Pediatric workforce: A look at pediatric nephrology data from the American Board of Pediatrics
Article Outline
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 nephrology. Readers are encouraged to read the initial report in the series as it provides information regarding general pediatrics and summary information about other ABP subspecialties.1 In 1974, pediatric nephrology became the third ABP subboard to offer a certification examination, with the first examination yielding 121 board-certified pediatric nephrologists. Today, almost 670 pediatricians have been certified by the ABP as pediatric nephrologists. 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 three 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 1997-1998, all subspecialty fellows in all training levels were tracked. In 2005, the ABP contacted all accredited pediatric nephrology training programs in the US (n=35) and Canada (n=8) to obtain tracking information. All but two of the programs contacted returned their tracking information.
Results
Pediatric Nephrology 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 nephrology has increased by 73.1% since 1997, with the largest increase in 2004-2005. In addition, the total percentage of American Medical School Graduates (AMG) fellows and women in pediatric nephrology continues to increase.
Table I. Number of Pediatric Nephrology Fellows since 1997
| Year | Total | Female | Male | AMG⁎ | IMG |
|---|---|---|---|---|---|
| 1997-1998 | 67 | 48.8% | 51.2% | 32.8% | 65.7% |
| 1998-1999 | 65 | 50.8% | 49.2% | 36.9% | 63.1% |
| 1999-2000 | 72 | 47.2% | 52.8% | 36.1% | 63.9% |
| 2000-2001 | 71 | 46.5% | 53.5% | 40.8% | 59.2% |
| 2001-2002 | 69 | 46.4% | 53.6% | 46.4% | 53.6% |
| 2002-2003 | 74 | 54.1% | 45.9% | 50.0% | 50.0% |
| 2003-2004 | 86 | 58.1% | 41.9% | 64.0% | 36.0% |
| 2004-2005 | 115 | 60.0% | 40.0% | 63.5% | 36.5% |
| 2005-2006 | 116 | 65.5% | 34.5% | 65.5% | 34.5% |
⁎ AMG/IMG percents do not equal 100% as data were missing for one fellow. |
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 26.8%. The drop rate may be attributed to many factors such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, those who have completed fellowship training in Canada only need two years of training to be certified by the Royal College of Physicians and Surgeons of Canada. 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 nephrology fellows in training at each training level.
Pediatric Nephrology Career Data
The ABP has two primary opportunities to gather information regarding career interest in pediatric nephrology: 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 nephrology certification examination. The following section highlights results from both the 2005 general pediatrics and pediatric nephrology applications.
Of the 2,994 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. Nephrology was selected by 3.7% of these 866 applicants. Currently, pediatric nephrology is the tenth most-selected pediatric subspecialty, which is consistent with prior years.
The pediatric nephrology certifying examination is given every two years. In 2005, there were 40 first-time applicants for the pediatric nephrology certification examination. Of these applicants, 67% were women and 57% were AMGs. Of these applicants, approximately 70% plan to practice exclusively in pediatric nephrology in an academic setting. An additional 10% plan to practice exclusively in pediatric nephrology, but in a private practice or combined private practice and academic setting.
Certified Diplomates
As a pediatric subspecialty, pediatric nephrology is the tenth largest discipline with approximately 670 certified practitioners. The mean age of certified pediatric nephrologists is 54.3 years, with almost 85% ranging from 31 to 65 years of age.
The ratio of current ABP-certified pediatric nephrologists 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 pediatric nephrologists with known addresses in one of the 50 states or the District of Columbia. Pediatric nephrologists older than the average retirement age of 65 years were excluded. Based on these adjustments, the total number of certified pediatric nephrologists categorized in Table II is 438.
Table II. Number of ABP-Certified Pediatric Neprhology Diplomates by State (as of 12/31/05)
| State | Number of ABP Diplomates in Pediatric Nephrology | Child Population | Physician to Child Ratio (per 100,000 children) |
|---|---|---|---|
| Alabama | 8 | 1,094,533 | 0.7 |
| Alaska | 1 | 188,229 | 0.5 |
| Arizona | 3 | 1,547,260 | 0.2 |
| Arkansas | 5 | 676,550 | 0.7 |
| California⁎ (5) | 51 | 9,596,463 | 0.5 |
| Colorado | 2 | 1,178,889 | 0.2 |
| Connecticut⁎ (1) | 6 | 838,788 | 0.7 |
| Delaware | 3 | 193,506 | 1.6 |
| District of Columbia | 4 | 109,547 | 3.7 |
| Florida⁎ (2) | 23 | 4,003,290 | 0.6 |
| Georgia | 5 | 2,332,567 | 0.2 |
| Hawaii | 0 | 298,693 | 0 |
| Idaho | 0 | 372,411 | 0 |
| Illinois⁎ (1) | 23 | 3,238,150 | 0.7 |
| Indiana | 4 | 1,600,295 | 0.2 |
| Iowa | 3 | 680,437 | 0.4 |
| Kansas | 2 | 683,491 | 0.3 |
