Pediatric workforce: A look at pediatric emergency medicine data from the American Board of Pediatrics
Article Outline
Abbreviations: ABEM, American Board of Emergency Medicine, ABP, American Board of Pediatrics, FOPE II, Future of Pediatric Education II
This report, which is part of a series discussing workforce trends for general pediatrics and related subspecialty areas, highlights the American Board of Pediatrics’(ABP) workforce data for pediatric emergency medicine. Readers are encouraged to read the initial report1 in the series because it provides information regarding general pediatrics and summary information about other ABP subspecialties.
The pediatric emergency medicine certificate was established in collaboration with the American Board of Emergency Medicine (ABEM). The ABP issues the certificate to pediatricians, whereas the ABEM issues the certificate to emergency medicine physicians. The tracking data in this report include all fellows in training, regardless of whether they are pediatricians or emergency medicine physicians. However, the certification numbers, unless otherwise noted, include only those physicians who are certified by the ABP.
In 1992, pediatric emergency medicine became the ninth ABP sub-board to offer a certification examination, with the first examination yielding 239 board-certified pediatric emergency medicine physicians. Today, almost 1300 pediatricians have been certified by the ABP as pediatric emergency physicians. The focus of this report is to provide a snapshot of the current ABP workforce data for this subspecialty. The full ABP workforce data are available on the ABP Web site at www.abp.org.
Methods
As described in the initial report, the ABP uses 3 primary methods to collect and maintain data about workforce numbers: tracking of residents and fellows, examination application surveys, and continual maintenance of the ABP master database as individuals become certified tracking for first-year fellows began in 1995. By 1997 to 1998, all subspecialty fellows in all training levels were tracked. In 2005, the ABP contacted all accredited pediatric emergency medicine training programs in the US (n = 58) and Canada (n = 9) to obtain tracking information. All but 1 program contacted returned their tracking information.
Results
Pediatric Emergency Medicine Fellow Tracking
Table I provides the number of fellows in training since the 1997–1998 academic year, with a breakdown by gender and medical school. The number of fellows enrolled in pediatric emergency medicine has been steadily increasing, with a 64.0% increase since 1997. The total percentage of women fellows is at a current peak of 55.7%. Although this is only 0.4% higher than the percent in 1997, the proportion of women fellows had dropped to a low of 47.8% in 2001. The total percentage of American medical school graduates fellows has remained relatively steady since 1997, from 81.2% to 82.7%, with a peak in 2002 of 87.5%.
Table I. Total number of pediatric emergency medicine fellows in training since 1997
| Year | Total | Female | Male | AMG | IMG |
|---|---|---|---|---|---|
| 1997-1998 | 197 | 55.3% | 44.7% | 81.2% | 18.8% |
| 1998-1999 | 183 | 53.6% | 46.4% | 82.0% | 18.0% |
| 1999-2000 | 210 | 52.9% | 47.1% | 80.0% | 20.0% |
| 2000-2001 | 214 | 50.9% | 49.1% | 81.3% | 18.7% |
| 2001-2002 | 230 | 47.8% | 52.2% | 83.5% | 16.5% |
| 2002-2003 | 255 | 49.4% | 50.6% | 87.5% | 12.5% |
| 2003-2004 | 282 | 50.4% | 49.6% | 83.7% | 16.3% |
| 2004-2005 | 296 | 48.0% | 52.0% | 84.8% | 15.2% |
| 2005-2006 | 323 | 55.7% | 44.3% | 82.7% | 17.3% |
The Figure illustrates the number of fellows in training at each level. Since 1997–1998, the average drop rate from training year 1 to training year 3 is 14%. The decline may be attributed to many factors such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, training programs in Canada accredited by the Royal College of Physicians and Surgeons of Canada are 2 years in duration, and nonpediatric physicians are eligible for certification by ABEM on completion of 2 years of training. These various factors make it difficult to ascertain whether the drop rate is a true reflection of those actually leaving the subspecialty.
Figure.
Number of pediatric emergency medicine fellows in training at each training level.
Pediatric Emergency Medicine Career Data
The ABP has 2 primary opportunities to gather information regarding career interest in pediatric emergency medicine: a survey given to all first-time applicants for the general pediatrics certification examination and a survey given to all first-time applicants for the pediatric emergency medicine certification examination. The following section highlights results from both the 2005 general pediatrics application and the 2004 pediatric emergency medicine application (no pediatric emergency medicine examination was administered in 2005).
Of the 2994 first-time candidates applying for the general pediatrics certification examination in 2005, 866 (29%) indicated an interest in one of the subspecialty areas in which the ABP awards or jointly awards certificates. Emergency medicine was selected by 11.3% of these 866 applicants. Currently of these 16 pediatric subspecialty choices, pediatric emergency medicine is the third most-selected option, which is consistent with prior years.
