Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Assessing the pediatric subspecialty pipeline: it is all about the data source

Pediatric Research volume 93, pages 1907–1912 (2023)Cite this article

Abstract

Background

National Resident Match Program (NRMP) data are often used to identify the pediatric subspecialty pipeline. Other data sources may provide greater accuracy.

Methods

Analysis of data from the NRMP and the American Board of Pediatrics (ABP) for 14 pediatric subspecialties from 2008 to 2020. We calculated, within each subspecialty, the annual number of first-year fellowship positions offered, the NRMP match rate, the actual number of fellows entering training (ABP data) relative to the number of positions in the match (fill rate), and the actual number of matriculating first-year fellows each year.

Results

For all subspecialties and years, the fill rate was greater than the match rate. All subspecialties had an increase in the relative and absolute number of first-year fellows, with the largest increases seen in emergency medicine (73.3%) and critical care (68.9%). Except for adolescent medicine, all subspecialties had an absolute increase in the number of positions offered, with the largest increase in pulmonology (32.1%).

Conclusions

NRMP data underestimate the actual number of first-year fellows entering subspecialty training. For all subspecialties, the number of first-year fellows has increased over time, indicating continued expansion in the pipeline for most. However, there remains great variation across subspecialties.

Impact

  • Perceptions of the pipeline for the pediatric subspecialty workforce vary depending on the data source.

  • The use of NMRP match data alone underestimates the number of matriculating trainees.

  • The number of unmatched fellowship positions has created a perception of a diminishing number of pediatric subspecialty fellows.

  • This study uses multiple data sources to better understand the actual number of fellows entering pediatric subspecialty training and demonstrates that the NRMP match rate alone underestimates the pipeline of the pediatric subspecialty workforce.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Goodman, D. C. Committee on Pediatric Workforce. The pediatrician workforce: current status and future prospects. Pediatrics 116, e156–e173 (2005).

    Article  PubMed  Google Scholar 

  2. Keller, D. M., Davis, M. M. & Freed, G. L. Access to pediatric subspecialty care for children and youth: possible shortages and potential solutions. Pediatr. Res. 87, 1151–1152 (2020).

    Article  PubMed  Google Scholar 

  3. Vinci, R. J. The Pediatric Workforce: recent data trends, questions, and challenges for the future. Pediatrics 147, e2020013292 (2021).

    Article  PubMed  Google Scholar 

  4. Basco, W. T. & Rimsza, M. E. Committee on Pediatric Workforce; American Academy of Pediatrics. Pediatrician workforce policy statement. Pediatrics 132, 390–397 (2013).

    Article  PubMed  Google Scholar 

  5. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2017 to 2032 (accessed 26 May 2022); https://www.aamc.org/system/files/2020-06/stratcomm-aamc-physician-workforce-projections-june-2020.pdf.

  6. Children’s Hospital Association. Pediatric Workforce Shortages Persist (accessed 26 May 2022); https://glin.com/files/documents/bulletin_board/chgme_workforce_shortage_fact_sheet.pdf.

  7. Turner, A., Ricketts, T. & Leslie, L. K. Comparison of number and geographic distribution of pediatric subspecialists and patient proximity to specialized care in the US between 2003 and 2019. JAMA Pediatr. 174, 852–860 (2020).

    Article  PubMed  Google Scholar 

  8. Macy, M. L., Van, K. D., Leslie, L. K. & Freed, G. L. Engagement in research among pediatric subspecialists at the time of enrollment in maintenance of certification, 2009-2016. Pediatr. Res. 87, 1128–1134 (2020).

    Article  PubMed  Google Scholar 

  9. Rimsza, M. E., Ruch-Ross, H. S., Clemens, C. J., Moskowitz, W. B. & Mulvey, H. J. Workforce trends and analysis of selected pediatric subspecialties in the United States. Acad. Pediatr. 18, 805–812 (2018).

    Article  PubMed  Google Scholar 

  10. Cull, W. L., O’Connor, K. G. & Olson, L. M. Part-time work among pediatricians expands. Pediatrics 125, 152–157 (2010).

    Article  PubMed  Google Scholar 

  11. Freed, G. L. The pediatric subspecialty workforce is more complex than meets the eye. JAMA Pediatr. 175, 1006–1008 (2021).

    Article  PubMed  Google Scholar 

  12. Primack, W. A. et al. The US pediatric nephrology workforce: a report commissioned by the American Academy of Pediatrics. Am. J. Kidney Dis. 66, 33–39 (2015).

    Article  PubMed  Google Scholar 

  13. Collaco, J. M. & Abman, S. H. Evolving challenges in pediatric pulmonary medicine. new opportunities to reinvigorate the field. Am. J. Respiratory Crit. Care Med. 198, 724–729 (2018).

    Article  Google Scholar 

  14. Committee on Pediatric Workforce. Financing graduate medical education to meet the needs of children and the future pediatrician workforce. Pediatrics 137, e20160211 (2016).

