576 - National Trends in the Percent of Generalist and Specialty Pediatricians Working in Systems: 2010-2018

Poster Number: 576
Publication Number: 576.222

Tracy J. Yang, Boston Children's Hospital, Boston, MA, United States; Carolyn San Soucie, Harvard University, Jamaica Plain, MA, United States; Mercedes V. McMahon, Boston Children's Hospital, Boston, MA, United States; David Cutler, Harvard University, Cambridge, MA, United States; Alyna Chien, Boston Children's Hospital / Harvard Medical School, Boston, MA, United States

Background: There is concern about the size of the pediatric workforce and optimizing resources to deliver high quality care. Systems (organizations delivering care across the continuum from primary care to inpatient services) may help support pediatric services due to their size and care coordination. Few studies estimate the size of the active pediatric workforce or describe the degree to which pediatricians work in health systems.

Objective: To: 1. Estimate the size of the pediatric workforce (generalists and specialists); and 2. Describe trends in the degree to which pediatricians work in health systems.

Design/Methods: This is a descriptive study of Health Systems Provider Database 2010-2018, a novel dataset using over 20 sources (including billing data as a signal of active practice) to provide a census of US physicians, their specialty, the type of organization in which they practice, and ownership of the practice by a health system. All nine years of data were used cross-sectionally to describe the number of active general pediatricians and all 31 pediatric specialties as categorized by the American Board of Medical Specialties. To calculate percent change in the number of pediatricians working in systems, we divided the change in the number of pediatricians between 2010 and 2018 by the number in the base year 2010.

Results: A mean of 43,833 (standard deviation [SD] 4,034) general pediatricians and 37,241 (SD 3,203) specialists were active during our study period. For pediatric specialties, workforce size had an “S” shaped distribution—seven pediatric specialties had fewer than 200 pediatricians each (e.g., pathology), a dozen had between 201-1,000 (e.g., nephrology), nine had between 1,001 to 2,700 (e.g., gastroenterology) and three had over 3,500 (e.g., psychiatry).  The percent of pediatricians working in systems grew across the study period. For general pediatricians, there was a 26.7% increase in percent working in systems (2010: 9.1% [3,401/37,472], 2018: 27.1% [13,401/49.462]). Across specialties, there was a 28.0% increase (2010: 18.9% [6,146/32,577], 2018: 35.8% [15,276/42,664]). Adolescent medicine had the smallest increase (9.6%, 2010: 6.9% [279/4,022], 2018: 17.6% [665/3,788]), and palliative care had the largest (61.2%, 2010: 25.9% [22/85], 2018: 47.44% [74/156]).

Conclusion(s): Our study demonstrates an increase in general pediatricians and specialists working in health systems, highlighting the importance of understanding how health systems support the pediatric workforce in delivering care. Future analysis will evaluate the degree to which children’s hospitals are present within systems.