This Periodic Survey was sent to a random sample of approximately 1000 U.S. active FAAPs. After five (5) mailed contacts, we received 708 in-scope questionnaires. For a final response rate of 71%.

The characteristics (professional activity, subspecialty area, age gender, office/practice location) of the respondents are fairly consistent with those of previous periodic surveys and the 1985 AAP Membership Census.

COMMUNITY HEALTH SERVICES

Fifty-four percent of the respondents said they participated in some capacity in a wide range of community-based activities. Among these pediatricians, 49% participated on a volunteer basis only, while 51% reported a mixture of volunteer service and participation for a full or reduced fee. Overall, pediatricians spent an average of 155 hours per year (the majority of which was volunteered time) participating in an average of 3.3 different community-based activities.

• In the average 155 hours of community service, pediatricians volunteered their services an average of 65 hours per year in community-based activities. They participated in community activities for a reduced fee an average of 49 hours per year, and participated for a full fee an average of 35 hours per year. (Respondents participated an average of 6 hours per year for an undefined pay status.)

• Among the 380 respondents who reported participation in community-based activities, the most frequently mentioned activities were volunteer organizations such as chapter or national AAP activities (101), Crippled Children�s Services/agencies (98), indigent care/public health clinics (88), health fairs (83), child protection services/agencies (79), camps (75), child advocacy settings (non-AAP) such as Healthy Mothers/Healthy Babies (72), public school consultant (67), courts (65), and early intervention programs such as Head Start (56).

• The majority of the respondents who participated in these settings volunteered their time in all but three of the activities: courts (48% volunteered, 29% were paid reduced fees, 23% received full fees), indigent care (41% volunteered, 47% accepted reduced fees), 13% received full fees), and Crippled Children�s Services (19% volunteered, 65% accepted reduced fees, 15% received full fees).

• In 6 of the 10 most frequently mentioned community-based activities the majority of pediatricians served as an advocate/consultant (volunteer organizations, 95%; child advocacy settings, 79%; public school consultant 75%; courts, 73%; health fairs, 63%; early intervention, 51%). In 3 of the 10 activities the majority served in direct patient care (indigent care/public health clinics, 82%; camps, 75%; crippled children�s service, 70%), and in 1 activity there was no clear majority (child protection services/agencies: advocacy, 48%; direct patient care, 37%; both, 15%).

INTERNATIONAL HEALTH

Respondents were asked if they would be interested in serving in some capacity in a developing country within the next three years. Thirty-eight percent of the respondents said they would or may be interested in so serving: 27% said �yes,� 11% said they were unsure, and 62% said they would not be interested in serving in a developing country in the near future.

• 46% of the pediatricians who said they would or might be interested in serving overseas said they would be willing to do so for 1-6 months if they were remunerated for their services (22% said 1 month, 13% said 3 months, 10% said 6 months). 29% said they would serve up to 3 weeks, if paid, and 24% said they would serve for 1 year or more, if paid.

• 61% said they would serve up to 3 weeks overseas without pay (18% said 1 week or less, 31% said 2 weeks, 12% said 3 weeks). 31% said they would serve 1-6 months without pay, and less than 1% said they would serve 1 year or more without pay. 8% said they would not be willing to serve overseas without remuneration.

The majority (68%) of pediatricians who would be willing to serve in a developing country said they would prefer to deliver care and 26% said they would prefer to teach. Teaching was named as the second choice for ways to serve in a developing country by 66% of the pediatricians, and 20% said delivering care was their second preference. Only about half of the respondents who made first and second choices also indicated a third preference, the largest portion of whom indicated administration as that choice.

Among all respondents, 17% said they recalled seeing a directory of overseas service opportunities published in the July 1988 issue of PEDIATRICS; 78% said they had not and 5% were unsure.

Among those who recalled seeing the directory or were unsure (approximately 152 pediatricians):

• 93% said they have not investigated any of these opportunities to date. In addition, when asked how likely they would be to do so within the next 2-3 years, 67% said not very likely, 26% said somewhat likely, and 7% said very likely.
• 7% said they have investigated some of the opportunities published in the PEDIATRICS directory. All of these pediatricians said the directory was either somewhat or very helpful in their investigation.

• 83% had not referred anyone else to the directory; 17% said they had.

Among those who said they would be interested in serving in a developing country within the next 3 years, one-fourth said they saw or might have seen the directory of overseas service opportunities in the July 1988 issue of PEDIATRICS (23% recalled seeing the directory, 2% were unsure); 74% said they did not recall seeing the directory. 21% percent of pediatricians who were unsure about their interest in serving overseas said they saw the directory in PEDIATRICS, 11% were unsure about seeing it, and 69% said they did not see the directory. Among respondents NOT interested in serving overseas within the next three years, 14% said they saw the directory of opportunities in PEDIATRICS, 6% were unsure, and 81% said they did not see the directory. The difference in response between groups was significant at the <.01 level.

