The National Academies Press

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From page 1... ... Pediatric subspecialists augment the care provided by primary care clinicians, such as general pediatricians, advanced practice providers (e.g., advanced practice registered nurses, physician assistants) , and family medicine physicians by caring for children who require technical procedures or have health conditions that occur too infrequently for primary care clinicians to gain and maintain up-to-date clinical knowledge. Read the entire page →
From page 2... ... In 2022, the National Academies of Sciences, Engineering, and Medicine (National Academies) , with support from a coalition of sponsors, formed the Committee on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being to recommend strategies and actions to ensure an adequate pediatric subspecialty physician workforce to support broad access to highquality subspecialty care and a robust research portfolio to advance the health and health care of infants, children, and adolescents.1 STUDY FOCUS AND CONTEXT The committee recognizes the important contribution of many different types of clinicians toward the care of children; however, based on the statement of task and discussions with study sponsors, this report focuses on the medical subspecialty physician workforce. Read the entire page →
From page 3... ... Secondary Primary–Subspecialty Interaction of subspecialists with primary care Focus Care Interface clinicians, including the following: • General Pediatricians • Advanced Practice Providers (e.g., Advanced Practice Registered Nurses, Physician Assistants) • Family Medicine Physicians NOTES: * Read the entire page →
From page 4... ... Some of the major influences include demand for subspecialty care, referral patterns, organization of services, geography, and health care financing. Furthermore, the adequacy of the workforce itself is also affected by children's changing health care needs, how well primary care clinicians and subspecialists are prepared to address those needs, the number of subspecialists, the influences on an individual's decision to pursue subspecialty training, how subspecialists interact with the larger health care workforce, and how pediatric subspecialists are reimbursed. Read the entire page →
From page 5... ... , and families' out-of-pocket costs can affect whether patients can access subspecialty care and with what frequency. For example, although children enrolled in Medicaid/CHIP have higher use rates of medical subspecialty care (as compared with those who are commercially insured) Read the entire page →
From page 6... ... ; • The presence of role models from subspecialty fields, particularly for URiM trainees (which may be scarce owing to the small num bers of subspecialists) ; • The length of fellowship training; • The requirement for scholarly activity during fellowship; • The debt burden of education and training; • Relatively lower salaries, particularly for some pediatric medical subspecialties compared with general pediatricians in outpatient practice and adult medical subspecialists; and • Lifestyle factors (e.g., work–life balance, job satisfaction, burnout) Read the entire page →
From page 7... ... However, specific challenges for pediatric research include a paucity of subspecialty-specific workforce data; lack of a robust mentorship environment, particularly for early career investigators; financial considerations that affect trainees' decisions to pursue research; lack of dedicated research time; competing clinical responsibilities; and inadequate research funding. The Primary Care–Subspecialty Interface In high-functioning health systems, primary care clinicians and pediatric subspecialists work collaboratively at the interface of primary and specialty care to provide the appropriate level and full spectrum of care for children with complex and atypical acute and chronic disorders. Read the entire page →
From page 8... ... This results in lower salaries for many pediatric subspecialties compared with internal medicine subspecialty counterparts; particularly in medical subspecialties, this can influence the career decisions of trainees pursuing pediatrics and pediatric subspecialty training. VISION, GOALS, AND RECOMMENDATIONS3 Ideally, the subspecialty workforce would be adjusted in both numbers and skills to fully meet children's subspecialty care needs. Read the entire page →
From page 9... ... Such a system would value high-quality care for all children, with care that embodies the six elements for quality defined by the Institute of Medicine4: safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. High-quality pediatric subspecialty care is safe when the referral, or lack of referral, does not result in harm. Read the entire page →
From page 10... ... Although the following recommendations are focused on improving the delivery of subspecialty care, many will also help to support primary care clinicians. Goal 1: Promote Collaboration and the Effective Use of Services Between Pediatric Primary Care Clinicians and Subspecialty Physicians Improved monitoring of children's changing health care needs and demands, the status of their access to needed care, disparities, and trends in workforce composition are all essential to inform future workforce planning efforts. Read the entire page →
From page 11... ... Finally, innovative models of care are needed to reset the relationship between pediatric subspecialty physicians and primary care clinicians, making them greater partners in care of children. Enhanced communication at the interface of primary and subspecialty care is essential within these models. Read the entire page →
From page 12... ... , along with the relatively low salaries and added time demands for some training pathways, require considering ways to remove financial disincentives to entering and staying in pediatric subspecialty careers. Therefore, the committee provides the following recommendations: RECOMMENDATION 8-1 To invest in children's health and address the factors that contribute to limited access to pediatric subspecialty care, Congress should allocate additional federal funding to increase payment for pediatric services. Read the entire page →
From page 13... ... Furthermore, the model of education and training for pediatric medical subspecialists includes a single model for most graduates with a focus on creating subspecialists who demonstrate competency in all aspects of academic careers, including clinical care, research, and education. However, pediatric subspecialty care would benefit from a workforce that is differentiated in skills and effort in each of these three areas. Read the entire page →
From page 14... ... Therefore, the committee provides the following recommendations: RECOMMENDATION 4-1 The Association of Medical School Pedi atric Department Chairs should periodically convene representatives from the American Board of Pediatrics, the Accreditation Council for Graduate Medical Education, all pediatric professional societies, and major pediatric education and training organizations (including, but not limited to, child and adolescent psychiatry, family medicine, and advanced practice providers) to review and adjust educational and training curricula (e.g., continuing education, standardized pediatric subspecialty training, and specialty recognition and certification) Read the entire page →
From page 15... ... Goal 4: Support the Pediatric Physician–Scientist Pathway Advances in child health require a highly skilled research workforce in which all disciplines pursue improved outcomes. For the purposes of this report, the committee focused on the role of the pediatric subspecialty physician–scientists who are crucial in research to improve subspecialty care and related health and organizational outcomes. Read the entire page →
From page 16... ... , the Pediatric Loan Repayment Program, and K awards, with attention to providing such grants to physician–scientists from backgrounds that are underrepresented in the scientific workforce and for high-priority subspecialties in pediatric research. Funding for individual K awards should be increased to reflect current salaries and research project expenses and should include additional explicit funding for mentorship. Read the entire page →
From page 17... ... It will also require a willingness to adapt to the changing needs of children and clinicians and a changing health care delivery system, while investing in the necessary time and resources. Implementing all of these recommendations in combination with other necessary supports to primary care will result in a health care system that serves the needs of all children and improves the health of the nation. Read the entire page →

From page 1...

... Pediatric subspecialists augment the care provided by primary care clinicians, such as general pediatricians, advanced practice providers (e.g., advanced practice registered nurses, physician assistants) , and family medicine physicians by caring for children who require technical procedures or have health conditions that occur too infrequently for primary care clinicians to gain and maintain up-to-date clinical knowledge.

Summary Pages 1-18

Summary
Pages 1-18