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Normally I don't put much stock in predictions of over or under supply of physicians in specific specialties, but still an interesting read.


US Has Surplus of Pediatricians For Next Twenty Years

HANOVER, NH--During the next two decades, the number of pediatricians will jump 58 percent while the number of children in the United States will increase only 9.3 percent, according to researchers from Dartmouth Medical School and Oregon Health & Science University.

The study, "The Expanding General Pediatrician Workforce," is one of the first published that looks specifically at the number of physicians who specialize in caring for children and uses a statistical model to assess outside forces that could affect the work force.

It is reported in the March issue of the journal Pediatrics by Drs. David C. Goodman, associate professor of pediatrics, and Jon D. Lurie, assistant professor of medicine at DMS and Dr. Scott A. Shipman, assistant professor of pediatrics at Oregon Health & Science University School of Medicine.

In the 1980s some experts predicted a surplus of physicians by the year 2000. Then, in the 1990s many professional health care organizations forecast an oversupply of subspecialists, but perhaps too few primary care physicians, including pediatricians.

More recently, waning interest in primary care specialties by U.S. medical students has heightened fears of an impending shortage of these physicians. The study questions this trend, at least for physicians who specialize in caring for the nation's children.

The researchers employ a novel approach to projecting the work force, allowing them to model the impact of various influences on the physician supply. Using the current number of working pediatricians and the child population in 2000 as the baseline for comparison, they created a statistical model that looked at several factors that may contribute to the change in the pediatric work force.

They considered: current supply of pediatricians; age and gender of new pediatricians entering the work force; new pediatricians from foreign countries who trained in the U. S.; population of the U.S.; changing work styles (full-time versus part-time); pediatrician deaths and retirement ages; market share (number of children who see primary care providers other than pediatricians).

The American Academy of Pediatrics concluded in 1998 that the total supply of pediatricians in the nation was adequate to meet the needs of the population. Today, there is approximately one pediatrician for every 2,040 children in the U.S. population. By 2020 this model predicts there will be one pediatrician for every 1,400 children.

The study will help plan for the future of children's health care and the role of pediatricians in serving their patients. The experience in pediatrics differs greatly from other primary care specialties, including family medicine and internal medicine, which are projected to begin a decline during the next 20 years relative to the growth in the populations they serve. Driving this disparity, say the researchers, is the expanding elderly population.

One of the demographic impacts researchers considered was the changing age and gender of pediatricians. The average age of pediatricians is increasing, as is the number of female pediatricians (more than 65 percent of pediatric residents are women). Older physicians and female physicians tend to work fewer hours to accommodate changing lifestyle priorities. But this trend did not significantly affect the study's conclusions.

Nor did education appear to have much impact. Even if there were a 50 percent decrease in students entering pediatrics training or pediatric residents selecting careers in general pediatrics, the pediatrician work force could nearly maintain its current size relative to the child population for the next 20 years, the team found.

A change in care providers or market share didn't make much of a difference either. Based on the model used, if all children ages 0 to 19 years were to switch from family physicians to pediatricians so that pediatricians treated all children in the U. S., there would still be more of these specialists in practice than needed to maintain today's pediatrician-to-child ratio. This model doesn't consider the significant variation in access to pediatricians across different regions of the U. S. or the impact of racial and ethnic variations in the pediatrician work force. Currently, there are three times as many pediatricians in some parts of the country than in others.

"We need to act now so this increase in pediatricians can be leveraged to benefit our children, not harm our health care system," said Shipman, the lead author. "We need to find incentives that will motivate pediatricians to provide care in parts of our country that continue to lack access despite the growing work force."

Another way the researchers suggest that this work force could benefit the community is by shifting the roles of some pediatricians toward advocacy in education, politics and/or public health.

"The potential for redefining the traditional role of the general pediatrician to better serve the needs of children is exciting... (and) may open up new opportunities for pediatricians to extend their reach," said Shipman.

To maintain their workload and income, however, the researchers said pediatricians may be forced to change the way they practice medicine by providing more medical services to fewer children in their care; expanding their patient population to include more young adults or attracting a greater number of children who are currently seeing non-pediatricians.

Such changes could invite competition and induce demand for unnecessary services that could drive up health care costs without improving the health of children. Additionally, medical training will need to evolve to prepare future pediatricians for the many changes they may encounter in their practices.