The Pediatric Subspecialty Workforce: Time to Test Our Assumptions

Over 20 years ago, my experiences as a rural National Health Service Corps physician challenged my assumptions that nearby pediatric care was of primary importance to parents. About halfway through my first year of practice, I was surprised to realize that many families continued to drive as long as 90 minutes to be seen by a family practitioner or an exceedingly busy pediatrician—this despite my Johns Hopkins training and wide-open practice. At the time, I ignored the contradiction that my family and I would routinely bypass our small town's grocery store and travel the extra hour to a slightly larger emporium that sold Pepperidge Farm cookies and Thomas' English Muffins, which were considered luxury foods in the northern tip of New Hampshire. Geography may be important in rural areas, but it is not destiny.

In this issue of Pediatrics, Mayer¹ provides a vivid and detailed description of the geographic availability of pediatric subspecialists. The limited supply of these physicians can vex families, primary care physicians, children's hospitals, and medical schools. This is a long-standing problem,² with a recent heightened level of concern.³ Despite efforts over 4 decades to address the overall shortage and geographic disparities, the goal of reducing supply barriers to children's subspecialty care remains a mirage on the horizon; we keep on walking but never seem to get closer. Perhaps this is because of the assumptions that we hold close to our professional hearts. For example, my experience as a rural pediatrician revealed that the “cost” and perception of travel and quality vary by parents. Assuming that closer medical care is always better can bind us to policy goals that are difficult, perhaps impossible, to achieve. What other assumptions do we make about the pediatric subspecialty workforce?

I will review some of the assumptions …

Address correspondence to David C. Goodman, MD, MS, Dartmouth Medical School, Department of Pediatrics, Center for Evaluative Clinical Sciences, 7251 Strasenburgh Hall, Hanover, NH 03755. E-mail: david.goodman{at}dartmouth.edu