Federation of Pediatric Organizations Subspecialty Forum

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Federation of Pediatric Organizations
Subspecialty Forum

• Michael R. Anderson, MD, FAAP
• Committee on Pediatric Workforce Subcommittee on
  Subspecialty Workforce

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The Impact of Public Policy on Pediatric
Subspecialty Workforce

• Brief History of Public Policy
• Factors Shaping the Future of Pediatric
  Subspecialty Workforce
• Pediatrician Demographics
• IMGs
• Role of Women
• Minorities
• Change in Professional/Personal Priorities
• Other Factors
• Child Demographics/Geographic Distribution
• Increase in volume and complexity of patients
• Competition amongst providers of subspecialty
  care
• Equitable re-imbursement for subspecialty care
• Availability of research and GME funding
• Impact of public policy restricting specialist
  physician supply
• Strategies to Improve Subspecialty Workforce

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A Little History and Macroscopic Analysis

• 1980-1990sTrends in Primary Care Emphasis
• Pendulum towards Primary Care
• Lack of Focus on Subspecialty Workforce
• COGME 110/ 50-50 rule

• Supply of Qualified Subspecialty Providers
• Disparities in Neonatology vs Rheumatology
• Role of Physician as Care Provider
• Educator
• RESEARCHER
• Administrator

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History

• Previous Public Policy Decisions
• Lumping of Primary Care and Subspecialty
• May Endanger Subspecialty Workforce

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Demographic Factors That Will Influence
Subspecialty Workforce
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1) Demographics Role of IMGs in Pediatrics

• Currently represent 30 of Pediatricians
• 2001 19.4 of first time ABP Exam Takers
• Subspecialty Bound
• Much Higher than AMGs
• Within IMGs J1 visa holders more likely to
  pursue sub-specialty training

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Are There Changes in IMGs Workforce?

• IMGs
• NRMP Decrease in ECFMG eligible applicants by
  32 from 2001 (1,687)
• Federal Changes to Visas and Limits on IMG
  Residency Applications
• ACGME Non Accredited Programs to Phase Out J1
  Visas by 2003 (Surgical Pediatric Specialists)
• USDA Eliminates and then re-instates sponsorship
  of J1 Physicians
• Potential Impact on IMG Limits
• Decreased Subspecialty Providers
• Research and Teaching Implications
• Increase numbers of AMGs choosing Peds but NOT
  subspecialty training

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2) Demographics Role of Women in Pediatrics

• Close to Parity in Pediatrics
• AAP 55 Male 45 Female
• Residents 40 Male 60 Female
• Impact on Subspecialty
• Fewer Numbers Pursuing Training
• ? Total Hours in Professional Activities
• Training Implications
• Effective Mentoring/Role Modeling
• Flexibility in Schedules
• i.e. part time positions
• Improvement in Professional Advancement

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Gender Pediatricians
Adapted from AMA, Physician Characteristics and
Distribution in the US. 2001-2002 Edition.
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3) Demographics Role of Minorities in Pediatrics

• Minorities
• Few Enter Pediatrics
• Implications for Subspecialty
• Impact on growing diverse patient population
• Training Implications
• Attraction of Minority Candidates
• Provision of Culturally Effective Care

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Race Pediatricians
White Asian/Pacific Black/
Hispanic/ Other Islander
African Latino
Male
Female
Source American Academy of Pediatrics, Division
of Health Policy Research, Periodic Survey of
Fellows 43, 2000
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Changing Demographics Impact on Subspecialty Care

• IMGs
• Safety Net---Underserved Areas
• Workforce for Pediatric Medical Subspecialties
  and Pediatric Surgical Specialties
• Patient Care AND Research and Teaching
• Women
• Workforce in Subspecialty
• Training Issues
• Recruitment into Subspecialty
• Disparity in Particular Subspecialties
• Neonatology
• Rheumatology
• Surgical Specialty Concerns

Shaping Public Policy
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Strategies to Ensure Adequate Supply of Pediatric
Subspecialists
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Strategies

• Attract American Medical Grads to Peds and
  Subspecialty
• Promote Careers in Subspecialty Careers-MENTORS
• Loan Forgiveness Programs
• Fellowship Training Process

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Strategies

• Educate Policy Makers/Public/Others re Unique
  Skills of Pediatric Subspecialists
• Educate re need for Subspecialty Workforce
• Educate re need for cogent workforce policy that
  addresses unique needs of different subspecialists

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Proposed ABP Changes

• Impact on Research
• Two-Tiered Training Graduates
• Workforce Implications
• Greater Numbers?
• Attracting Residents into Subspecialties
• Future of Pediatric Research

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AAP COPW

• Subspecialty Workforce Subcommittee
• Craft Cogent Policy
• Act as resource for AAP
• Serve as a voice advocating for Children and
  Pediatricians

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Final Perspectives

• Its Not A Workforce Problem
• Its Not A Health Policy Problem
• Its Not A Training Problem
• IT IS A KIDS HEALTH PROBLEM