Teaching and tomorrow: a novel recruitment program for a pediatric subspecialty

Child Health Needs and the Pediatric Gastroenterology Workforce: 2020-2040

This article is part of an American Board of Pediatrics Foundation-sponsored effort to analyze and forecast the pediatric subspecialty workforce between 2020 and 2040. Herein, an overview of the current pediatric gastroenterology workforce is provided, including demographics, work characteristics, and geographic distribution of practitioners. Brief context is provided on the changing nature of current practice models and the increasing prevalence of some commonly seen disorders. On the basis of a rigorous microsimulation workforce projection model, projected changes from 2020 to 2040 in the number of pediatric gastroenterologists and clinical workforce equivalents in the United States are presented. The article closes with a brief discussion of training, clinical practice, policy, and future workforce research implications of the data presented. This data-driven analysis suggests that the field of pediatric gastroenterology will continue to grow in scope and complexity, propelled by scientific advances and the increasing prevalence of many disorders relevant to the discipline. The workforce is projected to double by 2040, a growth rate faster than most other pediatric subspecialties. Disparities in care related to geography, race, and ethnicity are among the most significant challenges for the years ahead. Changes to training and education, incentives to meet the needs of underserved populations, and new multidisciplinary models for health care delivery will be necessary to optimally meet the volume, diversity, and complexity of children with gastroenterological diseases in the years ahead.

Addressing recruitment and retention in paediatrics: a pipeline to a brighter future

BACKGROUND

In the UK, the number of junior doctors completing foundation programme, and the number of trainees applying to paediatrics has been in decline in recent years. The NHS is at 'breaking point', exacerbated by workforce shortages, chronic underfunding, increasing service demand and poor job satisfaction within healthcare workers. Issues in recruitment and retention of paediatricians 'threaten the safety of our children's health', according to the Royal College of Paediatrics and Child Health.

AIM

To explore what strategies have been described in the literature to enhance recruitment and retention in paediatrics.

METHODS

A scoping review methodology was conducted, employing a qualitative approach to review the literature. The studies included were English-language studies. 16 full-text articles were reviewed and analysed.

STUDY FINDINGS

There is a paucity of data in the literature that describes evidence-based approaches to enhancing retention and recruitment in paediatrics. The most important strategies employed to help are identified and grouped into six main themes. These include professional advocacy, workforce diversity, mentorship, improving working conditions, career flexibility and enhancing educational opportunities. The authors have created a 'paediatric pipeline' paradigm of 'identify, engage, recruit, retain and champion', which allow us to present these themes in a pragmatic way for paediatricians and policymakers.

CONCLUSIONS

While some issues share similarities with other specialties in difficulty, much of the context and potential remedies within paediatrics are distinct. A strategic, multi-agency collaborative approach is required urgently to address the significant issues that face both paediatrics and the healthcare system.

Factors Affecting Psychiatry Resident Decision to Pursue Consultation-Liaison Psychiatry or Other Subspecialty Fellowship Training

BACKGROUND

There is a national shortage of psychiatrists with subspecialty fellowship training, and many fellowship positions are unfilled.

OBJECTIVE

We conducted a survey of US psychiatry residents to better understand the motivation to pursue fellowship training and to determine any specific factors that were particularly influential in choosing a fellowship in consultation-liaison (C-L) psychiatry.

METHODS

Online surveys were distributed electronically to US general psychiatry residents through the American Association of Directors of Psychiatric Residency Training list server.

RESULTS

A total of 219 questionnaires were completed. Interest in fellowship declined during residency training. Most important factors in consideration of fellowship training were lifestyle (89%), finances (69%), and academic opportunities (63%). Specific influential factors were residency experiences, attending staff as a role model, and medical school experiences. Most important discouraging factors were extra training time, financial concerns, and belief that fellowship training was not necessary. Only 30% of residents had outpatient C-L psychiatry experiences. Few residents belonged to any subspecialty organization or attended any subspecialty meeting. Residents interested in C-L psychiatry fellowships had lower expectation of increased salary than other residents. Outpatient practice settings were seen as preferable over inpatient settings by most residents.

CONCLUSIONS

Results of this survey suggest that enhancing consultation psychiatry exposure in medical school and residency with strong role models, outpatient C-L psychiatry experiences, facilitating subspecialty organization membership and meeting attendance, emphasizing academic opportunities of fellowship training, and improving remuneration for fellowship-trained psychiatrists might be important factors that could improve recruitment into C-L psychiatry and other psychiatric fellowships.

Timing and Stability of Fellowship Choices during Pediatric Residency: A Longitudinal Survey

OBJECTIVES

To determine, among pediatric residents, the timing and stability of decisions to pursue fellowship training and select a specific subspecialty, which can be used to inform strategies to better match the distribution of pediatric subspecialist with the needs of children.

STUDY DESIGN

A longitudinal survey administered with the General Pediatrics In-training Exam to pediatric residents in the US and Canada, 2010-2014. The study included residents who responded in each of their first 3 years of residency and indicated plans to enter fellowship or matriculated, 2013-2016, into 1 of the 14 medical subspecialty fellowships for which the American Board of Pediatrics grants a certificate. Descriptive and χ² statistics were calculated.

RESULTS

Of the 7580 residents who completed 3 annual surveys (response rate 99%) 4963 (65.5%) indicated plans to pursue fellowship training and 2843 (37.5%) matriculated into fellowship. Residents who did not enter fellowship were in smaller residency programs and programs with less interest in fellowship among interns. Most residents who matriculated into fellowship (68.4%) planned to do so as interns and maintained that plan throughout residency. In contrast, 22.7% had selected a specific subspecialty as interns. Fellowship decisions were made later in residency by female residents, American Medical Graduates, and residents in programs where <50% of interns planned to pursue fellowship training. Timing and stability of decisions varied across subspecialty fields.

CONCLUSIONS

Understanding the timing of pediatric medical subspecialty fellowship decisions could be used to shape medical education and, ultimately, the pediatric workforce.