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- Title
Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US.
- Authors
Bennett, Christopher L.; Espinola, Janice A.; Sullivan, Ashley F.; Boggs, Krislyn M.; Clay, Carson E.; Lee, Moon O.; Samuels-Kalow, Margaret E.; Camargo, Carlos A.
- Abstract
This cross-sectional study reviews the self-reported demographic characteristics, geographic distribution, as well as board certification and training of US-based clinically active physicians who provide emergency care to children and adolescents. Key Points: Question: What are the characteristics of the 2020 pediatric emergency physician workforce, and where do these physicians practice? Findings: In this cross-sectional study of 2403 self-identified pediatric emergency physicians in the US workforce, 99% reported working in urban areas. Three states had no pediatric emergency physicians (Montana, South Dakota, and Wyoming), 3 states had pediatric emergency physicians in only 1 county (Alaska, New Mexico, and North Dakota), and 17 counties (<1% of all counties) had 4 or more pediatric emergency physicians per 100 000 population. Meaning: Results of this study suggest that vast areas of the US lack availability of pediatric emergency physicians. Importance: Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however. Objective: To describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US. Design, Setting, and Participants: This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020. Main Outcomes and Measures: The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates. Results: A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P =.006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population. Conclusions and Relevance: This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.
- Subjects
UNITED States; LABOR supply; STATISTICAL significance; HEALTH services accessibility; CROSS-sectional method; PEDIATRICS; POPULATION geography; DESCRIPTIVE statistics; CHI-squared test; CERTIFICATION; DATA analysis software
- Publication
JAMA Network Open, 2021, Vol 4, Issue 5, pe2110084
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.10084