Pediatric Workforce: A Look at Pediatric Infectious Diseases Data from the American Board of Pediatrics
Article Outline
Abbreviations: ABP, American Board of Pediatrics, AMG, American Medical School Graduates, 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 infectious diseases. Readers are encouraged to read the initial report1 in the series, because it provides information about general pediatrics and summary information about other ABP subspecialties. In 1994, pediatric infectious diseases became the 12th ABP subboard to offer a certification examination, with the first examination yielding 501 board-certified pediatric infectious diseases subspecialists. Today, approximately 1000 pediatricians have been certified by the ABP as pediatric infectious diseases 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 1997-98, all subspecialty fellows in all training levels were tracked. In 2005, the ABP contacted all accredited pediatric infectious diseases training programs in the United States (n = 61) and Canada (n = 8) to obtain tracking information. All programs contacted returned their tracking information, for a 100% response rate.
Results
Pediatric Infectious Diseases Fellow Tracking
Table I provides the total number of fellows in training since the 1997-98 academic year, with a breakdown by sex and medical school. The number of fellows enrolled in pediatric infectious diseases has been steadily increasing since 1997. The percentage of women in pediatric infectious diseases training is currently 58.1%. This percentage has fluctuated from a low of 48.1% in 1998 to a high of 61.0% in 2003. The number of American Medical School Graduates (AMG) fellows has increased since 1997, from 51.6% to 63.7%, with a peak of 63.8% in 2002.
Table I. Number of pediatric infectious diseases fellows in training since 1997
| Year | Total | Female | Male | AMG | IMG |
|---|---|---|---|---|---|
| 1997–1998 | 125 | 51.2% | 48.8% | 51.6% | 48.4% |
| 1998–1999 | 131 | 48.1% | 51.9% | 48.9% | 51.1% |
| 1999–2000 | 138 | 50.7% | 49.3% | 50.0% | 50.0% |
| 2000–2001 | 161 | 48.4% | 51.6% | 57.1% | 42.9% |
| 2001–2002 | 158 | 55.7% | 44.3% | 63.3% | 36.7% |
| 2002–2003 | 163 | 56.4% | 43.6% | 63.8% | 36.2% |
| 2003–2004 | 164 | 61.0% | 39.0% | 62.2% | 37.8% |
| 2004–2005 | 177 | 59.3% | 40.7% | 60.5% | 39.5% |
| 2005–2006 | 179 | 58.1% | 41.9% | 63.7% | 36.3% |
The Figure illustrates the number of fellows in training at each level. Since 1997-98, the average drop rate from training year 1 to training year 3 has been 13%. The decline may be attributed to many factors such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, physicians who have completed fellowship training in Canada only need 2 years of training to be certified by the Royal College of Physicians and Surgeons of Canada. These varying factors make it difficult to ascertain whether the drop rate is a true reflection of those actually leaving the subspecialty.
Figure.
Number of pediatric infectious diseases fellows in training at each training level.
Pediatric Infectious Diseases Career Data
The ABP has 2 primary opportunities to gather information about career interest in pediatric infectious diseases: 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 infectious diseases certification examination. This section highlights results from both the 2005 general pediatrics and pediatric infectious diseases applications.
Of the 2994 first-time candidates applying for the general pediatrics certification examination in 2005, 866 (29%) indicated an interest in 1 of the subspecialty areas in which the ABP awards or jointly awards certificates. Pediatric infectious diseases was selected by 6% of these 866 applicants, making it the eighth most selected pediatric subspecialty.
The infectious diseases certifying examination is given every 2 years. In 2005, there were 91 first-time applicants for the pediatric infectious diseases certification examination. Of these applicants, 53.8% were women and 63.7% were AMG fellows. Approximately 41.8% plan to practice exclusively in pediatric infectious diseases in an academic setting. An additional 2.2% plan to practice exclusively in pediatric infectious diseases, but in a private practice or combined private practice and academic setting.
Certified Diplomates
As a pediatric subspecialty, infectious diseases is the seventh largest ABP discipline, with approximately 1000 certified practitioners (as of 12/31/2005). The mean age of certified pediatric infectious diseases physicians is 49.5 years, with approximately 96% ranging from 31 to 65 years of age.
The ratio of current ABP-certified infectious diseases physicians-to-children younger than 18 years 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 Table II is based on the US Census Bureau Population Estimates and includes all children younger than 18 years.2 These numbers are based on a list of pediatric infectious diseases physicians with known addresses in 1 of the 50 states or the District of Columbia. Pediatric infectious diseases physicians older than the average retirement age of 65 years were excluded. On the basis of these adjustments, the total number of certified pediatric infectious diseases physicians categorized in Table II is 887.
