pediatric workforce shortages: policy and advocacy challenges

Pediatric Workforce Pediatric Workforce Shortages: Policy and Shortages: Policy and Advocacy ChallengesAdvocacy Challenges

Overview: The Pediatrician Overview: The Pediatrician WorkforceWorkforce

Overview: The Pediatrician Overview: The Pediatrician WorkforceWorkforce

The general pediatrician pipeline

Pediatric subspecialty shortages

Potential solutions

Questions?

General Pediatricians

General Pediatricians: Training & General Pediatricians: Training & Board CertificationBoard Certification

General Pediatricians: Training & General Pediatricians: Training & Board CertificationBoard Certification

After 4 years of college, pediatricians must complete 4 years of medical school, traditionally followed by 3 additional years of residency training.

In order to qualify for board certification in general pediatrics, pediatricians who have completed residency training must sit for and pass a rigorous 2-day examination, administered by the American Board of Pediatrics.

Ongoing, continuing medical education (CME) is also required to maintain board-certified status.

The pediatrician, because of extensive training and commitment to lifelong pediatric learning, is the most qualified provider of pediatric primary health care.

YEARS of Formal Education YEARS of Formal Education (at Time of Completion)(at Time of Completion)


28

26

23

20

16

12

0 10 20 30

High school

College

Medical school

Residency training

Subspecialty training(minimum)Subspecialty training(maximum)

General pediatricians

Pediatric subspecialists

How Many General Pediatricians Are How Many General Pediatricians Are There?There?

How Many General Pediatricians Are How Many General Pediatricians Are There?There?

The general pediatrician pipeline is extremely important, as it represents the pool of potential pediatric fellowship trainees and, ultimately, determines the number of pediatric medical subspecialists and surgical specialists.

Total Active(2009)

Male Female Board-Certified

Non-Board-Certified

58,194 24,301 33,893 43,972 14,222

Source: Physician Characteristics and Distribution in the US, 2011 Edition (American Medical Association)

State Pediatrician-to-Population State Pediatrician-to-Population RatiosRatios

(# of children for each general pediatrician)(# of children for each general pediatrician)

State Pediatrician-to-Population State Pediatrician-to-Population RatiosRatios

(# of children for each general pediatrician)(# of children for each general pediatrician)Alabama 2,229:1 Kentucky 2,514:1 North Dakota 2,755:1

Alaska 2,292:1 Louisiana 1,994:1 Ohio 1,815:1

Arizona 2,193:1 Maine 1,717:1 Oklahoma 2,680:1

Arkansas 2,797:1 Maryland 1,143:1 Oregon 2,049:1

California 1,828:1 Massachusetts

1,040:1 Pennsylvania 1,623:1

Colorado 1,966:1 Michigan 2,018:1 Rhode Island 1,227:1

Connecticut 1,220:1 Minnesota 2,234:1 South Carolina

2,220:1

Delaware 1,289:1 Mississippi 2,833:1 South Dakota

3,641:1

DC 484:1 Missouri 1,868:1 Tennessee 1,930:1

Florida 1,605:1 Montana 2,759:1 Texas 2,421:1

Georgia 1,914:1 Nebraska 2,608:1 Utah 2,551:1

Hawaii 1,242:1 Nevada 3,054:1 Vermont 1,236:1

Idaho 4,280:1 New Hampshire

1,577:1 Virginia 1,590:1

Illinois 1,770:1 New Jersey 1,125:1 Washington 2,055:1

Indiana 2,714:1 New Mexico 2,158:1 West Virginia

2,068:1

Iowa 3,004:1 New York 1,068:1 Wisconsin 2,100:1

Kansas 3.300:1 North Carolina

1,895:1 Wyoming 3,077:1

Source: Mapping Health Care Delivery for America’s Children Project (US Census 2000, AMA/AOA Masterfiles, 2000)

General Pediatrician SupplyGeneral Pediatrician SupplyGeneral Pediatrician SupplyGeneral Pediatrician Supply

Maldistribution of general pediatricians

States with large rural areas and fewer training programs have biggest shortages

Physician/population ratios do not adequately reflect clinical workload

Pediatric Subspecialists

What Are Pediatric What Are Pediatric Subspecialists?Subspecialists?

What Are Pediatric What Are Pediatric Subspecialists?Subspecialists?

