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FOPO Bulletin: January 31, 2013

Working Groups Summarize the Major Issues Forces and Trends Within Their Domains and Prepare for the Visioning Summit in 2013: The Future of the Workforce in Pediatrics

Each of the Federation of Pediatric Organizations (FOPO) Working Groups, Child Health Research and Training, Diversity and Inclusion, Gender and Generations, and Pediatric Training Along the Continuum, have provided the pediatrics community with a summary of their research to date. The summaries in their entirety are posted on the FOPO website, www.fopo.org. The four summaries below are condensed versions.

Child Health Research and Training Working Group Executive Summary

The FOPO Child Health Research and Training Working Group has determined the following priority trends and issues in child health research and training and will be focusing these into “Megatrends”, which will be used to establish strategic action plans to promote accomplishment of specific outcomes.

  1. Challenges to child health in the US over the next 10 – 30 years will continue based on the following trends:
    • Large disparities (racial, gender, ethnic, geographical, income level, etc.) will continue to be large and will continue to limit the health of those groups affected.
    • Rising incidence, burden, cost of chronic diseases as well as many rare diseases
    • Poor translation of scientific (basic and clinical) evidence to improving health
  2. Child health research funding, including support for investigators and for infrastructure, has been and will continue to be inadequate in total dollars and as compared to research focused on adults.
    • Funding for child health research has not kept up with other NIH funding, which has reduced research capacity, limited new research initiatives, and produced unhealthy competition among pediatric investigators and trainees rather than increased collaborations. Furthermore, federal funding priorities have not been sufficiently driven by identified health problems and priorities, but rather by economic or political agendas. This has resulted in highly segmented and narrowly focused funding sources with resultant disconnects between basic and translational scientists.
  3. Training of Pediatric Physician-Scientists faces increasing impediments and competition for investments in other aspects of career development.
    • This trend will limit the workforce to conduct the essential research to solve persistent problems in children and prevent their burden and cost over their life course. The physician-scientist is uniquely well positioned to teach, create, and translate discoveries into care.
      • Over the last 30 years, proportionately fewer physician-scientists capable of sustaining a research program have committed to a hypothesis-driven research career focused upon child-health issues
      • Decreasing resources for research compromises the integrity of the pipeline at every career stage
      • Federal and foundation dollars are increasingly constrained. The difficulty in acquiring extramural funds is most palpable for early-stage investigators whose careers are further jeopardized by the instability of funding for their mentors and senior colleagues The risks inherent in research-based careers contrasts starkly with the relative stability of a primarily clinical career
      • Medical schools and clinical departments may be unable or unwilling to support unfunded research by early career stage physician-scientists
  4. The trend of decreasing engagement of pediatric physicians to careers in science will continue without an increase in and a realignment of incentives to support child health researchers
  5. Current organizational structures of the academic medical center will continue to be poorly aligned with the needs of children, particularly in solving highly prevalent health problems or promoting preventive care
  6. Current, traditional clinical lines will continue to inhibit collaborations that are necessary for more meaningful, large scale, cross disciplinary, and multi-institutional research studies to address big problems

Bill Hay, M.D. and Peter Szilaygi, M.D., Co-Chairs, Child Health Research and Training Working Group

Diversity and Inclusion Working Group Executive Summary

The FOPO Diversity and Inclusion Working Group has determined the following priority trends and issues and will be focusing these into “Megatrends”, which will be used to establish strategic action plans to promote accomplishment of specific outcomes.

  1. Workforce diversity
  2. Cultural Competency
  3. Leadership Diversity
  4. Knowledge base on diverse populations

With these 4 domains, the Working Group has been meeting in two sub groups. Fernando Mendoza is leading the Workforce Diversity / Leadership Diversity subgroup and Leslie Walker is leading the Cultural Competency/Knowledge Base on Diverse Populations subgroup. A Diversity / Cultural Competence survey will be administered to AMSPDEC members after their Annual meeting in March, 2013. The purpose of this survey is to obtain currently unknown information on Pediatric Departments across the country to identify the current state of Diversity and Cultural Competence for pediatric academic medicine. In addition, a PAS symposium will be held entitled, “Meeting the Challenge of Diversity through Organizational Change”, and will provide a forum for discussion with leadership from the AAMC, NIH, RWJ, Kaiser Permanente, and Stanford Medical School. These data will inform the development of a white paper. The Cultural Competency group is reviewing literature, determining the major issues and trends and providing an analysis that will provide data for determining the Megatrends in the next phase of our scenario planning process.

