Showing posts with label workforce. Show all posts
Showing posts with label workforce. Show all posts

Wednesday, June 3, 2015

Visioning Summit on Future of Workforce in Pediatrics: Five Megatrends and Ten Recommendations

By: Lewis First, MD, MS; Editor-in-Chief 
COD Newsroom
     No one can argue that the field of pediatrics is changing as new morbidities challenge us and relatively new concepts such as the medical home and inter-professional team-based care take on more and more import. When these new issues are then integrated into a workforce that is undergoing change as well in terms of work-hours, and more desire to do part-time rather than full-time work, is it any wonder that our workforce needs have become less clear and in need of more focus?      
     Fortunately the Federation of Pediatric Organizations, made up of seven organizations that together oversee pediatric academic medicine, opted to examine the workforce needs of pediatrics through four working groups—Child health Research and Training, Diversity and Inclusion, Gender and Generations, and Pediatric Training along the Continuum.  These four groups identified five mega-trends; oneAligning education to the emerging needs of children and families; two—promoting future support for research training and child health research; three striving toward mastery within the profession; four aligning and optimizing pediatric practice in a changing health care delivery system; and five taking advantage of the changing demographics and expertise of the pediatric workforce. 
     The four groups then used these mega-trends to make ten recommendations to insure a strong pediatric future workforce.  To learn more about these recommendations that provide the vision, solutions and actions for each mega-trend, then read this special article by Sectish et al. (doi: 10.1542/peds.2014-3493) and learn more.

Related Links

Wednesday, January 28, 2015

Can the Pediatric Clinical Workforce Shortage Be Met with Pediatric Nurse Practitioners Helping Meet Patient Demands?

By: Lewis First, MD, MS; Editor-in-Chief  

Courtesy of College of Dupage

     One of the solutions to workforce shortages to assure that all children have access to high-quality pediatric care is through the growth of the pediatric nurse practitioner workforce. But is this workforce actually growing sufficiently to meet the needs of patients?  Schell et al. ( (doi: 10.1542/peds.2014-0967) ) did some strategic modeling to determine if enough students entering pediatric nurse practitioner programs will suffice in the future. 
     Sadly—the most optimistic model suggests it will take at least 13 years for the nurse practitioner workforce to satisfy the demand for these practitioner positions, although the rate would be reduced to only 5 years if the numbers going into pediatrics increased by only 4% (which is easier said than done) based on prior workforce studies published in our journal by Freed et al. ( (doi: 10.1542/peds.2012-1131) ).    
     The authors model what might happen if the pass rate on the pediatric nurse practitioner certification exam were raised (delaying the ability to meet demand) or number of graduate programs increased (increasing the rate) as well as other modeling strategies—but sadly none result in the near future in the ability of this important group of pediatric clinicians to grow sufficiently to meet the growing demands being asked of them.   
     Nonetheless, reading this study may help policy makers and the pediatric provider community consider how some of these strategies can help reduce the delay in building the workforce in sufficient numbers that will improve the care delivery to children in the United States.  Read this important modeling study and learn more.

     Related Links: 

Monday, November 17, 2014

The Challenges of Practicing Pediatrics in China

Pediatrics Assistant Editor Lydia Furman, MD, shares her perspective on a forthcoming article from our December issue. The full version of the article is available now to subscribers here, and on December 1, 2014, an extract will be freely available to all.

Chinese flag. Public domain photo via Wikimedia Commons
More than a decade ago, Shugerman and colleagues examined determinants of satisfaction among pediatricians in the US (Shugerman et al Pediatr 2001). They compared general and subspecialty pediatricians and internists and family practitioners, and found that “despite lower incomes, general pediatricians reported the highest levels of satisfaction and the least job stress of all physician groups…” and “[Pediatricians] were least likely to endorse symptoms of burnout or job stress.”

This finding likely makes good sense to many of us, and more recent work underscores this finding, with more than half of pediatricians describing themselves as “very satisfied” with their careers (Schmidt et al Health Care Manag 2014). These studies did not, and we would not expect them to, ask about personal safety and violence on the job; the focus of surveys is on burnout, job satisfaction, aspects of daily life such as patient volume and acuity, and hours worked. In general, we do not expect to fear for our physical safety while serving as pediatricians, with limited exception perhaps for those serving in uniquely high-risk environments.

Our good fortune is precisely our blind spot. The courageous Pediatrics article by Xu and colleagues (doi: 10.1542/peds.2014-1377) about the extraordinary and frightening circumstances of pediatricians in mainland China is a showstopper.

Perhaps there are knowledgeable colleagues among us who have friends or family in China who are aware that it may be physically dangerous to practice pediatrics in mainland China, but this shocking (and I believe the word is appropriate) underbelly to medical practice is not widely appreciated. Xu et al. describe instances of physical violence directed against pediatricians, with an increasing rate of medical violence unchecked by the courts or the government.

As fewer medical school graduates choose pediatrics or apply for pediatric jobs in mainland China, the wait time for patient care and the number of patients the remaining pediatricians see has risen dramatically, with each practicing doctor responsible for 80-100 visits per day (even up to 150 per day). Most US pediatricians cannot imagine this workload, and would rapidly change jobs or negotiate for better pay and better hours, citing not just personal exhaustion but patient safety as mandating a change.

