The Division of Workforce and Medical Education Policy guides the Academy in the advocacy and development of public policy related to the health care workforce and the education of physicians.
Issues under the Division's purview include the funding of medical education, the regulation of the physician workforce through federal legislation and appropriations, the scope of practice of non-physicians, the diversity of the physician and patient populations, physician retirement patterns, and physician reentry into practice. The Division addresses these issues through collaboration with federal agencies, regulatory authorities, and other health care organizations engaged in policy development.
The Division also staffs the Committee on Pediatric Workforce (COPW), which formulates AAP workforce policy, and the Committee on Pediatric Education (COPE), which serves as a think tank of content experts on educational issues from medical school through continuing medical education. Other Division initiatives include The Physician Reentry into the Workforce Project and the Women in Pediatrics webpage.
The AAP Workforce Survey of Medical Subspecialty and Surgical Specialty Sections and Councils
The Division of Workforce and Medical Education Policy recently launched an official AAP workforce survey of the Academy's medical subspecialty and surgical specialty sections and councils. View the list of which sections and councils have signed on to participate.
Match Day 2013
National Resident Matching Program (NRMP): Match Day 2013
On March 15, 2013, medical school graduates were
matched to their residency programs through the National Resident
Matching Program. The Division of Workforce and Medical Education Policy has prepared a PowerPoint detailing the performance of Pediatrics in the Match. A short summary of this year’s Match results appears in AAP News online, and will be followed by a full-length feature article in the May 2013 print edition of AAP News.
What Is a Pediatrician?
The Divisions of Workforce and Medical Education Policy and State Government Affairs
have recently received a number of requests from members for an official AAP definition of the term "pediatrician." These requests stem from new legislation that requires a determination of which physicians do and do not fall into that category.
For example, the Health Information Technology for Economic and Clinical Health (HITECH) Act includes Medicaid incentive payments for electronic health record (EHR) adoption, with specific Medicaid patient caseload threshold requirements for "pediatricians." In this instance, the Centers for Medicare and Medicaid Services (CMS) has determined that "pediatrician" can be defined by each state Medicaid program for purposes of these payments. Additionally, the Patient Protection and Affordable Care Act (PPACA) includes a Medicaid payment increase in 2013-2014 for certain Evaluation & Management (E&M) and immunization administration primary care services, but these increases will only be available to physicians with the "primary specialty designation of family medicine, general internal medicine, or pediatric medicine."
In order to meet the needs of these legislative initiatives, the AAP has developed its own official definition
of "pediatrician" and "pediatrics," which includes pediatric medical subspecialists and surgical specialists and an important reference to the medical home.
AAP Response to Proposed Changes to the ACGME Common Program Requirements (November 2011)
The Accreditation Council for Graduate Medical Education (ACGME) recently solicited comments regarding proposed changes to the common program requirements. The Division of Workforce and Medical Education Policy solicited input regarding these proposed changes from all AAP committees, councils, and sections. Ten groups responded to this request. It is clear from the range of responses that the language used by the ACGME is open to wide interpretation. Additionally, and of particular concern, many groups were anxious that the ACGME might be overstepping its boundaries by instituting changes that, in effect, judge individuals rather than programs. The overall response is mixed at best, and the majority of respondents are uncomfortable with the changes as written. Read the official AAP response for more information.
AAP Response to Proposed Changes to the ACGME Pediatric Program Requirements (August 2011)
The Accreditation Council for Graduate Medical Education (ACGME) recently solicited comments regarding proposed changes to the pediatric residency program requirements. The Division of Workforce and Medical Education Policy solicited input regarding these proposed changes from all AAP committees, councils, and sections. Nineteen AAP groups provided feedback. Overall, the majority of the comments were specific in nature to each individual group. There were, however, two themes that transcended these individualized recommendations: (1) a concern that many programs are not large enough to allow residents to develop recommended procedural competencies, and (2) anxiety that the new requirements will not provide trainees with a solid foundation in general pediatrics. Read the official AAP response (the letter to the ACGME; the combined response from all committees, councils, and sections; and the SOMSRFT response) for more information.
