Published online September 30, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1192-1202 (doi:10.1542/peds.2004-2339)
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SPECIAL ARTICLE

The Pediatric Subspecialty Workforce: Public Policy and Forces for Change

Ethan Alexander Jewett, MA*, Michael R. Anderson, MD{ddagger} and Gerald S. Gilchrist, MD§

* Division of Graduate Medical Education and Pediatric Workforce, American Academy of Pediatrics, Elk Grove Village, Illinois
{ddagger} Department of Pediatrics, Division of Pediatric Pharmacology and Critical Care, Case Western University School of Medicine, Cleveland, Ohio
§ Department of Pediatric and Adolescent Medicine, Division of Hematology/Oncology (Emeritus), Mayo Clinic College of Medicine, Rochester, Minnesota

Policy has not adequately addressed the unique circumstances of pediatric subspecialties, many of which are facing workforce shortages. Pediatric subspecialties, which we define to include all medical and surgical subspecialties, are discrete disciplines that differ significantly from each other and from adult medicine subspecialties. Concerns about a current shortage of pediatric subspecialists overall are driven by indicators ranging from recruitment difficulties to long wait times for appointments. The future supply of pediatric subspecialists and patient access to pediatric subspecialty care will be affected by a number of key factors or forces for change. We discuss 5 of these factors: changing physician and patient demographics; debt load and lifestyle considerations; competition among providers of subspecialty care; equitable reimbursement for subspecialty services; and policy to regulate physician supply. We also identify issues and strategies that medical and specialty societies, pediatric subspecialists, researchers, child advocates, policy makers, and others should consider in the development of subspecialty-specific workforce-policy agendas.

Key Words: pediatric subspecialists • subspecialty care • pediatric workforce • workforce policy • access to health care

Abbreviations: GME, graduate medical education • IMG, international medical graduate • CHGME, Children's Hospital Graduate Medical Education • ABP, American Board of Pediatrics • ACGME, Accreditation Council for Graduate Medical Education • NACHRI, National Association of Children's Hospitals and Related Institutions

Accepted Apr 8, 2005.




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