General pediatrics, neonatology, and the law of diminishing returns.

Abstract

The growing consensus is that the US physician workforce is too big, growing too fast, and is too highly specialized. These concerns merit attention by pediatric clinicians, researchers, and policymakers. Although differing in their suggested remedies, those proposing to slow the growth of new physicians include diverse organizations and interests—the Association of American Medical Colleges, the Institute of Medicine, the Council of Graduate Medical Education, the American Medical Association, and the Pew Health Professions Commission.1-4 A number of specialty organizations have also called for barriers to international medical graduates and fewer residency positions.5 6 The federal government recently responded with a pivotal change in federal policy. Teaching hospitals will receive transitional funds from Medicare to replace Medicare graduate medical education support if they cut back residency slots by 20% to 25% over a 5-year period.7 8Although the legislation doesn't target pediatric residency programs, it doesn't shield them from cutback decisions made by hospitals. The high costs of health care in the United States has long been the driving force behind the efforts to constrain the physician supply.9 Physicians are unarguably expensive to train and, as the primary decision makers in patient care, expensive in practice. This is especially true for highly-paid specialists using costly technologies. Primary care physicians are usually excluded from the call for downsizing because they are often viewed as the less expensive alternative to specialty care.10 Pediatrics is now assessing its own future role in serving the health care needs of children through the Future of Pediatric Education II Project. This 3-year project, funded by the American Academy of Pediatrics, is particularly interested in pediatric workforce requirements in addition to the content and funding of pediatric education.11 Similarly the American Academy of Family Physicians is reevaluating its position on workforce …