The pediatric subspecialty of adolescent medicine—Help wanted!

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Adolescent medicine (AM) is the eleventh largest discipline with approximately 500 certified pediatricians. Of note, the AM certificate is developed in collaboration with the American Board of Family Medicine (ABFM) and the American Board of Internal Medicine (ABIM). The American Board of Pediatrics (ABP) issues certificates to pediatricians and the ABFM and ABIM issue to family medicine and internal medicine physicians respectively; currently there are 170 ABIM/ABF physicians with AM specialty certificates.

According to the report published in this issue, the total number of fellows enrolled in subspecialty training in AM has remained constant with minor variation since data were collected beginning in 1995. The 25 U.S. AM subspecialty training programs are distributed across 15 states and the District of Columbia. The actual number of physicians entering year one of AM subspecialty training has decreased from 25 to 19 fellows in 2005. Over half of the 2005 subboard examinees sitting for the board examination reported an intention to practice exclusively in an academic setting.

Although the adolescent population can be challenging, their health care needs require focused skills in targeted domains such as physical and psychosocial development and associated transitions, adolescent gynecology and reproductive health, nutrition, including eating disorders and obesity, sexually transmitted infections, and mental health, including substance use and abuse. Each of these areas offers research potential and provides an opportunity to combine clinical care, teaching, and applied research. The primary question this workforce assessment raises is: will there be enough AM physicians to meet the needs of youth in the future?

Clearly, if AM is to continue to grow and thrive as a specialty, it has both challenges and opportunities. Workforce issues that require attention include changing demographics, desire for schedule flexibility such as part-time positions, and disparity in distribution. The ABP data suggest an absence of adolescent providers in some states and limited numbers of providers in rural areas. Although gender shifts and interest in part-time work opportunities have been reported in general pediatrics workforce data, no such information exists at present for those in AM. Continued monitoring of these workforce issues is needed. That being said, it is important to offer a cautionary note that these data represent only one side of the equation; the demand for needed medical services from adolescents, their parents, and the larger community remains an unknown, but an important, variable. Our challenge is to galvanize interest in the subspeciality of AM and share with those physicians in the pipeline the rewards of caring, training, and improving through research the health and medical care of adolescents as they transition to young adulthood.