Pediatricians Are Primary Care Providers


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Pediatricians Are Primary Care Providers

  1. 1. America’s Children Need Access to Pediatric Subspecialists Timely access to pediatric subspecialist and pediatric surgical specialist care is becoming increasingly difficult for our nation’s children and families. Consider: The supply of pediatric subspecialists is inadequate to meet the health needs of children. • In the United States, there are approximately 28,000 pediatric medical subspecialists and surgical specialists to care for over 80 million children.1 • For most subspecialties, there are on average between 100,000 and 200,000 children per provider across hospital referral regions.2 • There is significant disparity in the geographic distribution of pediatric subspecialists across the country, resulting in many underserved rural and urban areas.3 (See attached maps) Most pediatric subspecialists practice in academic settings, leaving many rural areas and regions at some distance from academic centers without any pediatric subspecialists. • Approximately 1 in 3 children must travel 40 miles or more to receive care from a pediatrician certified in adolescent medicine, developmental behavioral pediatrics, neurodevelopment disabilities, pulmonology, emergency medicine, nephrology, rheumatology, and sports medicine.4 • Seven states – Nevada, Montana, Wyoming, North Dakota, South Dakota, Nebraska, and Vermont – lack any pediatricians specialized in adolescent medicine.5 • Nearly 300,000 children in the United States suffer from rheumatoid arthritis and other rheumatic diseases; yet 13 states lack a pediatric rheumatologist trained to treat these complex and often life-threatening diseases.6 Even in regions with pediatric subspecialists, families often face long wait times to obtain an appointment with pediatric subspecialist. • For many pediatric subspecialists, patients must wait between 5 weeks and 3 months to get an appointment.7 • In a 2009 national survey of children’s hospitals, the average wait time to see a pediatric neurologist was 9 weeks. An appointment with a developmental-behavioral pediatrician, experts in assisting children living with autism-spectrum disorders, requires wait of 13 weeks.8 • Sixty-eight percent of primary care pediatricians practicing in rural communities and 49 percent of non-rural pediatricians reported dissatisfaction with waiting times for appointments with pediatric subspecialist. Further, more than 65 percent of rural pediatricians rated the number of subspecialists in their area as poor or fair.9 Fewer medical residents are choosing careers in pediatric subspecialties, while the existing workforce continues to age. • In 2006, there were only 21 first year fellows training in adolescent medicine, 29 in developmental behavioral pediatrics, and 32 in pediatric rheumatology.10
  2. 2. • Residents often cite financial concerns, such as debt load, as a significant factor influencing career choice.11 Three in four pediatric residents have debt at graduation, many with more than $155,000 in loans. 12 Residents with debt are more likely to plan a primary care or hospitalist career, rather than a subspecialty. So while indebtedness may not influence selection of pediatrics as a career, it may impact the decision to pursue subspecialty training. • The mean age of pediatric subspecialists exceeds 50 years. The only exception being emergency medicine, which is a relatively new subspecialty. The anticipated retirement of existing pediatric subspecialty workforce will only further intensify current shortage.13 • Job vacancies lasting more than one year have been documented for pediatric neurology, endocrinology, pulmonology, gastroenterology, and developmental-behavioral pediatrics.14 As the pediatric workforce continues to shrink, demand for pediatric subspecialty care is on the rise. • Over the past decade, the pediatric population has experienced dramatic increase in the incidence and prevalence of attention deficit hyperactivity disorder, autism, asthma, depression, diabetes, and obesity. • The proportion of visits to pediatric specialists increased significantly from 1980 to 2000, from 1.6 percent to 4.5 percent.15 • Increases in patient referral volume have also been reported. In a national survey of pediatric subspecialists, one-third of respondents report increased volume of referrals. In particular, 47 percent of pulmonologist, 46 percent of endocrinologist, and 34 percent of cardiologist indicated an increase in referral volume.16 For more information, contact: Daniel Gage, Assistant Director Alison Perencevich, Legislative Assistant American Academy of Pediatrics, Department of Federal Affairs 202-347-8600 · · 1 American Academy of Pediatrics. Pediatric Work Force Work Group. 2006. 2 Mayer ML. Are We There Yet? Distance to Care and Relative Supply Among Pediatric Medical Subspecialties. Pediatrics. 2006;118(6): 2313- 2321. 3 Mayer 4 Mayer 5 Mayer 6 U.S. Department of Health and Human Services Health Resources and Services Administration. The Pediatric Rheumatology Workforce: A Study of the Supply and Demand for Pediatric Rheumatologists, 2007. Available at: 7 National Association of Children’s Hospitals and Related Information (NACHRI). Pediatric Subspecialty Shortages Affect Access to Care. 2010. Available at: 8 NACHRI 9 Pletcher BA, Rimsza ME, Cull WL, et al. Primary Care Pediatricians’ Satisfaction with Subspecialty Care, Perceived Supply, and Barriers to Care. J Pediatr. 2010;156:1011-1015. 10 American Board of Pediatrics. Workforce Data. Available at: 11 Jewett EA, Anderson MR, Gilchrist GS. The Pediatric Subspecialty Workforce: Public Policy and Forces for Change. Pediatrics. 2005;116(5):1192- 1202. 12 American Academy of Pediatrics. Department of Research Abstract. 2010. 13 American Board of Pediatrics. 14 NACHRI 15 Freed G, Nahra T, Wheeler J. Which Physicians Are Providing Health Care to America’s Children? Pediatrics & Adolescent Medicine. 2004; 158:22-26. 16 Stoddard JJ, Cull WL, Jewett EA, et al. Providing Pediatric Subspecialty Care: A Workforce Analysis. Pediatrics. 2000; 106(6):1325-1333.