| Kentucky | 8 | 980,187 | 0.8 |
| Louisiana⁎ (1) | 6 | 1,164,961 | 0.5 |
| Maine | 3 | 282,129 | 1.1 |
| Maryland ⁎ (1) | 14 | 1,394,808 | 1 |
| Massachusetts⁎ (2) | 15 | 1,464,189 | 1 |
| Michigan⁎ (2) | 16 | 2,533,439 | 0.6 |
| Minnesota⁎ (1) | 10 | 1,240,280 | 0.8 |
| Mississippi | 0 | 749,569 | 0 |
| Missouri⁎ (2) | 11 | 1,384,542 | 0.8 |
| Montana | 1 | 208,093 | 0.5 |
| Nebraska | 3 | 434,566 | 0.7 |
| Nevada | 2 | 603,596 | 0.3 |
| New Hampshire | 2 | 304,994 | 0.7 |
| New Jersey | 19 | 2,156,059 | 0.9 |
| New Mexico | 3 | 492,287 | 0.6 |
| New York⁎ (6) | 43 | 4,572,363 | 0.9 |
| North Carolina⁎ (1) | 6 | 2,118,492 | 0.3 |
| North Dakota | 0 | 138,955 | 0 |
| Ohio⁎ (3) | 22 | 2,779,212 | 0.8 |
| Oklahoma | 1 | 859,870 | 0.1 |
| Oregon | 4 | 852,357 | 0.5 |
| Pennsylvania⁎ (1) | 21 | 2,837,009 | 0.7 |
| Rhode Island | 4 | 243,813 | 1.6 |
| South Carolina | 6 | 1,024,700 | 0.6 |
| South Dakota | 0 | 190,874 | 0 |
| Tennessee⁎ (1) | 8 | 1,391,289 | 0.6 |
| Texas⁎ (3) | 35 | 6,266,779 | 0.6 |
| Utah | 3 | 740,114 | 0.4 |
| Vermont | 1 | 134,894 | 0.7 |
| Virginia⁎ (1) | 7 | 1,804,900 | 0.4 |
| Washington⁎ (1) | 11 | 1,486,020 | 0.7 |
| West Virginia | 3 | 384,641 | 0.8 |
| Wisconsin | 7 | 1,307,986 | 0.5 |
| Wyoming | 0 | 116,932 | 0 |
| 438 | 73,277,998 | 0.6 |
⁎ Note: States with an asterisk denote those with a pediatric nephrology training program. The number in the parenthesis indicates the number of programs. |
Six states (Hawaii, Idaho, Mississippi, North Dakota, South Dakota, and Wyoming) do not have a practicing certified pediatric nephrologist. The majority of states have a pediatric nephrologist-to-child ratio of less than one pediatric nephrologist per 100,000 children. States with a ratio of one or more include District of Columbia (3.7), Delaware (1.6), Rhode Island (1.6), Maine (1.1), Maryland (1.0), and Massachusetts (1.0).
The 35 US pediatric nephrology training programs are distributed across 25 states and the District of Columbia, as noted by the asterisk in Table II. The number in parentheses denotes the number of training programs in the state.
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 nephrologists in training (training years 1 through 3) remained stable from the previous year (an increase of only one fellow), but increased by almost 35% from 2003. This number has been steadily increasing since the beginning of tracking. The growing proportion of women selecting nephrology supports the claim of increased involvement of women in pediatric subspecialties.5
The data in Table II indicate the pediatric nephrologist-to-child ratio. However, the data do not indicate who is working full-time or part-time. General pediatrics research has shown an increasing trend toward part-time work.6, 7 There are no current data to indicate that this is the case in pediatric nephrology, but further research is needed. While it is important to have an adequate number of physicians, where these physicians practice is just as critical in determining if appropriate care is available to all children. As noted earlier, currently six states do not have a certified pediatric nephrologist.
As Stoddard et al note, the FOPE II study provides the supply-side perspective.4 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.
Although workforce studies are not new, attention to workforce issues for pediatric subspecialties is relatively new. Prior to this study, the last large-scale workforce studies for pediatric nephrology was in 1997.8, 9 At that point, it was noted that the need for pediatric nephrologists was rising and that efforts should continue to encourage pediatric residents to enter nephrology fellowships. Since this study, the number of entering fellows has increased from 29 to 39, with a peak in 2004-2005 of 46 fellows.
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 available at www.jpeds.com.
References
- . Pediatric Workforce (A look at general pediatrics data from the American Board of Pediatrics) . J Pediatr . 2006;148:166–169
- US Bureau of the Census. Population Estimates by State. Revised July 1, 2004. Available at: http://www.census.gov/popest/states/asrh/SC-est2004-02.html. Accessed April 18, 2005
- 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
- . The changing composition of the pediatric medical subspecialty workforce . Pediatrics . 2005;116:833–840
- . Predicting the pediatric workforce (Use of trend analysis) . J Pediatr . 2003;143:570–575
- . Women in pediatric practice (trends and implications) . Pediatric Ann . 1999;28:177–183
- . Future workforce needs for pediatric nephrology (An analysis of the nephrology workforce and training requirements by the Workforce Committee of the American Society of Pediatric Nephrology) . J Am Soc Nephrol . 1997;8:5–8
- . Estimating workforce and training requirements for nephrologists through the year 2010 (pediatric perspectives) . J Am Soc Nephrol . 1997;8:846–847
PII: S0022-3476(06)00259-9
doi:10.1016/j.jpeds.2006.03.040
© 2006 Elsevier Inc. All rights reserved.
