Experts are concerned about the future of pediatric subspecialties due to physician and scientist shortages that could affect both the "current and future availability of pediatric subspecialty care and research," as well as have "potential ramifications for child health and well-being," according to a report published Sept. 14 by the National Academy of Science, Engineering and Medicine.
The profession notably is also lacking in diversity and not keeping pace with the increasing diversity reflected in the pediatric patient population, the report states. On top of that, the pediatric subspecialty isn't as desirable of a field to get into for some physicians due to typically lower salaries and a variety of other factors.
In addition to highlighting key concerns, experts also outline multiple goals and solutions to boost both the occupation and pediatric health nationwide.
"The needs of children today are not the same as the needs of children 50 or 75 years ago," Frederick Rivara, MD, the chair of the committee on the Pediatric Subspecialty Workforce and its Impact on Child Health and Well-Being, stated in the report's preface. "The systems that provide them care need to evolve to meet these demands."
That evolution begins with improved access to care, strengthening loan repayment programs, compiling more robust data about the subspecialty profession, and fostering collaboration to move the needle toward further research and care efforts.
"Achieving a robust subspecialty workforce will require concerted efforts across federal and state governments, pediatric professional societies, major pediatric education and training organizations, medical schools and fellowship programs, and health systems, with input from
patients and families," the report states. "It will also require a willingness to adapt to the changing needs of children and clinicians and a changing healthcare delivery system, while investing in the necessary time and resources."
The following 13 recommendations were outlined in the report:
- A biennial report submitted by the Agency for Healthcare Research and Quality to the Secretary of the Department of Health and Human Services that focuses on "the changing demands and needs for pediatric primary and subspecialty care, status of access to that care, and disparities in receipt of those services."
- Collaboration between the American Academy of Pediatrics, the Council of Pediatric Subspecialties, and other pediatric professional societies to "develop, disseminate, and implement testing, management, and referral guidelines for health conditions commonly managed by subspecialists."
- Payers "should adequately reimburse evidence-based care delivery models that improve interprofessional, integrated, team-based care to enhance … access to pediatric subspecialty care."
- CMS and related agencies "should sponsor the development, implementation, and evaluation of innovations in the primary–specialty care interface and the pediatric subspecialty referral and care coordination processes."
- Congress should invest additional federal funding in efforts to address the contributing factors that limit access and availability to the pediatric subspecialty care and "increase payment for pediatric services."
- CMS should prioritize pediatric services when it assigns "relative value units that accurately reflect the time and resource use for pediatric subspecialty care."
- "Congress should increase funding for the Pediatric Specialty Loan Repayment Program and also focus on strengthening loan repayment for "high-priority pediatric medical subspecialties as well as subspecialists from underrepresented in medicine and/or economically disadvantaged backgrounds."
- All pediatric professional societies, and education and training organizations should regularly meet to "review and adjust educational and training curricula (e.g., continuing education, standardized pediatric subspecialty training, and specialty recognition and certification) for pediatric residents and fellows."
- Alongside the Accreditation Council for Graduate Medical Education, related organizations should work to "develop, implement, and evaluate distinct fellowship training pathways, including a 2-year option for those who aspire to a career with a primary focus on clinical care."
- Congress should work to reconfigure graduate medical education formulas and programs "to ensure equitable and sufficient support for pediatric graduate education."
- Health systems, medical schools and pediatric department leaders should aim to "develop, implement, and publicly report on plans and outcomes to attract, support, and retain students, residents, fellows and faculty from underrepresented in medicine backgrounds in pediatric subspecialties."
- The NIH's Pediatric Research Consortium "should engage with other government and nongovernment pediatric research funders to create and maintain a publicly …available central repository for qualitative and quantitative data on pediatric physician–scientists’ funding and success throughout their careers …including the development of new measures as needed to understand the initial success and retention of pediatric physician–scientists."
- The NIH in partnership with the AHRQ should "increase the number of career development grants in pediatrics, particularly institutional training 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."