Friday, March 6, 2009

Subspecialist shortages

The news is full of stories about an ever-shrinking group of pediatric specialists, rising average ages of these specialists, and the overall critical situation we are. I also happen to work in a state with a tremendous shortage of doctors, both primary care and specialist care. Needless to say, I spend a fair amount of time thinking about the predicament we are in.

The first things that comes to mind as a solution to this problem is to re-examine the current fellowship curricula. It used to be that different fellowships were different lengths, varying from one year to three, depending on the specialty. About fourteen years ago, the American Board of Pediatrics (ABP) made the decision to standardize the length of all pediatric fellowships to three years. I often wonder how much of an impact this has had on the number of graduating specialists. Please don't get me wrong, I think that certain fields require three years of training in addition to the three years of residency, i.e. pediatric intensive care, but others may not. Research plays into this length, I realize, and I know that research funding is very important to post-graduate education programs. When I was checking out the ABP website, I did learn that there is a way to do a fast-track fellowship for those people who already have documented research or other time in the field they're going into. For example, I might be able to do a developmental pediatrics fellowship in two years because I have a master's degree in early intervention. However, this only applies to a small pool of physicians.

As a resident, a pediatrician makes approximately $50,000/yr. During this period of training, one is also required to start paying off college and medical school loans; some residents also have families to support . In the current economic crisis, buying a house may not be an option anymore as it has become so much more difficult to get a loan, so one may be paying large sums in rent. Salaries increase a little bit during each additional year of training but not significantly. Then, finally when fellowship training is complete, depending on whether one chooses academic practice vs private practice, one may end up earning less than a private pediatrician and working more hours, and certainly earning less than almost any other type of physician except for family practice. This, after four years of college, four years of medical school, and six years of training. If one were to think of this as an investment, it is not a very high-yielding investment (then again, what is these days?). I know that it's "not all about money," but I feel strongly that time and money are realistic factors that medical students and residents take into consideration. I know this is going to sound cynical, but although passion is wonderful, it doesn't put food on the table.

I guess what I'm arguing for is that the ABP reconsider it's decision to standardize all fellowships to three years; what fits one specialty may not necessarily fit all. I would love to see a dialogue on this topic with specialists and generalists alike weighing in. Sadly, I don't know that this is going to happen, as there is so much else going on during these tumultuous times, and hopefully all of us will be focusing on helping President Obama revamp our health care system.


Dandelion said...

I'm a 3rd year med student.. For the longest time, I've wanted to be a general pediatrician, perhaps in Idaho or Montana. But I've seen a few articles saying that in the next ten to fifteen years there is actually going to be a surplus of general pediatricians...
So, I've considered heading a different direction that would still allow me to work with kids and their families like child and adolescent psych, which has a huge shortage...
Do you think areas in the mountain West are actually going to be seeing a surplus of pediatricians?

Alex said...

Hi! Thanks for your comment! I was just talking to some pediatricians in both Montana and Idaho a couple of weeks ago at a meeting. They do not think there will be a surplus in those areas. They are continuing to experience population growth, and many pediatricians are choosing to work in more populated areas.
When I was in medical school, there was a large group of researchers who thought there would be a glut of primary care docs now, and so far, they are simply wrong! I would choose a specialty based on what your heart tells you - there will always be pundits somewhere telling you to do something else!!