Providing pediatric subspecialty care: A workforce analysis

Objective. To provide a snapshot of pediatric subspecialty practice, examin e issues pertaining to the subspecialty workforce, and analyze subspecialis ts' perspective on the health care market. Background. Before the effort of the Future of Pediatric Education II (FOPE II) Project, very little information existed regarding the characteristics of the pediatric subspecialty workforce. This need was addressed through a comprehensive initiative involving cooperation between subspecialty sectio ns of the American Academy of Pediatrics and other specialty societies. Methods. Questionnaires were sent to all individuals, identified through ex haustive searches, who practiced in 17 pediatric medical and surgical subsp ecialty areas in 1997 and 1998. The survey elicited information about educa tion and practice issues, including main practice setting, major profession al activity, referrals, perceived competition, and local workforce requirem ents. The number of respondents used in the analyses ranged from 120 (plast ic surgery) to 2034 (neonatology). In total, responses from 10 010 pediatri c subspecialists were analyzed. Results. For 13 of the subspecialties, a medical school setting was specifi ed by the largest number of respondents within each subspecialty as their m ain employment site. Direct patient care was the major professional activit y of the majority of respondents in all the subspecialties, with the except ion of infectious diseases. Large numbers of subspecialists reported increa ses in the complexity of referral cases, ranging between 20% (cardiology) a nd 44% (critical care), with an average of 33% across the entire sample. In all subspecialties, a majority of respondents indicated that they faced co mpetition for services in their area (range: 55%-90%; 71% across the entire sample); yet in none of the subspecialties did a majority report that they had modified their practice as a result of competition. In 15 of the 17 su bspecialties, a majority stated that there would be no need in their commun ity over the next 3 to 5 years for additional pediatric subspecialists in t heir discipline. Across the entire sample, 42% of respondents indicated tha t they or their employer would not be hiring additional, nonreplacement ped iatric subspecialists in their field in the next 3 to 5 years (range: 20%-6 3%). Conclusion. This survey provides the first comprehensive analysis to date o n how market forces are perceived to be affecting physicians in the pediatr ic subspecialty workforce. The data indicate that pediatric subspecialists in most areas are facing strong competitive pressures in the market, and th at the market's ability to support additional subspecialists in many areas may be diminishing.