Fernando Mendoza, M.D. and Leslie Walker, M.D., Co-Chairs, Diversity and Inclusion Working Group

Gender and Generations Working Group Executive Summary

The Gender and Generations Working Group divided its members into two groups in order to address topics, issues, themes, and trends related to gender and generations in the pediatric workforce. The Gender Subgroup is exploring the overarching demographic trends related to the percentage of pediatricians represented by each gender, as well as the trend towards a greater proportion of females entering pediatric training. In addition, they are examining trends in the current work force related to gender by age group, as well as the relative percentage of American Medical Graduates (AMGs) and International Medical Graduates (IMGs). Topics and trends related to these changing demographics include:

  1. Hours worked
  2. Career choice (general versus subspecialty pediatrics, academic-based versus community-based practice, proportion serving in rural or underserved urban areas)
  3. Issues related to work- life balance, burnout, and career satisfaction
  4. Tendencies to engage in part-time, flexible, or shared practice
  5. Patterns for academic researchers related to applications for NIH or other research grants and success in obtaining funding.

In addition, the Gender Subgroup is considering what may be the long-term implications for patients and families and their preferences for pediatric providers and how this will impact on the pediatric workforce.

The Generations Subgroup is examining three important and interrelated themes to identify the issues and trends that will have an impact on the future of the workforce in pediatrics:

  1. Influence of social media and technology on the practice of medicine across the generations since it is likely that the practice of medicine will undergo profound transformation with the creation of technology-enabled practitioners and patients
  2. Interplay of generations at work and within teams, and how this influences the work environment and the culture – basically transforming the way we work
  3. Differences in generational identity and values that influence individual views on specific areas such as work-life balance, work ethic, and social justice. They are also examining how individuals in each of the generations may perceive and interpret the identity and values of co-workers from different generations and how this may influence the workplace. In particular this group is interested in exploring the perspectives of older or retired colleagues, a potentially untapped resource for solving problems offering historical or expert perspectives.

Nancy Spector, M.D. and Bonnie Stanton, M.D., Co-Chairs, Gender and Generations Working Group

Pediatric Training Along the Continuum Working Group Executive Summary

The Pediatric Training Along the Continuum Working Group is a diverse set of primary care providers and subspecialists who have a passion for education. Each individual represents aspects of pediatric training along the continuum.The group consists of individuals who represent diverse walks of life and different areas of the nation. The FOPO Pediatric Training Along the Continuum Working Group has determined the following priority trends and issues to explore and will consolidate these into “Megatrends”, which will be used to establish strategic action plans to promote accomplishment of specific outcomes.

  1. Training an effective Pediatric Workforce will require an increasing understanding of:
    • Appropriate numbers and balance between supply and demand of pediatricians
    • Impact of part time pediatricians on workforce estimates
    • Impact of inactive pediatricians and their re-entry issues
    • Retention of pediatricians in the workforce
  2. Apportionment of care between generalist and subspecialty physicians (pediatricians) is going to change
    • But which direction? Scope of practice will narrow or broaden
  3. Establishing appropriate funding for necessary pediatric training is a key component
    • Local, external and CMS/Congressional sources
    • Increasing funding for GME innovation
    • Special training grants (Title VII and HRSA)
  4. Health care financing methods and payments to doctors and hospitals are major incentives and will impact:
    • Supply (Number entering pediatric training)
    • Distribution of practitioners and academic physicians
  5. Defining best practices and identifying most important training issues must occur along the continuum:
    • Medical school through GME
    • Post-pipeline point of deployment
  6. Individualized and competency-based training and tracking will potentially impact:
    • Earlier entry into the workforce based on ability and accomplishments
    • Preparation for career
  7. Unmet health needs of children will drive the design training programs and post training program continuing education to meet these needs [medical home]:
    • Prevention
    • Chronic illness
    • Health disparities
    • Mental health care
  8. Effective transition of care into adulthood for pediatric patients will impact workforce needs:
    • Population Focus
      • ACO
      • Public Health issues
      • Social Determinants of Health
    • Advocacy

John Mahan, M.D. and Teri Turner, M.D., Co-Chairs, Pediatric Training Along the Continuum Working Group

FOPO encourages the entire pediatrics community to provide comments to the Working Groups by sending messages to Visioning_Summit@fopo.org or by responding to future Bulletins that may be sent with specific requests for comment. Please visit the FOPO website periodically at www.fopo.org to look for updates.

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