Chinese pediatricians do not have ability to increase their pay, and unlike physicians in other specialties, do not have the option to perform procedures or prescribe medications that will supplement their incomes to a tolerable level. Per Xu et al., pediatricians are fleeing their jobs and the job market, with no resolution in sight and no solutions in the pipeline to prevent, improve or change working conditions.

What is our role as fellow pediatricians? What is our government’s role? Do we have any options? Shouldn’t children in every corner of the globe have the same access to health care as in the US? Shouldn’t our colleagues in every corner of the globe have the opportunity to practice medicine in a safe working environment? This brief piece raises issues many of us did not even know needed to be confronted.

Wednesday, May 14, 2014

What’s in the Works for the Pediatric Workforce?

Photo by Eden, Janine and Jim via Flickr
By: Lewis First, MD, MS

With four generations of pediatricians in practice today (the “Silent Generation”, “Baby Boomers”, “Generation X”, and “Millennials”), one can’t help wonder what it means for changes in the pediatric workforce and how the different generations need to adapt in working with each other as well as patients who are being exposed to all generations of physicians. Throw in changes in gender mix, a move to more part-time versus full-time work to insure better work-life balance, and then add in technology and social media—and you have quite a complex set of workforce issues.

Fortunately Spector et al. (doi: 10.1542/peds. 2013-3016) have tried to tackle these complexities as part of a working group on Gender and Generations that formed one of several working groups for a recent Visioning Summit sponsored by the Federation of Pediatric Organizations (FOPO).

If you want to better understand the role of gender on career pathway (e.g. practice versus research) as well as the role of how different generational groups are responding to the use of technology and social media in providing pediatric care to patients, then don’t miss reading this special article which provides some vision and insight into our future.

Related Reading:

Wednesday, May 7, 2014

The Supply of and Demand for Pediatric Subspecialists in the United States

Photo by Logan Tuttle, via Wikimedia Commons
The workforce need in pediatrics remains a topic of great discussion amongst all of us nowadays based
on yearly data gathered by organizations, like the American Board of Pediatrics, that looks at who is entering and leaving our field overall as well breaking the data down for each subspecialty field in pediatrics. Yet how does the supply of subspecialists in the pediatric pipeline equate to the demand for those providers?

Ray et al. (doi: 10.1542/peds. 2013-3466) use data from the National Survey of Children with Special Health Needs while controlling for many confounders, to look at the association between supply and parent-reported demand in US residential counties. The results may surprise you and perhaps help you better understand how supply and demand relate to each other (or don’t, if you read the article carefully) in regard to how counties with the lowest supply of subspecialists are perceived by parents in regard to their utilization of these subspecialists.

If you are thinking about becoming a subspecialist and wonder where the need is greatest, this is a study that deserves your special (or subspecial) attention.

Related Reading:
Pediatrics: AAP Policy Statement: Pediatrician Workforce Statement
Pediatrics: The Pediatric Subspecialty Workforce: Public Policy and Forces for Change

Tuesday, January 21, 2014

Lessons Learned on Diversity and Inclusion: The 2013 Joseph St. Geme, Jr., Award Address Delivered by Dr. Renee Jenkins

Dr. Renee Jenkins, photo via
Every year at the Pediatric Academic Society (PAS) meetings, the Federation of Pediatric Organizations gives out the Joseph St. Geme Leadership Award to an outstanding leader in our field who has and continues to make a difference. At Pediatrics, we are fortunate to be able to publish the winner’s remarks delivered upon receiving this award during the opening session of the PAS meeting. This year
is no exception.

The 2013 winner of the St. Geme Award is Dr. Renee Jenkins, Professor of Pediatrics at Howard University College of Medicine, who shares her insightful and thought-provoking remarks on how we can all strive to be more diverse and inclusive in regard to who will be the future pediatricians who care for the children we serve (doi: 10.1542/peds.2013-2677).

This is must-reading and we are honored that Dr. Jenkins was willing to share her remarks with our journal. Enjoy, and learn from what she had to say (and now provides as meaningful text) on the very important topic of diversity and inclusion!

Monday, December 16, 2013

Occupational Exposures to Pertussis: Coughing Up Some Concerning Data

Photo by COD Newsroom via Flickr
If we are aware of an outbreak or even an individual case of pertussis in the community in which we work, and infection prevention control guidelines have been implemented, can we still put ourselves or others at risk for developing pertussis? Unfortunately the answer is yes and more often than you might suspect based on a study by Kuncio et al. (doi: 10.1542/peds.2013-0745) that we are early releasing this week.

The authors looked at data from occupational health and infection control records in a large quaternary pediatric care network from 2002 through 2011 and then looked at electronic health record data to find the pertussis cases not documented in the occupational health records. Sadly, almost half of the health care worker cases confirmed during an outbreak had no occupational health investigations despite the health care worker having been exposed to index cases of the infection. In what setting did these exposures occur and go untracked? Why weren't index cases able to better identify subsequent healthcare worker exposures?

You will not whoop with joy when you read this troubling study—but you will want to review your infection control policies when you do have an index case of pertussis to make sure steps are followed to not unnecessarily expose you or your fellow colleagues in the office, emergency room, or inpatient setting to this contagious organism.