    Article  Google Scholar 

  15. National Residency Matching Program. Medicine and Pediatric Specialties Match Calendar (accessed 26 May 2022); https://www.nrmp.org/fellowship/medicine-and-pediatric-specialties-match/.

  16. American Board of Pediatrics. Pediatric Physicians Workforce Data Book 2020-2021 (accessed 26 May 2022); https://www.abp.org/sites/abp/files/pdf/workforcedata2020-2021.pdf.

  17. National Residency Matching Program. Match Data and Reports Archive (accessed 26 May 2022); https://www.nrmp.org/match-data-analytics/archives/.

  18. The American Board of Pediatrics. Yearly Growth in Pediatrics Fellows by Subspecialty by Demographics and Program Characteristics (accessed 26 May 2022); https://www.abp.org/content/yearly-growth-pediatric-fellows-subspecialty-demographics-and-program-characteristics.

  19. Peltz, A. et al. Characteristics of rural children admitted to pediatric hospitals. Pediatrics 137, e20153156 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Macy, M. L., Leslie, L. K., Turner, A. & Freed, G. L. Growth and changes in the pediatric medical subspecialty workforce pipeline. Pediatr. Res. 89, 1297–1303 (2021).

    Article  PubMed  Google Scholar 

  21. Cull, W. L., Chang, C. H. & Goodman, D. C. Where do graduating pediatric residents seek practice positions. Ambul. Pediatr. 5, 228–234 (2005).

    Article  PubMed  Google Scholar 

  22. The American Board of Pediatrics. Comparison of ABP Data to the NRMP Match Data (accessed 26 May 2022); https://www.abp.org/content/comparison-abp-data-nrmp-match-data.

  23. Turner, A., Ricketts, T. & Leslie, L. K. Revisiting complexities in the pediatric subspecialty workforce. JAMA Pediatr. 176, 98–99 (2022).

    Article  PubMed  Google Scholar 

  24. American Academy of Pediatrics. Pediatric Subspecialty Shortage Fact Sheets (accessed 26 May 2022); https://www.aap.org/en/advocacy/pediatric-subspecialty-shortages-fact-sheets/.

  25. Freed, G. L. Revisiting complexities in the pediatric subspecialty workforce-reply. JAMA Pediatr. 176, 99 (2022).

    Article  PubMed  Google Scholar 

  26. National Academies. The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being (accessed 26 May 2022); https://www.nationalacademies.org/our-work/the-pediatric-subspecialty-workforce-and-its-impact-on-child-health-and-well-being.

  27. Freed, G. L., Dunham, K. M., Loveland-Cherry, C., Martyn, K. K. & Moote, M. J. American Board of Pediatrics Research Advisory Committee. Private practice rates among pediatric subspecialists. Pediatrics 128, 673–676 (2011).

    Article  PubMed  Google Scholar 

  28. Applegate, W. B. & Williams, M. E. Career development in academic medicine. Am. J. Med. 88, 263–267 (1990).

    Article  CAS  PubMed  Google Scholar 

  29. Coleman, M. M. & Richard, G. V. Faculty career tracks at U.S. medical schools. Acad. Med. 86, 932–937 (2011).

    Article  PubMed  Google Scholar 

  30. Florin, T. A. et al. Variation in the management of infants hospitalized for bronchiolitis persists after the 2006 American Academy of Pediatrics bronchiolitis guidelines. J. Pediatr. 165, 786–792.e1 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Aronson, P. L. et al. Variation in care of the febrile young infant <90 days in US pediatric emergency departments [published correction appears in Pediatrics. 2015 Apr;135(4):775]. Pediatrics 134, 667–677 (2014).

    Article  PubMed  Google Scholar 

  32. Barrett, K. J. et al. Addressing gaps in pediatric scientist development: the department chair view of 2 AMSPDC-sponsored programs. J. Pediatr. 222, 7–12.e4 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rubenstein, R. C. & Kreindler, J. L. On preventing the extinction of the physician-scientist in pediatric pulmonology. Front. Pediatr. 2014;2:4.

  34. Good, M., McElroy, S. J., Berger, J. N. & Wynn, J. L. Name and characteristics of National Institutes of Health R01-funded pediatric physician-scientists: hope and challenges for the vanishing pediatric physician-scientists. JAMA Pediatr. 172, 297–299 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of General Pediatrics, Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan Health Systems, Ann Arbor, MI, USA

    Gary L. Freed

  2. University of Michigan Medical School, Ann Arbor, MI, USA

    Kyle L. Wickham

Authors
  1. Gary L. Freed
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyle L. Wickham
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

G.L.F. conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and critically reviewed and revised the manuscript for important intellectual content. K.L.W. collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Gary L. Freed.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Freed, G.L., Wickham, K.L. Assessing the pediatric subspecialty pipeline: it is all about the data source. Pediatr Res 93, 1907–1912 (2023). https://doi.org/10.1038/s41390-022-02438-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-022-02438-5

Search

Advanced search

Quick links