GAO Releases Report on Physicians Serving Children Covered by Medicaid and CHIP
On June 30, 2011, the U.S. Government Accountability Office (GAO) released a report called "MEDICAID AND CHIP: Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care.” This report was mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), which contained a provision for a study to be conducted by the GAO regarding children’s access to primary care and specialty services under Medicaid and CHIP. The Academy has considerable interest in pediatric workforce issues and the provision of care to pediatric patients covered by Medicaid and CHIP, and was therefore concerned about the survey instrument that was used to gather data for this report.
The GAO report discusses:
- the extent to which physicians are enrolled as Medicaid and CHIP providers and serving children in these programs;
- the extent to which physicians are accepting these and other children as new patients; and
- the extent to which physicians experience difficulty referring children in Medicaid and CHIP for specialty care, as compared to privately insured children.
Staff from the Division of Workforce & Medical Education Policy have prepared a companion brief that should be reviewed prior to reading the GAO report.
Pediatric Subspecialty and Surgical Specialty Workforce
AAP Supports Expansion of Pediatric Subspecialty and Surgical Specialty Workforce ("Health Care Workforce Loan Repayment Programs")
The AAP has taken a strong, proactive stand in advocating for full funding of Section 5203 of the Affordable Care Act. This program provides loan repayments for pediatric medical specialists and pediatric surgical specialists and for child and adolescent mental and behavioral health professionals. In a letter to both the Senate and House the AAP noted that, "By fully funding this authorization, more graduating pediatricians and mental and behavioral health professionals will choose to train and practice in these specialties and more of America's children will be able to access the specialized medical care they so desperately need."
In support of this advocacy effort, a fact sheet on the pediatric subspecialty and surgical specialty workforce has been prepared.
Pediatric Subspecialty Workforce Shortage Presentation
The National Governors Association (NGA) Center for Best Practices recently approached the AAP and asked us to participate in a Webinar on the pediatrician workforce. The Division of Workforce and Medical Education Policy, working in conjunction with the Division of State Government Affairs, took the lead in preparing an extensive PowerPoint presentation regarding shortages in the pediatric subspecialty workforce (with a general background regarding the pediatric workforce) which was delivered by Mary Ellen Rimsza, MD, FAAP, current chair of the Committee on Pediatric Workforce (COPW). The presentation addressed not only subspecialty workforce shortages, but also the reasons behind the shortages and successful strategies that states have used to address them. The presentation was virtually attended by health policy staff in governors' offices nationwide and will be sent to AAP chapters with a suggestion that they perform additional outreach regarding this important issue. To assist chapters and anyone else who is able to promote the pediatrician workforce, the Division of State Government Affairs has prepared a briefing sheet that outlines key advocacy opportunities. Helping policy makers understand that the supply of pediatric subspecialists and surgical specialists is inadequate to meet the health needs of children is vital.
Physician Reentry into the Workforce
Many physicians, particularly women, leave practice and then wish to reenter the physician workforce after an extended period of time away from clinical medicine. The reasons range from childbearing and caring for elderly relatives to taking a position in administration or management. When a physician wishes to return to practice, what kind of retraining is needed? How is the person's clinical competence evaluated? What role in the workforce should the individual pursue? How should licensure and credentialing issues be addressed? The Academy, in collaboration with 20 other medical organizations, is exploring these and many other important questions related to physician reentry into the workforce. To learn more about what the Academy and its partners are doing in this area, visit the Reentry web page.
Resident Duty Hours
AAP responds to IOM Report on Resident Duty Hours (March 2009)
In December 2008, the Institute of Medicine (IOM) issued a report on resident duty hours entitled, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety". This report contains a number of recommendations calling for revisions to the resident duty hours limitations set by the Accreditation Council for Graduate Medical Education (ACGME) in 2003. These recommendations have served as the impetus for thought-provoking conversations around patient safety and the quality of the educational environment. For further information on the report, visit the IOM Website.
ACGME Duty Hours Response (August 2010)
This AAP Response to the Accreditation Council for Graduate Medical Education (ACGME) Proposed Duty Hours Revision is based on a solicitation for feedback that was sent to all AAP Councils, Committees and Sections. These responses form the basis of the 19-page document. The first two pages comprise a letter that summarizes the key findings and AAP positions. The remainder of the document is an appendix that conveys each group’s individual response or perspectives. Click here to read the letter.
