Pediatrician Oversupply

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tantrum

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I read the study and newsletter of AAP about Pediatrician oversupply by 2020. The increase in the number of pediatricians is more than the increase in number of children. How do you guys feel about it?
I'm just about to practice in an underserved area and I know so many similar places where there is still a shortage but what will happen 14 years from now? I'm not too worried as I've worked in so many places (different countries and moving is not an issue with me) and by that time, I'm actually slowing down but what will happen to the future pediatricians? Will they still be attracted to Pediatrics?

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There are natural ebbs and flows to the physician market. 20 years ago the discussion was all about the glut of subspecialists and the lack of primary care MDs. At that time incentives were put in place for students to go into primary care, and we are seeing the results of those. Now the pendulum is swinging in the other direction, and we'll probably start seeing incentives for specialization, especially in some of the specialties with big needs in both pediatric and adult medicine (and little reimbursement!)-rheum, endo, etc. There is also increased specialization even within general peds. Gradually general pediatricians have given up the NICU (to OBP!), PICU, ED, and now the trend is towards giving up inpatient care altogether and letting that be done by peds hospitalists.

And the disparities in pediatrician market saturation will always persist; I live in a nice community that's good for families with an excellent pediatric residency. Therefore we have approximately 1 pediatrician for every 5 children (OK, maybe a SLIGHT exaggeration :)). 2 hours from here in the rural southern tier, they are begging for pediatricians, because most new grads don't want to move their newly expanding families away from a larger community to a rural place where they don't know anyone and where the schools and services aren't great.

Overall I think the market forces work pretty well for this aspect of medicine; the problem is that any change in supply has to begin well down the pipeline.
 
tantrum said:
I read the study and newsletter of AAP about Pediatrician oversupply by 2020. The increase in the number of pediatricians is more than the increase in number of children. How do you guys feel about it?
I'm just about to practice in an underserved area and I know so many similar places where there is still a shortage but what will happen 14 years from now? I'm not too worried as I've worked in so many places (different countries and moving is not an issue with me) and by that time, I'm actually slowing down but what will happen to the future pediatricians? Will they still be attracted to Pediatrics?

I make no claims to expertise in physician supply issues. I have been hearing this oversupply claim since I was a resident in the early 1980's and still don't see it, so I'm dubious of claims about what will happen in the future. Looking at the physician supply paper in "Pediatrics" last year makes it sound to me like they have no real idea what will happen with demand for pediatricians. It may be that like other fields, pediatricians will have to compete a bit for patients with other caregivers. More locally, there seem to be ups and downs in the job market for general pediatricians. I can't identify any clear pattern at all for the residents finishing up. No one really disputes that the job market is excellent for virtually all subspecialties of pedi and that there are large underserved areas. I am very dubious that these positions will get filled rapidly.

So, I think that every field has the risk of oversupply, especially for primary care practices in the midst of big cities and nice areas, but there are still plenty of opportunites. I doubt that will change. America is still the home of lots of kids!

With regard to neonatology taking over pediatric business, in general this has been driven by two factors. The first is pediatrician time - in any city of size at all, it just isn't practical for pediatricians to attend deliveries and manage level 2 patients. Gradually, more and more pediatricians don't have the time to see well babies or minor problems and turn this over to neonatologists as well. The second factor is malpractice and hospital policies which are encouraging neonatologists to set up shop where once it was the realm of pediatricians. I am concerned that residents are no longer getting much experience in handling delivery room problems and this will pose long-term problems.

By the way, speaking of general pediatrics, I am speaking at the AAP meeting in Atlanta in October. Should be fun. I rarely go to AAP but am looking forward to it this year. PM me (any SDN pedi folks) to find out what session!

Regards

OBP
 
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