Taking a Cue from Big Business: Strategies for Optimizing Pediatric Recruitment
Article Outline
To paraphrase Mark Twain, the report of the death of primary care specialties is an exaggeration. But, like all exaggerations, truths are told and there are lessons to be learned. Between 1997 and 2006, the percentage of US medical school graduates entering primary care specialties did decrease.1 Pediatrics did not escape this epidemic. Although the past 3 years have seen a significant resurgence of students matching in pediatrics,2 the prospect of a “near-death experience” of our specialty warrants a period of reflection on how to improve its vitality. The long-term health of pediatrics is dependent upon our ability to recruit students into the profession. In fact, we do not want just any students: we must continue to seek out actively the most exceptional candidates to serve the children of tomorrow.
Recruiting in any successful business venture takes substantial effort. Historically, pediatrics has relied on its altruistic nature to entice idealistic medical students. This is an incredibly passive approach to healthy and sustainable recruitment. We can no longer wait for students to discover us or to choose us based on the good deeds we do or the satisfaction we derive from serving children.3 It is time for pediatrics to emerge from its dependency on the good will of others and start behaving more like a Fortune 500 company that is competing to capture recruits from the finest institutions of learning. To be successful, we need to be innovative about our business practices and sales efforts by borrowing from the triumphs realized in the corporate boardroom. We have, therefore, drawn from the expertise of corporate recruiting firms to create a model that optimizes the recruitment of medical students into pediatrics. By Creating a Corporate Brand, Becoming Competitive, and Creating a Pipeline4, 5 we will become recruitment leaders in medicine, thereby ensuring the development of future physician leaders in pediatrics.
Creating a Corporate Brand
Most importantly, we need to polish our image. Anyone who has ever read a student’s personal statement for pediatrics knows that far too many report choosing pediatrics because they “love kids.” Although it is a heart-warming sentiment, unfortunately they rarely say they choose pediatrics because it is intellectually stimulating, houses renowned research scientists, trains visionary leaders, or creates doctors who will change the world. Yet these statements all describe pediatrics as much as, if not more so, than any other specialty. To be frank, we have done a deplorable job in promoting our profession; students who value prestige, intellectual challenge, innovation, and research opportunities do not choose primary care specialties.6 Exceptional recruits are attracted to exceptional brands, and we have failed to create a dynamic marketing strategy for our luxury commodity.
We need to start immediately to brand pediatrics as the specialty in which the most innovative, intellectually rigorous, and altruistic leaders practice. This should be promoted on the national level (eg, the American Board of Pediatrics, American Academy of Pediatrics, Association of Pediatric Program Directors, Association of Medical School Pediatric Department Chairs, Council on Medical Student Education in Pediatrics) and on the local level of individual programs, schools, and practices. Our faculty, residents, and primary practitioners are our best representatives, but students have to be exposed early, often, and with a uniform message. More importantly, we need to identify, as early as possible, trainees who are “star material” and generate in them a sentiment of competitive privilege that emanates from joining those who pursue pediatrics as a career. Our recommendations for boutique clerkships, scholarship opportunities, and academic achievements will demonstrate this in design, and our colleagues will reinforce it with their actions.
Becoming Competitive
Ultimately, all job decisions come down to the offer on the table. Although one opportunity might offer more money, another might have superior benefits. A similar balance of factors influences medical students’ career choices, and it is important that we address them outright with the students who compose the next generation of physicians.
Lifestyle
Increasingly, medical students view controllable lifestyle (ie, the ability to control time spent at work) as an important aspect of their future careers.7 Pediatrics is not a “lifestyle-unfriendly” specialty,8 but we must do two things to be competitive: better promote the positive aspects of our lifestyle and create a more controllable lifestyle for ourselves. We must find role models who can demonstrate the variety of lifestyles in pediatrics (academic/private practice; research; administration; education; part-time/full-time, etc.). And, to lead by example, we must also ensure that our benefits reflect the value we place on sustainable lifestyles. This includes appreciation of the needs for competitive salaries, reasonable leave opportunities, childcare options, and overall personal wellness. Similarly, we need to advocate, promote, support, and encourage creative flexibility in training and career structures.
Opportunities
Students have a diverse array of interests beyond clinical medicine. Despite the increase in research opportunities within residencies, we must further expand the notion of what constitutes scholarship for trainees. There are many programs that have special tracks in primary care, public health, and global health. More residencies should offer such tracks and include opportunities for additional Master’s-degree-level training. This would not only attract more students to the opportunities available in our field, it would also emphasize the rigor inherent in pediatric practice and research investigation.