When we examined the responses to all the items on international health by practice area and by gender, we found no statistically significant differences between groups. When we looked at age groups (pediatricians under age 45 compared to those 45 years old or older) only one survey item was found to be significant at the p<.05 level:

• More younger pediatricians recalled seeing the directory of overseas opportunities in PEDIATRICS than did older pediatricians (19% v. 13% and more younger than older pediatricians said they were unsure whether they had seen the directory (6% v. 4%).

Current Overseas Service:

Sixteen pediatricians (about 2% of all respondents) said they participate in overseas health programs, and have devoted an average of 122.3 hours in those activities during the past year. Among these pediatricians, 69% volunteered their time, 19% participated for a reduced fee, and 12% participated for a full fee. The pediatricians were equally divided on how they participated in the overseas health programs: 33% each said they did direct patient care, participated as an advocate/consultant, and did both direct patient care and advocacy/consultation.

INTEREST IN SPORTS MEDICINE

The majority of pediatricians (61%) said they spent 1-10% of their time during an average work week in sports medicine related activities. Nearly 7% of the respondents said they spent between 11 and 20% in such activities, and 1% said sports medicine activities occupied 21-30% of their time per week. Nearly one-third of the respondents (32%) said they did not spend any time in sports medicine related activities.

• Pediatricians in nonmetropolitan/rural areas spent more time in sports medicine related activities than did those in small or large metropolitan areas: 15% of pediatricians practicing in nonmetropolitan areas said they did not spend any time during an average week in sports medicine related activities, compared to 33% of pediatricians from small metro areas and 36% practicing in large metro areas (p<.001).

8% of the respondents said they have served as a team physician within the last three years; 92% said they have not. Among those who were team physicians, 45% have served as one for the past 3 years. 18% have been a team physician for the past 2 years, 16% have served as one for the past year, and 21% have been a team physician for less than 1 year.

• 19% of nonmetro/rural pediatricians have served as a team physician within the past 3 years compared to 7% of pediatricians from large metro areas and 5% from small metro areas (p<.001).

About one-third of the respondents said they are or might be interested in seeking a �certificate of added qualifications� in sports medicine if one were available: 26% said they were interested in doing so, and 11% said they were unsure. The remaining 63% said they were not interested in such a certificate.

• More pediatricians under 45 years of age reported an interest in seeking a certificate of added qualifications in sports medicine if one were available than did pediatricians 45 years or older: 30% of younger pediatricians said they would be so interested compared to 20% of older pediatricians, and 14% of younger pediatricians were unsure compared to 7% of older pediatricians (p<.001).

Education in Sports Medicine Related Areas:

Respondents were asked to indicate the number of hours of Continuing Medical Education and the number of months of formal training (beyond �normal� rotations in medical school) they had in sports medicine, physical medicine and rehabilitation, and orthopedics. Overall, more pediatricians reported having had additional education or training in orthopedics (185 pediatricians so reported) than in sports medicine (174), or in physical medicine and rehabilitation (76).

23% of the respondents reported Continuing Medical Education hours in sports medicine, 21% have had CME hours in orthopedics, and 8% have had CME hours in physical medicine and rehabilitation. In addition, 9% of the respondents reported having had formal training beyond medical school in orthopedics, 5% reported formal training in physical medicine and rehabilitation, and 4% have had such training in sports medicine.

• Approximately two-thirds of the pediatricians reporting CME hours in either sports medicine orthopedics or physical medicine and rehabilitation, reported having had between 1 and 10 hours of such education (67%, 68%, 69%). 17% have had 11-20 CME hours in sports medicine, 25% have had 11-20 CME hours in orthopedics, and 15% have had this number of CME hours in physical medicine. The mean number of CME hours in sports medicine was 19.8; for orthopedics, 11.2; and, for physical medicine and rehabilitation, 25.5.

• More than one-half of the pediatricians reporting formal training in orthopedics said they have had 1 month of training in this area (56%); 19% said they have had 2 months of training, and 16% reported 3 months of such training. One month of formal training in sports medicine was reported by 46% of the pediatricians who reported training in this area; 25% said they have had 2 months of training, and 8% have had 3 months of training. In the area of physical medicine and rehabilitation, 36% reported 1 month of formal training in this area; 18% said they have had 2 months, and 21% said they have had 3 months of such training. The mean number of formal training months reported for orthopedics was 2.2; for sports medicine, 3.3; for physical medicine and rehabilitation, 4.1.