The term “pediatric subspecialist” is a global term that encompasses all physicians who have received special pediatric-specific training in a wide range of medical subspecialties, surgical specialties, and other medical fields.

Subspecialists can be grouped into those who received their initial training in general pediatrics and those who initially trained in “adult” medicine.



28

26

23

20

16

12

0 10 20 30

High school

College

Medical school

Residency training

Subspecialty training(minimum)Subspecialty training(maximum)

General pediatricians


Subspecialty Certification by the ABPSubspecialty Certification by the ABPSubspecialty Certification by the ABPSubspecialty Certification by the ABP

Adolescent medicine Pediatric cardiology Critical care Child abuse pediatrics Developmental pediatrics Ped emergency medicine Pediatric endocrinology

Pediatric gastroenterology Pediatric heme-onc Pediatric infectious

diseases Neonatal medicine Pediatric nephrology Pediatric pulmonology Pediatric rheumatology

In addition to certification in general pediatrics, the American Board of Pediatrics (ABP) offers a certificate of special qualifications in the following pediatric subspecialties:

Pediatric Subspecialists: Training & Pediatric Subspecialists: Training & ABP Board CertificationABP Board Certification

Pediatric Subspecialists: Training & Pediatric Subspecialists: Training & ABP Board CertificationABP Board Certification

Candidates for subspecialty certification must complete an additional 3 to 5 years of subspecialty training following 3 years of residency training, 4 years of medical school, and 4 years of college.

A candidate must have achieved initial board certification in general pediatrics and continue to maintain that certification in order to take a subspecialty examination.

A candidate must have a current, unrestricted license to practice medicine in one of the states, districts, or territories of the United States.

Only after successful completion of these requirements may a candidate sit for examination in a subspecialty.

Recent passing rates for first-time exam takers range from 71.6% (for pulmonology in 2006) to 93.3% (for sports medicine in 2009).

Other Pediatric Subspecialty Training Other Pediatric Subspecialty Training (years)(years)

Other Pediatric Subspecialty Training Other Pediatric Subspecialty Training (years)(years)

28

26

23

20

16

12

0 10 20 30

High school

College

Medical school

"Adult" Residencytraining

Subspecialty training(minimum)

Subspecialty training(maximum)

“Adult “ residency


Subspecialty Certification by Other Subspecialty Certification by Other Specialty BoardsSpecialty Boards

Subspecialty Certification by Other Subspecialty Certification by Other Specialty BoardsSpecialty Boards

Adolescent medicine Child and adolescent

psychiatry Pediatric emergency

medicine

Pediatric otolaryngology Pediatric pathology Pediatric rehabilitation Pediatric radiology Pediatric surgery

Some pediatric subspecialists, particularly pediatric surgical specialists, are certified by other specialty boards (such as the American Board of Otolaryngology). Subspecialties certified by other boards include:

So: How Many Pediatric So: How Many Pediatric Subspecialists Are There?Subspecialists Are There?So: How Many Pediatric So: How Many Pediatric

Subspecialists Are There?Subspecialists Are There?

Data regarding this question varies, but the most expansive definition of pediatric subspecialists—which would include surgical specialists and other specialist physicians—places the number at around 27,400 (AMA, 2009).

The 2010 U.S. Census counted more than 75 million children under the age of 18 nationwide.

AN IMPORTANT CAVEATAN IMPORTANT CAVEATAN IMPORTANT CAVEATAN IMPORTANT CAVEAT

That number (27,400) is not likely to equal the actual number of pediatric subspecialists who are actively caring for children.

Not all physicians are actively engaged in patient care.• Administrative work• Academic Teaching• Research• Other

Not all physicians are working full-time.

When a Community Lacks When a Community Lacks Pediatric Subspecialists…Pediatric Subspecialists…When a Community Lacks When a Community Lacks Pediatric Subspecialists…Pediatric Subspecialists…

Care may be provided by adult medicine subspecialists who lack appropriate training in pediatric care.

Care for children who have complex illnesses may be provided by general pediatricians.

Families must travel to a distant center for care.

Families may need to relocate to another community.

Why Is Pediatric—as Opposed to Why Is Pediatric—as Opposed to Adult—Subspecialty Care Important?Adult—Subspecialty Care Important?


Pediatric subspecialty care:

Improves quality of care for children• Diagnosis, management, outcome

Lowers complication rates• surgical procedures

Decreases medical costs• Shorter length of stay and lower hospital

charges



Pediatric subspecialty care is associated with:

Shorter length of stay for closed femoral shaft fractures when treated by a pediatric orthopedic surgeon (JT Smith et al., 1999).