Women in Pediatrics
Women comprise more than 57% of pediatricians and 70% of pediatric residents. Gender therefore has a important influence on the pediatrician workforce. Relevant issues range from part-time practice and balancing professional and personal lives to building leadership skills and advancement within academic medicine. The Division of Workforce and Medical Education Policy, working with partners such as the American Medical Association Women Physicians Congress and the Association of American Medical Colleges, has undertaken a number of activities to study this critical topic. More information can be found on the Women in Pediatrics Web page.
Frequently Asked Questions
How many pediatricians are there in the United States?
According to the American Medical Association Masterfile, there were 58,194 general pediatricians in the United States in 2009, the most recent year for which data are available. An additional 4,322 physicians were trained jointly in internal medicine-pediatrics. Finally, there were 19,091 pediatric subspecialists. (Smart DR, ed. Physician Characteristics and Distribution in the US, 2011 Edition. Chicago, Ill: American Medical Association, 2011.)
Where can I find additional information on the number of pediatricians in pediatric subspecialties?
The above-referenced book provides information on the number of physicians in pediatric subspecialties using data from the American Medical Association Masterfile. In addition, pediatric specialty associations may be able to provide you with specialty specific statistics.
In support of Section 5203 of the Affordable Care Act, the AAP Department of Federal Affairs and the Division of Workforce and Medical Education Policy prepared this fact sheet about the pediatric subspecialty and surgical specialty workforce.
How many children are there in the United States?
The U.S. Census Bureau estimates that as of July 1, 2009, there were approximately 74,548,215 children between the ages of 0 and 17 in the United States. (U.S. Bureau of the Census. Estimates of the Resident Population by Selected Age Groups for the United States, States, and Puerto Rico: July 1, 2009. http://www.census.gov/popest/states/asrh/tables/SC-EST2009-01.xls. Accessed May 2011.)
What is the ideal pediatrician-to-population ratio?
As the circumstances of each local health market vary widely, there is no ideal ratio. Many factors dictate the appropriate ratio between physicians and patients, including the number of insured and uninsured patients in the market, referral patterns, commuting patterns for subspecialty care, disease burden of the community, the presence of an academic medical center, and overall number of physicians.
How much do pediatricians earn?
Medscape's 2011 Physician Compensation Report, which is based on 2010 data, reports a median pediatrician salary of $148,000. However, reported salaries vary considerably by geographic location, practice arrangement, career stage, gender, hours worked, and a variety of other factors. (Medscape. Physician Compensation Report 2011. http://www.medscape.com/viewarticle/740086. Accessed May 2011.)
Is there a pediatrician shortage?
On behalf of the American Academy of Pediatrics Committee on Pediatric Workforce, Committee Chairperson Beth A. Pletcher, MD, FACMG, FAAP, spoke out in a commentary in AAP News calling for pediatrics to play a prominent role in health policy debates and noting the critical and worsening shortage of pediatric medical subspecialists and pediatric surgical specialists, as well as the geographic maldistribution of pediatricians and other workforce issues and concerns. Read this commentary on the Pediatric Workforce for insights on the pediatric workforce.
The AAP Committee on Pediatric Workforce is currently revising its flagship policy statement on the pediatrician workforce. It will address emerging physician workforce issues and articulate prior concerns about the adequacy of the pediatrician supply and maldistribution of pediatricians, pediatric subspecialists, and pediatric surgical specialists.
Where can I find information and resources for physicians wishing to reenter the workforce?
The AAP Physician Reentry into the Workforce Project provides resources and information for physicians, organizations, and employers seeking information regarding physician reentry issues. The Reentry Project is a collaborative endeavor that examines the diverse issues encompassed under the rubric of reentry. It creates guidelines, recommendations, and strategies that serve both physicians and organizations. More information can be found here.
For more information and resources on workforce and educational policy issues, please visit the Web pages for the Committee on Pediatric Workforce and the Committee on Pediatric Education.
Holly J. Mulvey, MA
Division of Workforce and Medical Education Policy
Carrie Radabaugh, MPP
Senior Health Policy Analyst
Division of Workforce and Medical Education Policy