Reprinted with permission of AAP News, June 2005

Subspecialty growth among
changes shaping workforce policy

from the AAP Division of Graduate Medical Education and Pediatric Workforce

Over the last 75 years, the pediatrician workforce has undergone dramatic transformation and growth. As a result, the development of workforce policy has become increasingly complex.

Workforce policy is a discipline that evaluates the effects of the supply, demographics, distribution and practice characteristics of physicians and other health professionals on access to and the delivery of health care services. Workforce studies generally attempt to identify global trends in access to services and health care delivery, and may evaluate national, regional or local health care resources and needs. The focus of workforce studies has changed over time as the health care system and patient needs have changed.

"Two of the most significant forces for change over the past 75 years have been the establishment and growth of pediatric subspecialties and the increase in the number of women pediatricians," according to Michael R. Anderson, M.D., FAAP, chair of the AAP Committee on Pediatric Workforce (COPW).

The first pediatric subspecialty, pediatric cardiology, was created in 1961. Today, 16 pediatric subspecialties are certified by the American Board of Pediatrics. The pediatrician workforce also includes those certified in other specialties, including pediatric surgeons and pediatric specialists in specialties ranging from genetics to radiology. Many factors contributed to the creation of these subspecialties, such as the increasing survival of children with severe and chronic illness, advances in medical research and new technology. The workforce issues vary from subspecialty to subspecialty, but all involve supply relative to the number of children.

In 2000, the Future of Pediatric Education II (FOPE II) Project Task Force published its landmark report, "Organizing Pediatric Education to Meet the Needs of Infants, Children, Adolescents and Young Adults in the 21st Century" (www.aap.org/fope2). This project and the report were a collaborative endeavor of the entire pediatric community. The report's recommendations covered a wide range of issues pertaining to the entire spectrum of pediatric education and the pediatrician workforce. The report, for example, expressed concern about the paucity of pediatric scientists and educators who will forge the future of the specialty. It noted that the number of pediatrician-scientists was "critically low" and called for remedies to increase these numbers, including incentives such as federally sponsored loan forgiveness.

The recommendations also noted that the number of women in pediatrics had grown substantially over the past two decades, and strategies would be needed to promote the success of women in fellowship training and academia. "The report recommended that 'both practices and academic settings should consider coordinated schedules, fair leave policies, quality day care, and flexibility in academic promotion, advancement and in achieving partnership in private practices for women as well as men," noted Richard E. Behrman, M.D., FAAP, executive chair of the Federation of Pediatric Organizations' (FOPO's) Pediatric Education Steering Committee. "These recommendations are a central responsibility of our profession. The commitment of pediatrics to the health and well-being of children and youth should encompass the families of those who choose to pursue careers in pediatrics."

In support of this goal, FOPO has convened the Task Force on Women in Pediatrics, and its report is near completion.

What the FOPE II report did not anticipate were the shortages of patient-care clinicians that emerged within many pediatric subspecialties. These shortages are related to a host of factors such as greater demand for clinical services, the increasing lifespan of chronically ill children, changes in the complex dynamics of health care delivery and systemic barriers to accessing care, including lack of insurance.

Also, recent research shows that more pediatricians are working part time than physicians in any other specialty (www.aap.org/womenpeds/Pt-time2.doc). This trend is expected to continue and grow more robust because of the strong association between gender and part-time employment. In addition to the obvious workforce policy implications, there are important practice and employment aspects of this trend.

Many employers in both practice and academic settings are uncertain of the advantages of hiring a physician part time and have little or no guidance in how to structure such an arrangement equitably. Employers have to address a number of issues in establishing part-time positions, including the number of hours, meetings, benefits, interdependence with full-time-equivalent physicians, academic tracks and criteria for promotion. Many physicians engaged in or interested in part-time employment seek information on these same topics. The Academy is partnering with the American Medical Association's Women Physicians Congress to develop a Web-based resource and clearinghouse on this workforce trend.

Most recently, the COPW has been examining the complex issues related to the provision of culturally effective pediatric care and the diversity of the pediatrician workforce.

"Ensuring that there is an appropriate pediatrician workforce to provide optimal health care for infants, children, adolescents and young adults is central to the mission of the Committee on Pediatric Workforce," Dr. Anderson said.
In the coming month, the Academy will publish its flagship statement on the pediatrician workforce and a new technical report that will provide an in-depth analysis of key physician and pediatrician workforce topics.

"We can be proud of the work we have accomplished," Dr. Anderson said. "The AAP has created workforce policy with the best interests of children at the forefront. The next 75 years will continue to test our mettle and demand both vigilance and creativity from AAP leaders to meet the changing needs of America's children."

For more information, contact Holly J. Mulvey, director, AAP Division of Graduate Medical Education & Pediatric Workforce, at hmulvey@aap.org.

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