Workforce Concerns
Workforce issues have been a source of serious concern for the Pediatric
Pulmonology Division Directors Association (PPDDA) and Pediatric
Pulmonary Training Directors Association (PEPTDA) for the past two
decades. Data from the American Board of Pediatrics indicate that the
number of first year fellows in pediatric pulmonology has remained
relatively static between 2001 and 2019.5 This is
compared to significant increases in subspecialties such as
Neonatal/Perinatal Medicine, Cardiology, Critical Care Medicine,
Emergency Medicine, Endocrinology, Gastroenterology, and
Hematology-Oncology (Figure 1). National Residency Match Program data
demonstrate that there are significantly fewer pediatric pulmonology
programs, fellowship positions, and fully matched programs compared to
those subspecialties.7 During the 2020 match, there
were only 52 applicants for 74 positions offered by 46 programs. Forty
six percent of programs were unfilled, while 34% of positions were
unfilled (Figure 2).
The reasons for this are complex and several scholarly articles have
been written to address this concern.8-10 Potential
contributing factors include: insufficient exposure to pediatric
pulmonology in early years of medical education, subspecialty-specific
factors, financial disincentives for fellows to complete training, and
inadequate infrastructure to support physician-scientists and
physician-educators. Attrition during training and an aging pediatric
pulmonology workforce have also negatively impacted the availability of
subspecialists.6,11 Some experts in the field have
predicted the “extinction” of the physician-scientist in pediatric
pulmonology.12,13
Of particular concern is that, despite the need to increase the
pediatric pulmonology workforce, training programs are vulnerable to
elimination because of inadequate funding
streams.14,15 Graduate medical education funding by
the Centers for Medicare and Medicaid Services and the Children’s
Hospital Graduate Medical Education Payment Program are unstable. The
total number of institutional (T32) training grants sponsored by the
National Institutes of Health has decreased over the last decade and
potential federal budget cuts would further curtail the ability to train
academic pulmonologists and physician scientists.14Pediatric pulmonology training programs fit the profile of those at
highest risk for being perceived by fellowship program directors as
financially insecure, as they are primarily small (6 fellows or less),
have >25% unfilled positions and programs, and have a high
proportion of funding from division or extramural
sources.16 In fact, 27% of pediatric pulmonology
program directors felt insecure about the future funding of their
fellowships, which was higher than in other hospital-based
subspecialties such as neonatal-perinatal medicine, critical care and
emergency medicine.17