The pediatric emergency medicine certifying examination is given every 2 years. In 2004, there were 121 first-time ABP applicants for the pediatric emergency medicine certification examination. Of these applicants, 50% were women, and 86% were American medical school graduates. Approximately 78.5% plan to practice exclusively in pediatric emergency medicine in an academic setting. An additional 15% plan to practice exclusively in pediatric emergency medicine, but in a private practice or combined private practice and academic setting. The next examination is scheduled for November 2006.
Certified Diplomates
As a pediatric subspecialty, pediatric emergency medicine is the fourth largest ABP discipline, with approximately 1300 certified practitioners. The mean age of certified pediatric emergency medicine physician is 46.5 years, with a range of 31 to 65 years of age.
The ratio of current ABP-certified pediatric emergency medicine physicians to children younger than 18 years of age in each of the 50 states and the District of Columbia is shown in Table II (available at www.jpeds.com). The population of children listed in the table is based on the US Census Bureau Population Estimates and includes all children under the age of 18.2 These numbers are based on a list of ABP-certified pediatric emergency medicine physicians with known addresses in one of the 50 states or the District of Columbia. Anyone older than the average retirement age of 65 years was excluded. Based on these adjustments, the total number of ABP-certified pediatric emergency medicine physicians categorized in Table II is 1197.
Table II. Number of ABP-Certified Pediatric Emergency Medicine Diplomates by State (as of 12/31/05)
| State | Number of ABP diplomates in pediatric emergency medicine | Child population | Physician-to-child ratio (per 100,000 children) |
|---|---|---|---|
| Alabama⁎ (1) | 18 | 1,094,533 | 1.6 |
| Alaska | 0 | 188,229 | 0 |
| Arizona⁎ (1) | 17 | 1,547,260 | 1.1 |
| Arkansas⁎ (1) | 10 | 676,550 | 1.5 |
| California⁎ (5) | 76 | 9,596,463 | 0.8 |
| Colorado⁎ (1) | 21 | 1,178,889 | 1.8 |
| Connecticut⁎ (2) | 22 | 838,788 | 2.6 |
| Delaware⁎ (1) | 8 | 193,506 | 4.1 |
| District of Columbia⁎ (1) | 8 | 109,547 | 7.3 |
| Florida⁎ (2) | 77 | 4,003,290 | 1.9 |
| Georgia⁎ (2) | 49 | 2,332,567 | 2.1 |
| Hawaii | 7 | 298,693 | 2.3 |
| Idaho | 1 | 372,411 | 0.3 |
| Illinois⁎ (1) | 45 | 3,238,150 | 1.4 |
| Indiana | 3 | 1,600,295 | 0.2 |
| Iowa | 5 | 680,437 | 0.7 |
| Kansas | 9 | 683,491 | 1.3 |
| Kentucky⁎ (1) | 18 | 980,187 | 1.8 |
| Louisiana | 7 | 1,164,961 | 0.6 |
| Maine | 2 | 282,129 | 0.7 |
| Maryland⁎ (1) | 25 | 1,394,808 | 1.8 |
| Massachusetts⁎ (3) | 61 | 1,464,189 | 4.2 |
| Michigan⁎ (2) | 33 | 2,533,439 | 1.3 |
| Minnesota⁎ (1) | 29 | 1,240,280 | 2.3 |
| Mississippi⁎ (1) | 3 | 749,569 | 0.4 |
| Missouri⁎ (3) | 44 | 1,384,542 | 3.2 |
| Montana | 0 | 208,093 | 0 |
| Nebraska | 6 | 434,566 | 1.4 |
| Nevada | 10 | 603,596 | 1.7 |
| New Hampshire | 0 | 304,994 | 0 |
| New Jersey⁎ (1) | 46 | 2,156,059 | 2.1 |
| New Mexico | 3 | 492,287 | 0.6 |
| New York⁎ (10) | 150 | 4,572,363 | 3.3 |
| North Carolina | 17 | 2,118,492 | 0.8 |
| North Dakota | 1 | 138,955 | 0.7 |
| Ohio⁎ (4) | 91 | 2,779,212 | 3.3 |
| Oklahoma | 5 | 859,870 | 0.6 |
| Oregon | 7 | 852,357 | 0.8 |
| Pennsylvania⁎ (3) | 66 | 2,837,009 | 2.3 |
| Rhode Island⁎ (1) | 11 | 243,813 | 4.5 |
| South Carolina | 8 | 1,024,700 | 0.8 |
| South Dakota | 0 | 190,874 | 0 |
| Tennessee⁎ (2) | 38 | 1,391,289 | 2.7 |
| Texas⁎ (2) | 67 | 6,266,779 | 1.1 |
| Utah⁎ (1) | 15 | 740,114 | 2 |
| Vermont | 0 | 134,894 | 0 |
| Virginia⁎ (2) | 20 | 1,804,900 | 1.1 |
| Washington⁎ (1) | 23 | 1,486,020 | 1.5 |
| West Virginia | 4 | 384,641 | 1 |
| Wisconsin⁎ (1) | 11 | 1,307,986 | 0.8 |
| Wyoming | 0 | 116,932 | 0 |
| 1197 | 73,277,998 | 1.6 |
⁎Note: States with an asterisk denote those with a pediatric emergency medicine training program. The number in parentheses indicates the number of programs tracked in the 2005-2006 academic year. |
Six states (Alaska, Montana, New Hampshire, South Dakota, Vermont and Wyoming) do not have a practicing ABP-certified pediatric emergency medicine physician. More than half of the states have a pediatric emergency medicine physician-to-child ratio of at least 1:100,000 The District of Columbia has the largest ratio (7.3 per 100,000), followed by Massachusetts (4.5 per 100,000). The 58 US pediatric emergency medicine training programs are distributed across 29 states and the District of Columbia, as noted by the asterisk in Table II. The number in parentheses denotes the number of accredited training programs that were tracked in 2005.
