Projecting the Future Pediatric Subspecialty Workforce: Summary and Recommendations

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.

Where Are All the Pediatricians?

“…There is a predicted shortage of pediatric specialists in many fields, and without an influx of new trainees, this shortfall will be exacerbated. 1,4,5 Not only are fewer medical students choosing to enter pediatrics, but many pediatricians are also leaving the field early or choosing parttime hours to make the career sustainable. 1,5 The administrative burden of patient care oriented around an electronic health record-based system has made the daily life of physicians less rewarding.…”

“…rate 9 as well as fewer pediatric subspecialists per population than other regions. 4 So, what must advocates do to have excellent pediatricians to take care of the children we love? Politicians must agree that their care is important.…”

“…The urgency of this moment means that children with all insurance types are currently having a hard time getting care, and it is going to get worse. There is a predicted shortage of pediatric specialists in many fields, and without an influx of new trainees, this shortfall will be exacerbated . Not only are fewer medical students choosing to enter pediatrics, but many pediatricians are also leaving the field early or choosing part-time hours to make the career sustainable …”

“…We worry that applicants are concerned about the scope of their training and practice being limited, as well as their own safety in these states. These trends could exacerbate an already existing geographic disparity in pediatric care; the South has the highest childhood poverty rate as well as fewer pediatric subspecialists per population than other regions …”