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Shortage of Specialty Pediatricians?

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TexasRose

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https://www.abp.org/RESIDENT/trchanges.htm

Will be helpful as well. A key question is whether a clinical pathway should be considered that would be 2 years in duration and have a decreased research requirement. We've discussed this issue before. I personally am in favor of it, but that opinion is not widely shared among academic pediatric senior faculty.

Whether reducing the training by one year (and presumably not changing the total amount of night call and clinical training at all) would increase the appeal of pediatric specialties is certainly debatable, but I think most would agree that it would have some positive impact.

Whether it would be good for patient care, research and academics is even more controversial.
 
https://www.abp.org/RESIDENT/trchanges.htm

Will be helpful as well. A key question is whether a clinical pathway should be considered that would be 2 years in duration and have a decreased research requirement. We've discussed this issue before. I personally am in favor of it, but that opinion is not widely shared among academic pediatric senior faculty.

Whether reducing the training by one year (and presumably not changing the total amount of night call and clinical training at all) would increase the appeal of pediatric specialties is certainly debatable, but I think most would agree that it would have some positive impact.

Whether it would be good for patient care, research and academics is even more controversial.

I don't know that an extra year of research has much affect on patient care. It would have an affect on the research and academic components, seems to me.

I think there are plenty of residents out there who balk at the 2 years of required research in order to specialize. Many of them want to be in private practice and have very little interest in producing research. If there was a pathway for them to be fellowship trained with less time in research, I think it would appeal to them. Maybe increase the number of practicioners in specialty care.

It's also a shorter time to earning a salary, which weighs heavy on a lot of residents' minds.
 
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Great article. Thanks TexasRose!

I'm interested in Hem-Onc as a subspecialty but I agree that the mounting debt and loans from college/medical school and relative difficulty of paying those off significantly in residency do give me pause about subspecializing.

Also, the difficulty of not being near a large academic center is very valid. Not everyone can fly/commute to the nearest peds hospital to get adequate care. Based on my very limited experience though, kids who have hem/onc issues are seen at a relatively quicker pace. I can't remember a case that took more than 2-3 weeks for adequate follow up in the hem/onc rotation I was on.

As for knocking off a year, I think prior to the start of my 4th year, I was all for making peds residency 2 years. Now I'm not as sure. It really does seem that the 3rd year of residency is where the final touches are made on the graduating resident. I could see the 3rd year being a time to really hone in on those exam skills that become 2nd nature when sub-specializing.

I do think that the research aspect is important as a foundation for fellowship since seeing trends and knowing the research is important in advancing the knowledge. It doesn't have to be bench research, it could be clinical etc... Anyways, I would hope that specialties would aim to provide more financial support in the future to attract residents into the specialties.

Especially for fields like neuro or nephro... that is definitely scary for a parent to have to wait for several months and watch your kid's seizures worsen because there aren't enough physicians.
 
I don't know that an extra year of research has much affect on patient care. It would have an affect on the research and academic components, seems to me.

I think there are plenty of residents out there who balk at the 2 years of required research in order to specialize. Many of them want to be in private practice and have very little interest in producing research. If there was a pathway for them to be fellowship trained with less time in research, I think it would appeal to them. Maybe increase the number of practitioners in specialty care.

It's also a shorter time to earning a salary, which weighs heavy on a lot of residents' minds.

This is all true and for many years pedi specialties were 2 years. But how do you justify the academic community training its private practice competition? Also, do you think that some folks who would otherwise decide they like research never get a chance to really see what the academic world is like? In other words, would the creation of a 2-year clinical track harm the further development of academic researchers? What are the relative obligations of the "system" to train caregivers vs research and education-oriented attendings?

There are no right or wrongs on these, and raising these points doesn't mean I entirely agree with them, but I do understand both sides of the debate fairly well and think it's important that those considering pediatrics understand it as well.
 
I think it's reasonable to require research for some subs like ID or even critical care. But how about adolesecent med? You do a three year fellowship so you can make less money than a general pediatrician. Many peds won't treat kids over 12. We need people with this specialty, but to expect them to do something they could cover in 12 months is nutty. Personally, I'd love only to do clinical medicine. I'm going to be starting an PICU fellowhsip at 42, I'd really like to omit the research and whatever I do, it aint going to be in the lab. So many fellows are doing BS projects anyway.

Enough of my rant.

Ed
 
But how do you justify the academic community training its private practice competition?

What are the relative obligations of the "system" to train caregivers vs research and education-oriented attendings?

I actually heard a lot about this issue on my GI rotation because of the lack of private practice GI's in my area. It seemed to me an entirely different way to look at fellowship training.

Doesn't everyone who wants a subspecialty training have to go through an academic program? That's an argument for there being no non-academic specialists, which would be a gross disservice for patients not near a major academic center.

I think the "system" has an obligation to train physicians. (not to avoid competition)
 
Wow I had a discussion with one of the Hem-Onc docs I working with and he was talking about finding your niche in a certain specialty and you will be virtually made of gold especially if a hospital desperately needs it. Sure you can't always just pick up and go where you like.

I'm enjoying Heme- Onc, but I can't imagine another three years after residency. Sorry no way...
 
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