Discussion
Although many studies have projected physician workforce needs, it was not until the Future of Pediatric Education II (FOPE II) task force report that a recent and detailed study focused exclusively on pediatrics, both at the generalist and subspecialty level.3, 4
In 2005, the total number of pediatric emergency medicine physicians in training (training years 1 through 3) increased by 9% from the previous year, with the number of pediatric emergency medicine physicians entering training increased from 114 to 129 fellows. The number of entering pediatric emergency medicine physicians has been increasing steadily since the beginning of tracking.
The data in Table II indicate the ABP-certified pediatric emergency medicine physician-to-child ratio. However, the data do not indicate who is working full time or part time. Nor does it include the number of pediatric emergency medicine physicians certified through ABEM. Currently, there are approximately 170 ABEM-certified pediatric emergency medicine physicians.
General pediatrics research has shown an increasing trend toward part-time work, particularly with the increase in the number of women entering pediatrics.5, 6 However, there are no current data to indicate that this is the case in pediatric emergency medicine, but further research is needed. In fact, studies have reported that women are equally likely to work full time and treat an equal number of patients as their male colleagues.6, 7 In addition, as noted earlier, the proportion of male to female physicians has not changed drastically in pediatric emergency medicine.
While it is important to have an adequate number of physicians, where these physicians practice is just as critical in determining whether appropriate care is available to all children. As noted earlier, currently 6 states do not have a certified pediatric emergency medicine physician. In addition, the FOPE II survey results indicate that only 3% of pediatric emergency medicine physicians practice in rural areas.3, 4
Also contributing to a growing need for pediatric emergency medicine physicians is an increase in referrals.4 The FOPE II survey indicates that 32% of pediatric emergency medicine physicians believe that the volume of referrals has increased, and 38% also believe that the referral complexity has increased. Less than 40% of pediatric emergency physicians anticipate that their communities will not need additional subspecialists in the next 3 to 5 years.3, 4
As Stoddard et al4 note, the FOPE II study provides the supply-side perspective. The ABP data in this report provide the same perspective. These data are useful not only to those studying workforce trends, but also to medical students and pediatric residents making career decisions. However, these data do not address or gauge the need for medical services. However, as Wiley et al8 note, given the current estimated attrition rate, frequency of leave from clinical duties, and projection for increased need for pediatric emergency medicine physicians in the future, there are likely workforce implications.
Although workforce studies are not new, attention to workforce issues for pediatric subspecialties is relatively new. It is important that workforce research continues, from both the supply and demand perspective. Only then can we be sure that the goal of providing all children with access to high-quality care be met.
References
- . Pediatric Workforce: a look at general pediatrics data from the American Board of Pediatrics. J Pediatr. 2006;2006:148;166-9
- . Population Estimates by State. 2005;Revised July 1, 2004. Available on http://www.census.gov/popest/states/asrh/SC-est2004-02.html. Accessed April 18
- The Future of Pediatric Education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century. Pediatrics. 2000;105:163–212
- . Providing pediatric subspecialty care: a workforce analysis. Pediatrics. 2000;106:1325–1333
- . Women in pediatric practice: trends and implications. Pediatr Ann. 1999;28:177–183
- . Predicting the pediatric workforce: use of trend analysis. J Pediatr. 2003;143:570–575
- . The changing composition of the pediatric medical subspecialty workforce. Pediatrics. 2005;116:833–840
- . A comparison of pediatric emergency medicine and general emergency medicine physicians’practice patterns: results from the Future of Pediatric Education II Survey of Sections Project. Pediatr Emerg Care. 2002;18:153–158
PII: S0022-3476(06)00806-7
doi:10.1016/j.jpeds.2006.08.033
© 2006 Mosby, Inc. All rights reserved.
