Pediatrician Maldistribution: Pediatric Residents Report the Reasons and Possible Solutions

William L Cull ¹, Scott A Shipman ² and David C Goodman ³. (Sponsored by Beth K. Yudkowsky)¹Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL; ²Department of Pediatrics, Oregon Health & Science University, Portland, OR and ³The Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH.

 

Background: The pediatric workforce has long been unevenly distributed throughout the US. Recent trends have shown decreases in the number of residents accepting positions in rural areas.

 

Objective: To examine the job search behaviors and attitudes of graduating pediatric residents, with a focus upon the impact of resident job search patterns on pediatrician distribution.

 

Design/Methods: The AAP Third Year Resident Survey is mailed annually to a national random sample of 500 graduating categorical pediatrics residents. A total of 307 residents (61%) completed the survey in 2003 following up to 4 mailings between May and August.

 

Results: A total of 43% of graduating residents applied for general pediatrics positions. Of those residents, 73% obtained their most desired position, whereas 13% reported considerable difficulty in their job search. 84% of residents reported applying for positions in underserved communities including urban, inner-city (60%), small city/town (pop. 2,500 to 50,000) (50%), and rural ( pop. < 2,500) (11%) locations. However, far fewer of these newly-trained pediatricians actually accepted positions in these areas: urban, inner-city (14%), small city/town (20%), and rural (1%). Nearly half of residents (44%) accepted positions in the same city or area of their residency. When residents were asked about factors that influenced their decision whether to pursue rural or small-town positions, the most commonly reported drawbacks were social life (52%), adequacy of professional back-up (47%), call coverage (47%), and quality of area schools (34%). Residents were also asked if they would consider practicing in a small town or rural area for 3 years for varying levels of debt relief. 52% of residents reported interest if there were relief of 60% of their debt, 70% reported interest for 80% relief, and 83% reported interest for complete relief.  Finally, 28% of residents reported that very few or no general pediatrics jobs were available within 50 miles of their training site, while only 5% thought there were very few or no jobs available throughout the US.

 

Conclusions: Many graduating pediatric residents do consider underserved areas in their job search, but far fewer accept positions in these areas. Residents indicated that incentive programs offering substantial debt relief would lead them to consider practicing in these areas, at least for a limited time.