Providing Pediatric Subspecialty Care: A Workforce Analysis

Abstract

This survey provides the first comprehensive analysis to date on how market forces are perceived to be affecting physicians in the pediatric subspecialty workforce. The data indicate that pediatric subspecialists in most areas are facing strong competitive pressures in the market, and that the market's ability to support additional subspecialists in many areas may be diminishing.

The practice of clinical genetics: A survey of practitioners

“…10 In the year preceding the survey, many more geneticists had noted an increase in the volume and/or complexity of referrals, which is similar to other pediatric subspecialty practices. 10 One potential reason for increasing complexity of referrals is that primary care physicians may feel increasing pressure to follow less complex cases themselves (i.e., a child or adult with Down syndrome, Fragile X syndrome, or neurofibromatosis) and to refer only the most medically complex cases to the genetic specialist. Rapid advances in the field of genetics are also increasing the complexity of care for practicing geneticists.…”

“…10 The majority of clinical geneticists likewise tend to practice in a market with population bases greater than one million. Merely 2% of geneticists function in a solo practice setting, with only critical care (2%) and emergency medicine (EM) (0%) at or below this level.…”

“…Merely 2% of geneticists function in a solo practice setting, with only critical care (2%) and emergency medicine (EM) (0%) at or below this level. 10 Only 14% of geneticists find themselves in a freestanding group practice, which is less than all subspecialties, except for ID (12%) and EM (11%). 10 The location of geneticists in academic medical centers may be influenced by many factors, including their dependence on research funding to supplement income and a reliance on internal and external providers for patient referrals and collaborative care of complex patients.…”

“…10 Only 14% of geneticists find themselves in a freestanding group practice, which is less than all subspecialties, except for ID (12%) and EM (11%). 10 The location of geneticists in academic medical centers may be influenced by many factors, including their dependence on research funding to supplement income and a reliance on internal and external providers for patient referrals and collaborative care of complex patients. These and other factors may serve as barriers to geneticists who wish to establish themselves in solo practice.…”

“…Although 50% of geneticists experienced competition for patients from outside sources, this rate is lower than that reported for other pediatric subspecialties, with the exception of ID. 10 It is possible that geneticists and ID specialists perceive less competition, because of their medical school milieu and fewer number of direct patient care hours. In addition, referring specialists may not feel as comfortable managing or diagnosing these types of patients.…”