Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, ...and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.
The pediatric endocrinology (PE) workforce in the United States is struggling to sustain an adequate, let alone optimal, workforce capacity. This article, one of a series of articles in a supplement ...to Pediatrics, focuses on the pediatric subspecialty workforce and furthers previous evaluations of the US PE workforce to model the current and future clinical PE workforce and its geographic distribution. The article first discusses the children presenting to PE care teams, reviews the current state of the PE subspecialty workforce, and presents projected headcount and clinical workforce equivalents at the national, census region, and census division level on the basis of a subspecialty workforce supply model through 2040. It concludes by discussing the educational and training, clinical practice, policy, and future workforce research implications of the data presented. Data presented in this article are available from the American Board of Pediatrics, the National Resident Matching Program, and the subspecialty workforce supply model. Aging, part-time appointments, and unbalanced geographic distribution of providers diminish the PE workforce capacity. In addition, limited exposure, financial concerns, and lifestyle perceptions may impact trainees. Additional workforce challenges are the subspecialty's increasingly complex cases and breadth of conditions treated, reliance on international medical graduates to fill fellowship slots, and high relative proportion of research careers. The recent limitations on pediatric endocrinologists providing gender-affirming care may also impact the geographic distribution of the subspecialty's workforce. Deliberate actions need to be taken now to continue serving the needs of children.
Objective: There is ongoing debate regarding the impact of youth behavior problems on placement change in child welfare compared to the impact of placement change on behavior problems. Existing ...studies provide support for both perspectives. The purpose of this study was to prospectively examine the relations of behavior problems and placement change in a nationally representative sample of youths in the National Survey of Child and Adolescent Well-Being. Method: The sample consisted of 500 youths in the child welfare system with out-of-home placements over the course of the National Survey of Child and Adolescent Well-Being study. We used a prospective cross-lag design and path analysis to examine reciprocal effects of behavior problems and placement change, testing an overall model and models examining effects of age and gender. Results: In the overall model, out of a total of eight path coefficients, behavior problems significantly predicted placement changes for three paths and placement change predicted behavior problems for one path. Internalizing and externalizing behavior problems at baseline predicted placement change between baseline and 18 months. Behavior problems at an older age and externalizing behavior at 18 months appear to confer an increased risk of placement change. Of note, among female subjects, placement changes later in the study predicted subsequent internalizing and externalizing behavior problems. Conclusions: In keeping with recommendations from a number of professional bodies, we suggest that initial and ongoing screening for internalizing and externalizing behavior problems be instituted as part of standard practice for youths entering or transitioning in the child welfare system. (Contains 2 tables and 4 figures.)
Longitudinal Analyses of Pediatrician Burnout Cull, William L.; Frintner, Mary Pat; Starmer, Amy Jost ...
Academic pediatrics,
April 2019, 2019-04-00, 20190401, Letnik:
19, Številka:
3
Journal Article
Recenzirano
Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased ...burnout.
Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time.
In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio aOR, 0.28; 95% confidence interval CI, 0.22–0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22–0.36), or a job change (aOR, 0.48; 95% CI, 0.36–0.65).
Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians’ jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.
The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers. Certification helps demonstrate that a general ...pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills continuous certification requirements (Maintenance of Certification MOC). One current component of the MOC program is a closed-book examination administered at a secure testing center (ie, the MOC Part 3 examination). In this article, we describe the development of an alternative to this examination termed the "Maintenance of Certification Assessment for Pediatrics" (MOCA-Peds) during 2015-2016. MOCA-Peds was conceptualized as an online, summative (ie, pass/fail), continuous assessment of a pediatrician's knowledge that would also promote learning. The system would consist of a set number of multiple-choice questions delivered each quarter, with immediate feedback on questions, rationales clarifying correct and incorrect answers, references for further learning, and peer benchmarking. Questions would be delivered quarterly and taken at any time within the quarter in a setting with Internet connectivity and on any device. As part of the development process in 2015-2016, the ABP actively recruited pediatricians to serve as members of a yearlong user panel or single-session focus groups. Refinements to MOCA-Peds were made on the basis of their feedback. MOCA-Peds is being actively piloted with pediatricians in 2017-2018. The ABP anticipates an expected launch in January 2019 of MOCA-Peds for General Pediatrics, Pediatric Gastroenterology, Child Abuse, and Pediatric Infectious Diseases with launch dates for the remaining pediatric subspecialties between 2020 and 2022.
Amid concerns about the pediatrician-scientist workforce, we hypothesized that declining numbers of pediatric subspecialists devote at least 25% of their professional time to research with fewer ...younger and female pediatricians engaged in research over the study period.
