Pediatric workforce: A look at neonatal-perinatal medicine 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 neonatal-perinatal medicine. 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 1975, neonatal-perinatal medicine became the fourth ABP subboard to offer a certification examination, with the first examination yielding 357 board-certified neonatologists-perinatologists. Today, almost 4500 pediatricians have been certified by the ABP as neonatologists-perinatologists. 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
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 neonatal-perinatal medicine training programs in the US (n=95), Canada (n=14), and Puerto Rico (n=1) to obtain tracking information. All 108 programs contacted returned their tracking information.
Results
Neonatal-Perinatal Medicine Fellow Tracking
Table I provides the total 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 neonatal-perinatal medicine has been steadily increasing, with a 47.7% increase since 1997. This past year yielded the smallest increase of only 2%, from 592 to 604 fellows. The total percentage of women in neonatal-perinatal training also continues to increase and is currently at 57.8%. The number of American Medical School Graduates (AMG) fellows has increased since 1997, from 42.8% to 56.3%, with a peak in 2003-2004 of almost 59%.
Table I. Total Number of Neonatal-Perinatal Medicine Fellows in Training since 1997
| Year | Total | Female | Male | AMG1 | IMG |
|---|---|---|---|---|---|
| 1997-1998 | 409 | 46.0% | 54.0% | 42.8% | 57.0% |
| 1998-1999 | 422 | 48.8% | 51.2% | 39.1% | 60.9% |
| 1999-2000 | 453 | 49.0% | 51.0% | 42.2% | 57.8% |
| 2000-2001 | 471 | 49.9% | 50.1% | 45.4% | 54.6% |
| 2001-2002 | 506 | 50.8% | 49.2% | 54.0% | 46.0% |
| 2002-2003 | 542 | 47.2% | 52.8% | 56.1% | 43.9% |
| 2003-2004 | 567 | 51.0% | 49.0% | 58.7% | 41.3% |
| 2004-2005 | 592 | 52.4% | 47.6% | 57.1% | 42.9% |
| 2005-2006 | 604 | 57.8% | 42.2% | 56.3% | 43.7% |
1 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 15.4%. 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 neonatal-perinatal fellows in training at each training level.
Neonatal-Perinatal Medicine Career Data
The ABP has two primary opportunities to gather information regarding career interest in neonatal-perinatal 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 neonatal-perinatal medicine certification examination. The following section highlights results from both the 2005 general pediatrics and neonatal-perinatal medicine applications.
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. Neonatal-perinatal medicine was selected by 18.0% of these 866 applicants. Currently, neonatal-perinatal medicine is the most frequently selected pediatric subspecialty, which is consistent with prior years.
The neonatal-perinatal medicine certifying examination is given every two years. In 2005, there were 307 first-time applicants for the neonatal-perinatal medicine certification examination. Of these applicants, 48% were women and 63% were AMGs. Approximately 45% plan to practice exclusively in neonatal-perinatal medicine in an academic setting. An additional 49% plan to practice exclusively in neonatal-perinatal medicine, but in a private practice or combined private practice and academic setting.
Certified Diplomates
As a pediatric subspecialty, neonatal-perinatal medicine is the largest discipline with approximately 4500 certified practitioners (as of 12/31/2005). The mean age of certified neonatologists-perinatologists is 51.9 years, with roughly 93% ranging from 31 to 65 years of age.
The ratio of current ABP-certified neonatologists-perinatologists 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 neonatologists-perinatologists with known addresses in one of the 50 states or the District of Columbia. Neonatologists-perinatologists older than the average retirement age of 65 years were excluded. Based on these adjustments, the total number of certified neonatologists-perinatologists categorized in Table II is 3714.
Table II. Number of ABP-Certified Neonatal-Perinatal Medicine Diplomates by State (as of 12/31/05)
| State | Number of ABP Diplomates in Neonatal-Perinatal | Child Population | Physician to Child Ratio (per 100,000 children) |
|---|---|---|---|
| Alabama⁎ (1) | 35 | 1,094,533 | 3.2 |
| Alaska | 8 | 188,229 | 4.3 |
| Arizona | 46 | 1,547,260 | 3 |
| Arkansas⁎ (1) | 23 | 676,550 | 3.4 |
| California⁎ (10) | 478 | 9,596,463 | 5 |
| Colorado⁎ (1) | 56 | 1,178,889 | 4.8 |
| Connecticut⁎ (2) | 61 | 838,788 | 7.3 |
| Delaware⁎ (1) | 13 | 193,506 | 6.7 |
| District of Columbia⁎ (2) | 16 | 109,547 | 14.6 |
| Florida⁎ (3) | 210 | 4,003,290 | 5.2 |
| Georgia⁎ (2) | 90 | 2,332,567 | 3.9 |
| Hawaii⁎ (1) | 26 | 298,693 | 8.7 |
| Idaho | 8 | 372,411 | 2.1 |
| Illinois⁎ (6) | 206 | 3,238,150 | 6.4 |
| Indiana⁎ (1) | 65 | 1,600,295 | 4.1 |
| Iowa⁎ (1) | 32 | 680,437 | 4.7 |
| Kansas | 27 | 683,491 | 4 |
| Kentucky⁎ (2) | 39 | 980,187 | 4 |
| Louisiana⁎ (2) | 59 | 1,164,961 | 5.1 |
| Maine | 14 | 282,129 | 5 |
| Maryland⁎ (3) | 104 | 1,394,808 | 7.5 |