Shorter time spent by young children treated for fever in the pediatric emergency department (Isaacman et al., 2001).

Lower complication rates and shorter lengths of stay for children with significantly perforated appendicitis when treated by pediatric surgeons (Alexander, 2001).

Increased precision in tumor removal and decreased risk of mucosal perforation post pyloromyotomy (Albright et al., 2000).

Shorter lengths of stay and/or lower costs for appendectomy and ureteroneocystostomy (Kokoska et al., 2001; Snow et al., 1996).

Reduced length of stay by 40 minutes when pediatric emergency medicine physicians treated croup (Hampers and Faries, 2002).

What Does Pediatric Subspecialty What Does Pediatric Subspecialty Care Cost, and What Are the Savings?Care Cost, and What Are the Savings?

What Does Pediatric Subspecialty What Does Pediatric Subspecialty Care Cost, and What Are the Savings?Care Cost, and What Are the Savings?

Pediatric emergency medicine physicians treating croup reduced direct costs by $90 when compared to the same treatment delivered by adult emergency medicine physicians (Hampers and Faries, 2002).

Younger children with appendicitis who were treated by pediatric surgeons had significant shorter hospital stays and/or decreased hospital charges than younger children treated by general surgeons for the same condition (Kokoski et al., 2004).

Pediatric orthopedic surgeons achieved lower hospital charges than adult orthopedic surgeons for closed femoral shaft fractures (JT Smith et al., 1999).

Demand for Pediatric SubspecialistsDemand for Pediatric SubspecialistsDemand for Pediatric SubspecialistsDemand for Pediatric Subspecialists

These physicians care primarily for children who have special health care needs that are beyond the scope of primary care physicians (e.g. cancer, congenital heart disease).

As the number of children who have chronic illness grows, the demand for pediatric subspecialists increases.

Subspecialist Supply: Indicators of a

Shortage

Where Do We Find Evidence of Where Do We Find Evidence of Shortages?Shortages?

Where Do We Find Evidence of Where Do We Find Evidence of Shortages?Shortages?

Wait times for subspecialty appointments

Difficulty referring to subspecialists

Difficulty recruiting subspecialists

Distance to care

Wait TimesWait TimesWait TimesWait Times

In 2010, the National Association of Children’s Hospitals and Related Institutions (NACHRI) reported on the number of weeks patients had to wait to obtain subspecialty appointments.

For 10 subspecialties, patients had to wait longer than 5 weeks.

For 3 subspecialties, patients had to wait longer than 10 weeks.

Specialty % of hospitals over 2-week

benchmark

Wait times (business

days)

Wait times (weeks)

Endocrinology 68% 51.4 10.3

Neurology 61% 47.6 9.5

Gastroenterology

59% 26.5 5.3

Nephrology 52% 33.6 6.7

Developmental Pediatrics

50% 65.7 13.1

Pulmonology 50% 40.7 8.1

Rheumatology 36% 31.9 6.4

Orthopedics 34% 38.2 7.6

Dermatology 32% 66.0 13.2

Urology 30% 35.2 7.0

Reproduced from NACHRI, Pediatric Subspecialty Shortages Affect Access to Care

Difficulty ReferringDifficulty ReferringDifficulty ReferringDifficulty Referring

“The percent of pediatric outpatient visits resulting in referral increased from 3.5% in 1999 to 6.1% in 2007” (Merline et al., 2010).

“68% of rural PCPs and 49% of nonrural PCPs were dissatisfied with waiting times for [subspecialist] appointments … more than 65% of rural and only 19% of non-rural PCPs rated the number of subspecialists in their area as poor or fair” (Pletcher et al., June 2010).

A recent GAO report found that 84% of physicians treating children insured by Medicaid or CHIP had great or some difficulty making specialty referrals; 26% of physicians treating privately insured children had great or some difficulty making specialty referrals.

For all children, physicians had the most difficulty making referrals for mental health, dermatology, and neurology.

