Pediatricians see no need for increase in work force

The American Academy of Pediatrics supports maintaining, not increasing, U.S. medical student numbers and keeping the number of pediatric residencies unchanged, according to its new work-force statement released in July.

The AAP policy stands in contrast to that of the Council on Graduate Medical Education and the Assn. of American Medical Colleges, which are advocating a 15% increase in allopathic medical school enrollment as well as a corresponding increase in residency positions.

The AAP policy is also markedly different from that of the American College of Cardiology and other medical specialty groups that say they are experiencing work-force shortages now or expect to be in the near future. According to American Medical Association policy, there are regional and specialty shortages of physicians and an expansion of medical school and residency slots is needed.

"We're not convinced, at least for pediatric care, that there is a real need for an increase of numbers," said Michael Anderson, MD, chair of the AAP's work-force committee. "While overall the number of pediatricians is OK, we need to find ways to improve access."

Dr. Anderson explained that there are plenty of general pediatricians, they just aren't distributed evenly across the population, leaving children in traditionally underserved areas without adequate access. What shortages do exist in pediatrics are limited to particular pediatric subspecialties, he said, like rheumatology, nephrology and infectious diseases.

The reason for what on the surface is a contrarian view is simple, the AAP said. Others are looking at the entire health care picture or specific aspects of the adult population's needs. The AAP is focused on children, and this population is growing at a vastly different rate from adults. For the past decade, the AAP said in its work-force policy, the ratio of pediatricians to children has been on the rise.

Because there appears to be an adequate supply of general pediatricians, Dr. Anderson said, the AAP wants to focus on ensuring access to quality care. To do this it is advocating expanding the National Health Service Corps and other incentive programs to promote pediatric practice in underserved areas. It also supports increasing diversity among pediatricians to keep pace with the growing diversity of America's children.

U.S. grads for the underserved

The AAP wants a more stable physician work force in underserved areas, which it believes can be accomplished by placing U.S. medical school graduates in these areas, not international medical school graduates using J-1 visa waivers.

"I want to be careful when looking at the IMG issue," Dr. Anderson said. "We want to ensure access in rural and underserved areas to high quality general and pediatric subspecialty care. The J-1 visa has been great for providing care to these underserved areas, but there's instability in the work force. We'd like to address access with a more stable source of physicians."

The waivers allow physicians with J-1 student visas to receive H-1B visas in exchange for three or more years of service in underserved areas. Many of these physicians leave once they've fulfilled their obligation, Dr. Anderson said, and the waivers are vulnerable to the ebb and flow of public policy. According to the AAP, one third of pediatricians are IMGs.

Bernd Wollschlaeger, MD, a family physician and chair of the AMA's international medical graduate section, said the real issue here is improving working conditions in underserved areas to attract and retain physicians, not differentiating between J-1 visa waiver physicians and U.S. medical graduates.

"Are these employment opportunities attractive to retain these doctors?" he asked. "The academy should ask how we can improve working conditions in underserved areas to attract physicians, not distinguish IMGs from U.S. graduates."