How Do Graduating Pediatric Subspecialty Fellows Perceive Job Availability?

The recent Medicine and Pediatric Subspecialty Match for prospective fellows highlighted the continued increase in the number of pediatric subspecialty positions offered in the National Resident Matching Program®, up 1,814 in 2022 from 1,754 certified positions in 2021. However, the overall fill rate decreased from 86.9% to 84.7%.¹ Similar to prior years, several pediatric subspecialties filled more than 95% of positions offered, including cardiology, critical care medicine, emergency medicine, gastroenterology, and hospital medicine, while the largest percentages of unfilled positions were in academic general pediatrics, endocrinology, infectious diseases, and nephrology. While some subspecialty fellowships have increased the total number of applicants since 2018 (e.g., neonatal-perinatal medicine, critical care medicine), others have decreased (e.g., hematology oncology, developmental and behavioral pediatrics), which undoubtedly impacts the pediatric subspecialty workforce and potential employment opportunities for graduates.² For decades, there have been concerns about the projected shortage of the subspecialist workforce.^3,4 However, less is known about how pediatric subspecialty fellows perceive job availability upon graduation.

This week in Pediatrics, we are early releasing an article by Dr. Laurel K. Leslie and her colleagues at the American Board of Pediatrics (ABP) entitled, “Perceived Job Availability of Graduating Pediatric Subspecialty Fellows in 2019 and 2021” (10.1542/peds.2022-057830). The authors evaluated the national ABP annual Subspecialty In-training Examination survey of graduating US- and Canada-based fellows from 2019 and 2021 in which 4 questions were added regarding perceptions of job availability. Of the 1,207 and 1,098 graduating pediatrics fellows in 2019 and 2021, respectively:

• Emergency medicine fellows showed the greatest decrease in probability of selecting “strongly agree/agree” in regard to their ability to secure a job across all questions, while infectious diseases showed the greatest increase
• Hematology and oncology consistently had the absolute lowest rated perception of job availability
• Critical care medicine, emergency medicine, endocrinology, gastroenterology, and neonatal-perinatal medicine showed statistically significant decreases in the probability of selection “strongly agree/agree” for the overall mean response between 2019 and 2021

The pediatric subspecialty workforce continues to shift pending subspecialty fellowship positions and fill rates; this study highlights another factor that may shape the complex decision about whether pediatric residents pursue fellowship – perceived job availability upon graduation. In a 2013 policy statement, the American Academy of Pediatrics stated, “the current pediatrician workforce is not meeting the primary care, subspecialty or surgical needs to provide quality health care for US children and that critical workforce shortages exist in pediatric medical subspecialties and pediatric surgical subspecialties.”³ Although national efforts are underway to study the current status of the pediatric workforce, including the Association of Medical School Pediatric Department Chairs 2025 Workforce Initiative⁵ and a National Academies of Science, Engineering, and Medicine’s consensus study on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being,⁶ the authors of this study call for “deliberate monitoring” of the various factors affecting the workforce supply and distribution, for which annual evaluation and dashboard displays could be informative for ongoing initiatives.

Whether you are a general pediatrician or subspecialist, I hope you will read this article and reflect on our workforce’s impact on the future of child health.

References:

1. The National Resident Matching Program. Match Results Statistics: Medicine and Pediatric Subspecialties – 2022. November 30, 2022. https://www.nrmp.org/wp-content/uploads/2022/11/Medicine-and-Peds-Specialties-MRS-Report.pdf. Accessed December 5^th, 2022.
2. Moerdler S, Borinstein SC. Recent trends in Pediatric Hematology Oncology fellowship match and the workforce impact. Pediatric Research. 2022;91:492-493.
3. Committee on Pediatric workforce, Basco WT, Rimsza ME, Hotaling AJ, Sigrest TD, Simon FA. Pediatrician Workforce Policy Statement. Pediatrics. 2013;132(2):390-397.
4. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. June 2021. https://www.aamc.org/media/54681/download. Accessed December 5, 2022.
5. Vinci RJ, Degnon L, Devaskar SU. Pediatrics 2025: The AMSPDC Workforce Initiative. Journal of Pediatrics. 2021;237:P5-8.E1.
6. National Academies of Sciences, Engineering, and Medicine. The Pediatric Subspecialty Workforce and Its Impact on children Health and Well-Being. https://www.nationalacademies.org/our-work/the-pediatric-subspecialty-workforce-and-its-impact-on-child-health-and-well-being. Accessed December 5, 2022.