| Massachusetts⁎ (3) | 107 | 1,464,189 | 7.3 |
| Michigan⁎ (3) | 108 | 2,533,439 | 4.3 |
| Minnesota⁎ (1) | 43 | 1,240,280 | 3.5 |
| Mississippi | 27 | 749,569 | 3.6 |
| Missouri⁎ (4) | 75 | 1,384,542 | 5.4 |
| Montana | 4 | 208,093 | 1.9 |
| Nebraska | 14 | 434,566 | 3.2 |
| Nevada | 18 | 603,596 | 3 |
| New Hampshire⁎ (1) | 11 | 304,994 | 3.6 |
| New Jersey⁎ (1) | 171 | 2,156,059 | 7.9 |
| New Mexico⁎ (1) | 19 | 492,287 | 3.9 |
| New York⁎ (11) | 297 | 4,572,363 | 6.5 |
| North Carolina⁎ (4) | 94 | 2,118,492 | 4.4 |
| North Dakota | 9 | 138,955 | 6.5 |
| Ohio⁎ (4) | 142 | 2,779,212 | 5.1 |
| Oklahoma⁎ (1) | 20 | 859,870 | 2.3 |
| Oregon⁎ (1) | 42 | 852,357 | 4.9 |
| Pennsylvania⁎ (4) | 187 | 2,837,009 | 6.6 |
| Rhode Island⁎ (1) | 8 | 243,813 | 3.3 |
| South Carolina⁎ (1) | 44 | 1,024,700 | 4.3 |
| South Dakota | 9 | 190,874 | 4.7 |
| Tennessee⁎ (2) | 76 | 1,391,289 | 5.5 |
| Texas⁎ (6) | 274 | 6,266,779 | 4.4 |
| Utah⁎ (1) | 38 | 740,114 | 5.1 |
| Vermont⁎ (1) | 5 | 134,894 | 3.7 |
| Virginia ⁎ (2) | 113 | 1,804,900 | 6.3 |
| Washington⁎ (1) | 62 | 1,486,020 | 4.2 |
| West Virginia | 19 | 384,641 | 4.9 |
| Wisconsin⁎ (2) | 62 | 1,307,986 | 4.7 |
| Wyoming | 0 | 116,932 | 0 |
| 3714 | 73,277,998 | 5.1 |
⁎ Note: States with an asterisk denote those with a neonatal-perinatal training program. The number in the parenthesis indicates the number of programs. |
A certified neonatologist-perinatologist practices in all but one state (Wyoming). The majority of states have a neonatologist-perinatologist to child ratio between three and eight neonatologists-perinatologists per 100,000 children. States with a ratio of less than three include Wyoming, Montana, Idaho, and Oklahoma. The District of Columbia has the largest ratio (14.6), followed by Hawaii (8.7).
The 95 US neonatal-perinatal medicine 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 that were tracked during the 2005-2006 tracking period.
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 neonatologists-perinatologists in training (training years 1 through 3) increased by almost 2% from the previous year. However, the number of neonatologist-perinatologist entering training decreased from 224 to 215 fellows. This is the first drop in entering fellows since 2000 where the number of entering fellows decreased by almost 10%, from 190 to 171. Overall, the average rate of increase in the number of entering fellows since 1997 is about 6%.
The data in Table II provide the neonatologist-perinatologist 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, 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 neonatal-perinatal 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
While it is important to have an adequate number of physicians, where these physicians practice is critical in determining if appropriate care is available to all children. While neonatal intensive care has experienced tremendous growth in the past 30 years, regional variation in the capacity of neonatal intensive care exists, as the expansion has not occurred evenly across the United States.8, 9, 10 However, Goodman et al9 noted that neonatal intensive care capacity is not preferentially located in regions with greater newborn needs as measured by low birth rates. In addition, no consistent relationship between the number of neonatal intensive care beds and neonatal mortality was found.11 The FOPE II survey results for neonatal-perinatal medicine indicate that only 4% of neonatologists-perinatologists are in rural areas.3, 4 Future research is needed to gain a better understanding of the implication of neonatal intensive care capacity.
According to the FOPE II survey, neonatologists-perinatologists reported the least amount of increase in referrals of all pediatric subspecialties, with only 24% of neonatologists-perinatologists reporting an increase and 63% reporting no change in the volume.3, 4 Yet, about two-thirds of neonatologists-perinatologists anticipate that their communities will not need additional subspecialists in the next three to five years.3, 4
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. 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 on 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 supspecialty care (a workforce analysis) . Pediatrics . 2000;106:1325–1333
- . 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
- . The changing composition of the pediatric medical subspecialty workforce . Pediatrics . 2005;116:833–840
- . The uneven landscape of newborn intensive care services (variation in the neonatology workforce) . Eff Clin Prac . 2001;4:178–179
- . Are neonatal intensive care resources located according to need? Regional variation in neonatologists, beds, and low birth weight newborns . Pediatrics . 2001;108:426–431
- . The relation between the availability of neonatal intensive care and neonatal mortality . N Engl J Med . 2002;346:1538–1544
- . Specialty newborn care (trends and issues) . J Perinatol . 2000;20:520–529
PII: S0022-3476(06)00265-4
doi:10.1016/j.jpeds.2006.03.046
© 2006 Elsevier Inc. All rights reserved.
