than half (43%; n = 161) reported this to be their long-term career plan. This fi nding varied by both medical school type and by gender. CONCLUSIONS:The majority of pediatric residents and chief residents who take hospitalist positions immediately after training do not intend for hospital practice to be the long-term focus of their careers. As the fi eld of hospital medicine continues to develop, understanding career trajectories can help inform current and future efforts regarding the potential for different mechanisms for training and certifi cation. Long-term Plans for Those Selecting Hospital Medicine as an Initial Career ChoiceMuch recent attention has been focused on those who practice hospital medicine (aka, hospitalists) and the potential for recognition of these clinicians into a defi ned fi eld of practice.1 Over the past several years, there have been efforts to establish specifi c training programs to prepare hospitalists for a unique role in the health care system.2 Although currently variable in content and duration, such programs are growing in number. However, there are currently no fi xed expectations or requirements for those who practice hospital medicine. Thus, the "price of entry" into the fi eld is lower than formally trained subspecialists and similar to general pediatricians. As such, there are fewer barriers to changing direction, and some who begin their clinical careers as hospitalists may not remain in those roles over time.

This study is the largest to date of practicing pediatric subspecialists. Variation in work patterns found between genders, with time in practice, and between subspecialties suggests that future research should focus on these issues.