Board-certified pediatricians enrolling online in the American Board of Pediatrics (ABP's) Maintenance of Certification (MOC) program October 2009 through 2016 were invited to complete a survey with questions about the allocation of their professional time. Responses from individuals in the 14 ABP-certified subspecialties were analyzed. The number and proportions of respondents devoting 25-49% and 50% or more of professional time to research were calculated over time. Age and gender were also examined.
We analyzed 21,367 responses over 8 years. A small number of pediatric subspecialists engaged in research with 5.2-6.7% devoting 25-49% and 5.6-8.4% at least 50% of their professional time to research across subspecialties. There was no discernable increase or decrease over time or pattern by age or gender.
Less than 10% of pediatric medical subspecialists devote at least 50% of their professional time to research. Efforts to promote research among pediatric subspecialists have not increased the size of the population that reports engaging in research at this level.
This article describes a 2-phase process implemented by the American Board of Pediatrics in 2021 to investigate and remove potential bias on its General Pediatrics Certifying Examination at the item ...(question) level based on gender or race and ethnicity. Phase 1 used a statistical technique known as differential item functioning (DIF) analysis to identify items in which 1 subgroup of the population outperformed another subgroup after controlling for overall knowledge level. Phase 2 involved a review of items flagged for statistical DIF by the American Board of Pediatrics' Bias and Sensitivity Review (BSR) panel, a diverse group of 12 voluntary subject matter experts tasked with identifying language or other characteristics of those items that may have contributed to the observed performance differences. Results indicated that no items on the 2021 examination were flagged for DIF by gender and 2.8% of the items were flagged for DIF by race and ethnicity. Of those items flagged for race and ethnicity, 14.3% (0.4% of total items administered) were judged by the BSR panel to contain biased language that may have undermined what the item was intending to measure and were therefore recommended to be removed from operational scoring. In addition to removing potentially biased items from the current pool of items, we hope that repeating the DIF/BSR process after each examination cycle will increase our understanding of how language nuances and other characteristics impact item performance so that we can improve our guidelines for developing future items.
To determine, among pediatric residents, the timing and stability of decisions to pursue fellowship training and select a specific subspecialty, which can be used to inform strategies to better match ...the distribution of pediatric subspecialist with the needs of children.
A longitudinal survey administered with the General Pediatrics In-training Exam to pediatric residents in the US and Canada, 2010-2014. The study included residents who responded in each of their first 3 years of residency and indicated plans to enter fellowship or matriculated, 2013-2016, into 1 of the 14 medical subspecialty fellowships for which the American Board of Pediatrics grants a certificate. Descriptive and χ2 statistics were calculated.
Of the 7580 residents who completed 3 annual surveys (response rate 99%) 4963 (65.5%) indicated plans to pursue fellowship training and 2843 (37.5%) matriculated into fellowship. Residents who did not enter fellowship were in smaller residency programs and programs with less interest in fellowship among interns. Most residents who matriculated into fellowship (68.4%) planned to do so as interns and maintained that plan throughout residency. In contrast, 22.7% had selected a specific subspecialty as interns. Fellowship decisions were made later in residency by female residents, American Medical Graduates, and residents in programs where <50% of interns planned to pursue fellowship training. Timing and stability of decisions varied across subspecialty fields.
Understanding the timing of pediatric medical subspecialty fellowship decisions could be used to shape medical education and, ultimately, the pediatric workforce.
Concerns exist regarding the adequacy of the pediatric subspecialty workforce in the United States. Data on practice patterns and job characteristics are necessary to help develop policies to ensure ...availability.
We performed survey data analysis of all pediatric subspecialists enrolled in Maintenance of Certification in 2013 and 2014, assessing demographic information, characteristics of current positions, plans for retirement, and satisfaction with allocation of professional and clinical responsibilities. Four logistic regression models examined the independent association of demographic variables collected along with variables of practice ownership and academic appointment with the outcome variables of pediatric subspecialists reporting match of desired with current actual professional duties, match of desired with current actual clinical responsibilities, current part-time employment, and expected age of retirement <65 years of age.
Data from 5100 subspecialists were analyzed (response rate 87.2%). Most (83%;
= 4251) reported their current allocation of professional time was what they desired in their current position; similarly, 93% (
= 4755) reported likewise for clinical responsibilities. Differences by gender and years in subspecialty were evident, with women much more likely to work part time than men (odds ratio 6.22); those >20 years in practice were less likely to retire before the age of 65 compared with those <10 years in practice (odds ratio 0.33).
This study is the largest to date of practicing pediatric subspecialists. Variation in work patterns found between genders, with time in practice, and between subspecialties suggests that future research should focus on these issues.
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