Table II. Number of American Board of Pediatrics-certified pediatric infectious diseases diplomates by state
| State | Number of ABP diplomates in pediatrics infectious diseases | Child population | Physician to child ratio (per 100,000 children) |
|---|---|---|---|
| Alabama⁎ (1) | 13 | 1,094,533 | 1.2 |
| Alaska | 0 | 188,229 | 0 |
| Arizona | 6 | 1,547,260 | 0.4 |
| Arkansas⁎ (1) | 4 | 676,550 | 0.6 |
| California⁎ (8) | 100 | 9,596,463 | 1 |
| Colorado⁎ (1) | 16 | 1,178,889 | 1.4 |
| Connecticut⁎ (1) | 16 | 838,788 | 1.9 |
| Delaware | 4 | 193,506 | 2.1 |
| District of Columbia⁎ (1) | 7 | 109,547 | 6.4 |
| Florida⁎ (2) | 41 | 4,003,290 | 1 |
| Georgia⁎ (1) | 30 | 2,332,567 | 1.3 |
| Hawaii | 3 | 298,693 | 1 |
| Idaho | 1 | 372,411 | 0.3 |
| Illinois⁎ (2) | 26 | 3,238,150 | 0.8 |
| Indiana | 12 | 1,600,295 | 0.7 |
| Iowa | 1 | 680,437 | 0.1 |
| Kansas | 2 | 683,491 | 0.3 |
| Kentucky⁎ (1) | 7 | 980,187 | 0.7 |
| Louisiana⁎ (1) | 15 | 1,164,961 | 1.3 |
| Maine | 3 | 282,129 | 1.1 |
| Maryland⁎ (3) | 60 | 1,394,808 | 4.3 |
| Massachusetts⁎ (2) | 41 | 1,464,189 | 2.8 |
| Michigan⁎ (2) | 20 | 2,533,439 | 0.8 |
| Minnesota⁎ (2) | 16 | 1,240,280 | 1.3 |
| Mississippi | 5 | 749,569 | 0.7 |
| Missouri⁎ (2) | 18 | 1,384,542 | 1.3 |
| Montana | 0 | 208,093 | 0 |
| Nebraska⁎ (1) | 5 | 434,566 | 1.2 |
| Nevada | 2 | 603,596 | 0.3 |
| New Hampshire | 2 | 304,994 | 0.7 |
| New Jersey⁎ (1) | 36 | 2,156,059 | 1.7 |
| New Mexico | 4 | 492,287 | 0.8 |
| New York⁎ (9) | 93 | 4,572,363 | 2 |
| North Carolina⁎ (1) | 25 | 2,118,492 | 1.2 |
| North Dakota | 1 | 138,955 | 0.7 |
| Ohio⁎ (4) | 33 | 2,779,212 | 1.2 |
| Oklahoma | 5 | 859,870 | 0.6 |
| Oregon | 8 | 852,357 | 0.9 |
| Pennsylvania⁎ (3) | 36 | 2,837,009 | 1.3 |
| Rhode Island⁎ (1) | 4 | 243,813 | 1.6 |
| South Carolina | 7 | 1,024,700 | 0.7 |
| South Dakota | 0 | 190,874 | 0 |
| Tennessee⁎ (2) | 27 | 1,391,289 | 1.9 |
| Texas⁎ (4) | 76 | 6,266,779 | 1.2 |
| Utah⁎ (1) | 1 | 740,114 | 0.1 |
| Vermont | 2 | 134,894 | 1.5 |
| Virginia⁎ (2) | 23 | 1,804,900 | 1.3 |
| Washington⁎ (1) | 19 | 1,486,020 | 1.3 |
| West Virginia | 5 | 384,641 | 1.3 |
| Wisconsin | 5 | 1,307,986 | 0.4 |
| Wyoming | 1 | 116,932 | 0.9 |
| 887 | 73,277,998 | 1.2 |
⁎Note: States with an asterisk denote those with a pediatric infectious disease training program. The number in parentheses indicates the number of programs tracked in the 2005–2006 academic year. |
Only 3 states (Alaska, Montana, and South Dakota) do not have a practicing ABP-certified infectious diseases physician. Twenty-eight states have a pediatric infectious diseases physician-to-child ratio of at least 1 per 100,000 children, with the District of Columbia having the largest ratio (6.4 per 100,000), followed by Maryland (4.3 per 100,000). The 61 infectious diseases training programs in the United States are distributed across 27 of the 50 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 2005-06 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 number of pediatric infectious diseases physicians in training (training years 1-3) remained fairly stable from the previous year (an increase of only 2 fellows), but it has more than doubled since 1997. The growing proportion of women selecting pediatric infectious diseases as a discipline supports the claim of increased involvement of women in pediatric subspecialties.5
Although the data in Table II provide the pediatric infectious diseases physician-to-child ratio, 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 pediatric infectious diseases. Studies have reported that women in subspecialties are equally likely to work full time and treat an equal number of patients as their male colleagues.6, 7
Although 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 aforementioned, currently 3 states do not have an ABP-certified infectious diseases physician. In addition, the FOPE II survey results indicate that only 4% of infectious disease physicians practice in rural areas.3, 4
Also contributing to a growing need for infectious diseases physicians, the FOPE II survey results indicate that 25% of infectious diseases physicians believe that the volume of referrals has increased and 39% also believe that the referral complexity has increased. However, approximately 65% of pediatric infectious diseases physicians anticipate that their communities will not need additional subspecialists in the next 3 to 5 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. Before this study, the last large-scale workforce study specifically for pediatric infectious diseases was in 1995.8 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;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
- . Predicting the pediatric workforce: use of trend analysis. J Pediatr. 2003;143:570–575
- . Women in pediatric practice: trends and implications. Pediatr Ann. 1999;28:177–183
- . The changing composition of the pediatric medical subspecialty workforce. Pediatrics. 2005;116:833–840
- . The future of pediatric infectious diseases: manpower issues. Pediatr Infect Dis J. 1995;14:1023–1025
PII: S0022-3476(06)01094-8
doi:10.1016/j.jpeds.2006.11.021
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