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Developmental-behavioral specialists grapple with workforce shortage :

March 13, 2018

The needs of children with developmental or behavioral issues are growing, while health care providers are struggling to keep up, a new study found.

Authors from several expert groups including the Academy say the field needs to expand its workforce, reduce administrative burdens and make patient visits more efficient.

“We have a real crisis and that creates an opportunity for us to make some really valuable changes,” said Carolyn Bridgemohan, M.D., FAAP, lead author of the study and a member of the AAP Section on Developmental and Behavioral Pediatrics Executive Committee.

About 15% of U.S. children have a developmental or behavioral condition, and those children may be treated by a generalist or specialist depending on the complexity.

To examine the workforce, experts from the Academy, Society for Developmental and Behavioral Pediatrics and National Association of Pediatric Nurse Practitioners collaborated on a survey to update data from 1997. Their findings are published in the article “A Workforce Survey on Developmental-Behavioral Pediatrics” (Bridgemohan C, et al. Pediatrics. Feb. 16, 2018, https://doi.org/10.1542/peds.2017-2164).

Respondents included 411 physicians who were fellowship trained in developmental-behavioral pediatrics (DBP) or neurodevelopmental disabilities, 147 non-fellowship-trained physicians and 125 nurse practitioners.

The study found patients are growing in number and complexity and so are wait times to see a provider. About 61% of specialist physicians, 18% of generalist physicians and 30% of nurse practitioners reported wait times of eight weeks or more to see new patients for non-urgent appointments.

The survey showed females spent more time with patients and on administrative duties compared to males, but authors could not determine the impact of the disparity on quality of care. Males and females alike reported that paperwork, patient complexity, lack of clinical support, administrative duties and inadequate payment make it difficult to see more patients.

“Respondents indicated that the current situation is not sustainable and described burnout because of feeling overwhelmed and undervalued,” authors wrote.

An already stretched workforce is in danger of shrinking further as about one-third of the physicians said they plan to retire in three to five years, while only about 31 are entering DBP fellowship training each year. The survey did not find significant differences between genders regarding working part time or in academic settings. However, females who took the most recent DBP sub-board exam were more likely to do both, and they made up 79% of the exam takers.

To expand the workforce, the field needs to start recruiting earlier and “create better awareness about the value of the work we do, the rewards of this kind of career, what difference you can make in a child’s life and the life of a family through this kind of specialty,” said Dr. Bridgemohan, co-director of the Autism Spectrum Center at Boston Children’s Hospital.

She also called for additional training and support for general pediatricians and nurse practitioners who could help treat patients who are less severe and those who are waiting to see a specialist.

“We need to think about expanding the workforce not just of subspecialty-trained physicians, but also thinking about other health care providers … and how can we work together,” Dr. Bridgemohan said.

Those already in the field need better payment models and support systems that allow them to focus on patients instead of paperwork, according to the study. Group treatment and telehealth also could help increase efficiency and access.

The authors of a related commentary said solutions “will require innovation and perseverance.”

“A shared vision and integrated workforce are sorely need if we are to meet the needs of children and families,” they concluded.

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