% of Primary Care Pediatricians Reporting Too Few % of Primary Care Pediatricians Reporting Too Few Subspecialists to Meet the Needs of PatientsSubspecialists to Meet the Needs of Patients

(by Subspecialty Type and Practice Location)(by Subspecialty Type and Practice Location)

% of Primary Care Pediatricians Reporting Too Few % of Primary Care Pediatricians Reporting Too Few Subspecialists to Meet the Needs of PatientsSubspecialists to Meet the Needs of Patients

(by Subspecialty Type and Practice Location)(by Subspecialty Type and Practice Location) Medical Specialty Total (n = 590) Non-rural (n = 514) Rural (n = 76)

Child/adolescent psychiatry

95.8 95.1 100.0

Developmental peds 86.6 85.9 92.0

Pediatric dermatology 81.6 80.5 89.3

Pediatric rheumatology 68.2 67.3 74.0

Pediatric neurology 66.7 66.1 70.7

Adolescent health 64.2 64.2 64.9

Pediatric endocrinology 58.8 57.2 69.3

Pediatric gastroenterology

54.5 53.8 59.2

Pediatric emergency med 49.2 46.4 68.4

Pediatric nephrology 48.1 46.2 61.3

Pediatric genetics 45.1 45.1 44.7

Pediatric pulmonology 41.7 40.2 52.0

Surgical Specialty Total (n = 590) Non-rural (n = 514) Rural (n = 76)

Pediatric orthopedics 54.6 52.3 70.7

Pediatric neurosurgery 49.4 47.9 59.2

Pediatric urology 46.6 44.7 59.2

Pediatric ophthalmology 42.2 38.5 67.6

Pediatric otolaryngology 37.9 35.1 55.3Reproduced from Pletcher et al. Primary care pediatricians' satisfaction with subspecialty care, perceived supply, and barriers to care. The Journal of Pediatrics. 2010;156:1011-1015.

Difficulty RecruitingDifficulty RecruitingDifficulty RecruitingDifficulty Recruiting

Subspecialty Percentage of Organizations

Recruiting

Percentage of Organizations

Reporting Medium to High Difficulty in

Recruiting

Percentage of Positions Being Recruited for 6 Months or More

Emergency Medicine

33% 83% 67%

Endocrinology 33% 75% 50%

Gastroenterology 33% 75% 50%

General Pediatrics 42% 40% 60%

General Surgery 33% 100% 100%

Nephrology 33% 100% 60%

Neurology 33% 100% 75%

Reproduced from ECG Management Consultants, 2010 ECG Trends Webinar Series, “The Pediatric Subspecialty Market: Compensation, Benefits, Recruitment, and Employment Trends”.

Difficulty RecruitingDifficulty RecruitingDifficulty RecruitingDifficulty Recruiting

In 2010, NACHRI compiled a list of pediatric subspecialties that have vacancies lasting longer than 12 months.

62.8%

41.9% 41.9% 39.5%37.2%

0

20

40

60

80

Neurology

Developmental-Beha...

Endocrinology

Pulmonology

Gastroenterology

Reproduced from NACHRI, Pediatric Subspecialty Shortages Affect Access to Care

Mean Distance to CareMean Distance to Care Mean Distance to CareMean Distance to Care

Pediatric Subspecialty: Adolescent medicine Critical care medicine Developmental pediatrics Neonatal medicine Neurodevelopment Pediatric cardiology Pediatric endocrinology Pediatric rheumatology Pediatric sports medicine Pediatric nephrology Pediatric gastroenterology

Distance to Care (miles): 42 26 44 15 73 22 26 60 78 36 32

Myer ML. Are We There Yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006;118:2313-2321.

Percentage of children who must travelPercentage of children who must travel > 80 miles to care > 80 miles to care

Percentage of children who must travelPercentage of children who must travel > 80 miles to care > 80 miles to care

Subspecialty: Adolescent medicine Critical care medicine Developmental pediatrics Neonatal medicine Neurodevelopment Pediatric cardiology Pediatric heme/onc Pediatric endocrinology Pediatric rheumatology Pediatric sports medicine Pediatric gastroenterology Pediatric nephrology

Percentage of U.S. Children: 19 7 20 4 26 7 8 11 24 30 12 16

Myer ML. Are We There Yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006;118:2313-2321.

31

Subspecialty Supply: Contributing Factors to a

Shortage

What Factors Contribute to What Factors Contribute to Subspecialty Shortages?Subspecialty Shortages?

What Factors Contribute to What Factors Contribute to Subspecialty Shortages?Subspecialty Shortages?