Creating a Pipeline
In business practice, companies create pipelines that identify talented individuals early so as to supply their workforce needs continuously. Pediatric medicine is no different. According to one study, pediatrics is the most common specialty choice at the beginning of medical school, yet that interest drops significantly by the end of the second year.1 Unfortunately, two-thirds of students have chosen their specialty by then.9 Thus, it is imperative that we capitalize on the a priori interest of medical students. Fortunately, there are many venues for involvement during the first 2 years of medical school and a continued pipeline into the clinical years.
Preclinical Exposure
Members of the faculty of the pediatrics department must be intimately involved during the first 2 years of medical school. Lecturing in the preclinical courses (eg, physiology, microbiology, etc.) gives pediatricians the opportunity to demonstrate the intellectual rigor of our profession long before clinical exposure. These faculty members serve as prestigious role models who will strongly influence students’ choices of specialty.10 We must also develop and use programs outside of the traditional curriculum to create contact. Electives, extracurricular meetings and workshops, 11, 12 and social media can all be used to offer such opportunities for students and have been noted to be influential on future career choices.1 The relationships created in such “sales efforts” offer bridges to the clinical years and permit the insinuation of the so-called luxury brand competitive model from the start.
Clinical Exposure
It is important that we become creative in structuring clinical exposure. We must create clerkships that offer opportunities for students not only to see all aspects of pediatrics (inpatient, outpatient, research, etc.), but also to truly embed as members of the health care team. Clerkship directors can actively target the preferences of students when assigning clinical sites, thus creating “boutique clerkships” that afford tailored experiences, including the potential impact of experiences in community pediatric offices.13 Team structures that increase the direct involvement of students can increase their sense of autonomy14 and fulfill the sense of community that the students desire throughout their clinical years.
Discussion
In short, we must expose students to the best that pediatrics has to offer, both early and often. By maintaining this exposure, creating mentoring relationships, and allowing our amazing peers to role model while providing excellent care, we will be developing a pediatric pipeline program.
We have elucidated several strategies for improving recruitment of medical students into pediatrics. It is in no way a complete list, but the concepts of Building a Pipeline, Becoming Competitive, and Creating a Corporate Brand offer a framework of ways to continually improve. We strongly believe that the strength of our specialty and the vision of its members can turn such a framework into a robust prescription for treating the epidemic from which pediatrics, and primary care in general, have suffered for the past decade. Pediatrics is far too important to the future of our world for us to fail to recruit the most exceptional students into its ranks.
References
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- Association of American Medical Colleges. Graduation Questionnaire All Schools Reports. Available at https://www.aamc.org/data/gq/allschoolsreports/. Accessed February 27, 2011.
- . Influencing career decisions in pediatrics. J Pediatr. 2004;144:693–694
- Sullivan J. 20 principles of recruiting and talent management. Available at http://www.ere.net/2008/07/07/the-20-principles-of-strategic-recruiting/ ( Jul 7, 2007). Accessed April 11, 2011.
- Smith J. Recruiting tomorrow for today: 4 key reasons you need a talent pipeline. Available at http://thehiringsite.careerbuilder.com/2011/03/17/recruiting-for-tomorrow-today-4-key-reasons-you-need-a-talent-pipeline/ (Mar 17, 2011). Accessed April 11, 2011.
- . Primary care specialty choices of United States medical graduates, 1997-2006. Acad Med. 2010;85:947–958
- . Making pediatrics residency programs family friendly: views along the professional educational continuum. J Pediatr. 2006;149:1–2
- . The variable influence of lifestyle and income on medical students’ career specialty choices: data from two U.S. medical schools, 1998-2004. Acad Med. 2005;80:809–814
- . The decision to enter a medical specialty: timing and stability. Med Educ. 1992;26:327–332
- . The impact of role models on medical students. J Gen Intern Med. 1997;12:53–56
- . Three innovative curricula for addressing medical students’ career development. Acad Med. 2011;86:72–76
- . FaMeS: an innovative pipeline program to foster student interest in family medicine. Fam Med. 2010;42:28–34
- . Third-year medical student survey of office preceptorships during the pediatric clerkship. Arch Pediatr Adolesc Med. 2001;155:592–596
- . Evaluation of an innovative pediatric clerkship structure using multiple outcome variables including career choice. J Hosp Med. 2007;2:401–408
PII: S0022-3476(11)00456-2
doi:10.1016/j.jpeds.2011.04.049
© 2011 Mosby, Inc. All rights reserved.
