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