Geographic maldistribution

Low payment to debt ratio

Mechanism of financing GME

Distance to CareDistance to CareDistance to CareDistance to Care

The population-weighted average distances to care ranges from 15 miles for a neonatologist to 75 miles for a sports medicine specialist.

A 2005 study by Mayer et al. found that a child must travel 27.1 miles to the nearest pediatric surgeon and neurosurgeons, and cardiothoracic surgeons are far greater.”

Mayer ML, Beil HA, von Allmen D. Distance to care and relative supply among pediatric surgical subspecialties. Journal of Pediatric Surgery. 2009;44:483-495.

Distribution of SubspecialistsDistribution of SubspecialistsDistribution of SubspecialistsDistribution of Subspecialists

Reproduced from Mayer ML, Beil HA, von Allmen D. Distance to care and relative supply among pediatric surgical subspecialties. Journal of Pediatric Surgery. 2009;44:483-495.

Trends in Average Educational Debt Among Graduating Pediatric

Residents

Trends in Average Educational Debt Among Graduating Pediatric

Residents

$0

$25,000$50,000

$75,000

$100,000$125,000

$150,000

$175,000$200,000

$225,000

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Average debt, among all residents

Average debt, among residents reporting any debt

Source: AAP Graduating Resident Survey, 1997-2010. Numbers in $2010; includes spousal debt.

Financing GMEFinancing GMEFinancing GMEFinancing GME

Federal and (some) state government agencies provide a major part of the funding for graduate medical education (GME), especially for primary care.

The nature of children’s hospital GME (CHGME) funding is uncertain because it is appropriated annually; in the proposed 2012 federal budget, it has been zeroed out.

Without this crucial funding, many residency training programs would be forced to close.

Many of the poorest patients in the U.S., who rely on teaching hospitals, would lose access to care.

Fewer programs and residents would lead to an even greater shortage of physicians and further reduce access to care.

Working toward Solutions

What Can We Do Nationally about the What Can We Do Nationally about the Pediatric Subspecialty Shortage?Pediatric Subspecialty Shortage?

What Can We Do Nationally about the What Can We Do Nationally about the Pediatric Subspecialty Shortage?Pediatric Subspecialty Shortage?

Advocate for continued, consistent support of CHGME.

Target GME to areas of need (provider and location).

Support the appropriation of Section 5203 of the ACA (pediatric subspecialty loan repayment program) and state loan repayment programs.

Promote appropriate payment for pediatricians.

Advance the development of long-term workforce policy.

Encourage the pediatrician-led, patient-centered medical home model.

What Can States Do?What Can States Do?What Can States Do?What Can States Do?

Advocate for state contributions to GME.

Advocate for increased state support for programs that improve access to care in underserved areas, such as the NHSC and Rural Health Clinics.

Explore how health information technologies (such as telemedicine) may be used to enhance delivery of pediatric care by general pediatricians and pediatric subspecialists in shortage areas.

Use workforce and quality of care data to advocate for public policy that is the best interests of infants, children, adolescents, and young adults.

Provide information to health care policy-makers about the unique education, skills, and care provided by pediatricians and pediatric subspecialists.

State Success Stories and Solutions

ModelsModelsModelsModels

General pediatricians fill some gaps.

Other successful models include:

Incentive programs Loan repayment programs Technical assistance programs.

Pediatrician-Provided Dental CarePediatrician-Provided Dental CarePediatrician-Provided Dental CarePediatrician-Provided Dental Care

40 state Medicaid/CHIP programs pay pediatricians to provide preventive oral health services to young children (states not paying for this service are AR, AZ, DE, HI, IN, LA, NH, NJ, OK, and WV; Washington, D.C. also does not pay).

Dental caries constitute the leading chronic infectious disease of early childhood.

Many young children have difficulty accessing care from a dentist due to workforce shortages or a lack of dentists in the area willing to care for Medicaid/CHIP children.

Children see the pediatrician frequently in the early years; therefore, oral health prevention could and should take place in the pediatrician's office when a dentist is not available.

Pediatricians can also serve as a referral source to dentists in the community who may be willing to see young children, but are not aware of the need.

Pediatrician-Coordinated Mental Pediatrician-Coordinated Mental Health CareHealth Care

Pediatrician-Coordinated Mental Pediatrician-Coordinated Mental Health CareHealth Care

Arizona Telemedicine Program Provides telemedicine services, distance learning, informatics training, and telemedicine

technology assessment capabilities to communities throughout the state. Established a telemedicine link with the University of Arizona Department of Child and

Adolescent Psychiatry.

