LAS VEGAS — A medical student approaches you for some advice. She is seeking a career choice in pediatrics and has been thinking about becoming a pediatric gastroenterologist, but she's heard rumors that interest in training in the pediatric subspecialties has declined.
What should you tell her?
“This young lady needs to understand that she can get a job,” Dr. James Stockman III said at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP. Factors that influence the work force, he said, include the supply of trainees, the number of international medical school graduates, the increasing number of women coming into pediatrics, the impact of managed care, the increasing number of children that need to be cared for, and the “delicate interface between what a generalist does and what a subspecialist does.”
According to data from the American Board of Pediatrics, the bulk of pediatric subspecialists certified through January 2005 were in neonatal-perinatal medicine (4,136) followed by hematology/oncology (1,884) and cardiology (1,870).
“There are some subspecialties such as sports medicine where there are just a [few] people certified in the discipline,” said Dr. Stockman, who is president of the ABP. “We tend to see what looks like large numbers of neonatal/perinatal people, but these numbers actually are not huge. In fact, if you added up [all pediatric subspecialists] in the United States they would equal about half the number of adult cardiologists. So there are relatively few pediatric subspecialists in the United States.”
He noted that the percentage of pediatric residents going into subspecialties dropped to 18% by the late 1980s, largely as a result of the emphasis on gatekeeping in primary care. “Fortunately these numbers have turned around,” Dr. Stockman said. For example, 664 residents chose a subspecialty fellowship in 1997–1998, compared with 1,121 in 2004–2005.
To ensure enough people are being trained in specific subspecialties, the ABP tracks their average age. “We look at the people who are currently in the field who are age 50 or older, add up those numbers and [infer that] in 10–15 years they're not likely to be seeing patients,” he said.
Using pediatric gastroenterology as an example, he explained that almost half of diplomates in that subspecialty are aged 50 and older, “so this whole cohort needs to be replaced in the next 15 years,” said Dr. Stockman, also of the pediatrics departments at the University of North Carolina and at Duke University.