Illinois: DocAssist Improves delivery/coordination of mental health and substance use care by supporting

Medicaid-enrolled primary care providers treating children up to age 21. Child/adolescent psychiatrist available statewide for phone consultation services. Funded by IL Dept. of Healthcare and Family Services and IL Dept. of Human Services.

Massachusetts Child Psychiatry Access Project Helps primary care physicians statewide effectively respond to mental health concerns. 6 regional mental health teams comprised of child psychiatrists, therapists, and care

coordinators led by child psychiatry divisions of academic medial centers. Funded by the Dept. of Mental Health.

Vermont: Upper Valley Pediatrics Staff includes 1 pediatrician and 7 mental health therapists and LCSWs. LCSWs and therapists deliver psychotherapeutic services at the practice site. Credentialed by 3rd-party insurers.

Incentive ProgramsIncentive ProgramsIncentive ProgramsIncentive Programs

Incentives can include scholarships, visa waivers for IMGs, and tax credits.

Example: The Georgia Rural Physician Tax Credit (Georgia

Department of Revenue Regulation 560-7-8-20) provides a tax credit to primary care physicians and general surgeons in Georgia who primarily admit patients to a rural hospital and reside in a rural county or a county contiguous to the rural county in which they practice. The credit, which maxes out at $5,000 annually, can be claimed for a five-year continuous period.

Loan Repayment ProgramsLoan Repayment ProgramsLoan Repayment ProgramsLoan Repayment Programs

Physician loans may be repaid by state agencies, private foundations, physician employers, or some combination of all interested groups.

Example: The Health Professions Education Foundation Orange County

Pediatric Specialties Physicians Loan Repayment Program is available to physicians who have been or are in the process of being certified by a member board of the American Board of Medical Specialties in a pediatric subspecialty.

An awardee may receive up to $125,000 to repay educational debt. Each awardee commits to a 3-year service obligation to practice as a full-time physician providing direct patient care to a patient population of at least 50% Medi-Cal or Healthy Families members including children under age of 5 in Orange County.

The program is funded by California’s Office of Statewide Health Planning and Development.

Technical Assistance ProgramsTechnical Assistance ProgramsTechnical Assistance ProgramsTechnical Assistance Programs

Technical assistance usually involves physician recruitment, retention, or practice management services.

Example: The Bi-State Primary Care Association New Hampshire-Vermont

Recruitment Center works to recruit and retain primary care providers in New Hampshire and Vermont with particular emphasis on the needs of medically underserved areas and populations.

The Recruitment Center's clients include federally qualified community health centers, public health practices, rural health clinics, and hospital-sponsored and private practice groups.

Since 1994, the Recruitment Center has worked with over 100 practices to develop personalized recruitment and retention strategies, in addition to providing direct candidate referrals.

Questions?

AcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgments

Thanks to the National Governors Association Center for Best Practices for the opportunity to address this critical issue.

http://www.nga.org/cms/home.html

http://www.nga.org/cms/home.html

ResourcesResourcesResourcesResources

American Academy of Pediatrics, Division of Workforce and Medical Education Policy http://www.aap.org/workforce/

American Academy of Pediatrics, Committee on Pediatric Workforce (COPW) http://www.aap.org/copw/

American Academy of Pediatrics, Division of State Government Affairs http://www.aap.org/advocacy/stgov.htm [email protected] 1-800-433-9016, x7799

American Academy of Pediatrics, state chapter links http://www.aap.org/member/chapters/chapters.htm

American Academy of Pediatrics, oral health initiatives http://www.aap.org/oralhealth [email protected]

The federally funded Health Workforce Information Center (http://www.hwic.org/) also provides excellent health workforce information.

http://www.aap.org/workforce/

http://www.aap.org/copw/

http://www.aap.org/advocacy/stgov.htm

mailto:[email protected]

http://www.aap.org/member/chapters/chapters.htm

http://www.aap.org/oralhealth


http://www.hwic.org/

Mary Ellen Rimsza, MD, FAAPChair, Committee on Pediatric Workforce American Academy of Pediatrics

Professor of Pediatrics, University of Arizona College of Medicine

[email protected]


pediatric workforce shortages: policy and advocacy challenges

Documents

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pediatrician workforce

lifelong pediatric learning

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