Pediatric Workforce: A Look at Adolescent Medicine Data from the American Board of Pediatrics

Abstract

This report, which is part of a series discussing workforce trends for general pediatrics and related subspecialty areas, highlights the American Board of Pediatrics’ (ABP) workforce data for adolescent medicine. Readers are encouraged to read the initial report1Althouse L.A. Stockman J.A. Pediatric workforce: a look at general pediatrics data from the American Board of Pediatrics.J Pediatr. 2006; 148: 166-169Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar in the series, because it provides information about general pediatrics and summary information about other ABP subspecialties. The adolescent medicine certificate was developed in collaboration with the American Board of Family Medicine (ABFM) and the American Board of Internal Medicine (ABIM). The ABP issues the certificate to pediatricians, and the ABFM and ABIM issue the certificate to family medicine and internal medicine physicians, respectively. The tracking data in this report include all fellows in training, regardless of whether they are pediatricians, family medicine physicians, or internal medicine physicians. However, the certification numbers, unless otherwise noted, include only those physicians who are certified by the ABP. In 1994, adolescent medicine became the eleventh ABP subboard to offer a certification examination, with the first examination yielding 209 board-certified adolescent medicine physicians. Today, >500 pediatricians have been certified by the ABP as adolescent medicine physicians. The focus of this report is to provide a snapshot of the current ABP workforce data for this subspecialty. The full ABP workforce data are available on the ABP Web site at www.abp.org.MethodsAs described in the initial report, the ABP uses 3 primary methods to collect and maintain data about workforce numbers: tracking of residents and fellows, examination application surveys, and continual maintenance of the ABP master database as individuals become certified.Tracking for first-year fellows began in 1995. By the 1997-1998 academic year, all subspecialty fellows in all training levels were tracked. In 2005, the ABP contacted all accredited adolescent medicine training programs in the United States (n = 25) to obtain tracking information. All programs contacted returned their tracking information, for a 100% response rate.ResultsAdolescent Medicine Fellow TrackingTable I provides the number of fellows in training since the 1997-1998 academic year, with a breakdown by sex and medical school. Although the number of fellows enrolled in adolescent medicine has increased by 24.5% since 1997, there was 10.8% drop in total trainees from 2004 to 2005. The total percentage of women fellows is at a current peak of 83.3%. Since 1997, the total percentage of American Medical School Graduates (AMG) fellows has increased from 74.1% to 87.9%.Table ITotal number of adolescent medicine fellows in training since 1997YearTotalFemaleMaleAMGIMG1997-19985364.8%35.2%74.1%25.9%1998-19996464.1%35.9%76.6%23.4%1999-20006866.2%33.8%83.8%16.2%2000-20016361.9%38.1%82.5%17.5%2001-20026468.8%31.3%81.3%18.8%2002-20037474.3%25.7%81.1%18.9%2003-20047280.6%19.4%86.1%13.9%2004-20057479.7%20.3%91.9%8.1%2005-20066683.3%16.7%87.9%12.1%These data include all fellows in training, regardless of whether they will become certified through ABP, ABFM, or ABIM. Open table in a new tab The figure illustrates the number of fellows in training at each level. Since 1997-1998, the average dropout rate from training year 1 to training year 3 has been 23.0%. The decline may be attributed to many factors, such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, non-pediatric physicians are eligible for certification by ABFM and ABIM after completion of 2 years of training. These various factors make it difficult to ascertain whether the dropout rate is a true reflection of those actually leaving the subspecialty.Adolescent Medicine Career DataThe ABP has 2 primary opportunities to gather information about career interest in adolescent medicine: a survey given to all first-time applicants for the general pediatrics certification examination and a survey given to all first-time applicants for the adolescent medicine certification examination. This section highlights results from both the 2005 general pediatrics and adolescent medicine applications.Of the 2994 first-time candidates applying for the general pediatrics certification examination in 2005, 866 (29%) indicated an interest in 1 of the subspecialty areas in which the ABP awards or jointly awards certificates. Adolescent medicine was selected by 1.4% of these 866 applicants. Currently, of these 16 pediatric subspecialty choices, adolescent medicine is the 15th most-selected option, ahead only of medical toxicology.The adolescent medicine certifying examination is given every 2 years. In 2005, there were 38 first-time ABP applicants for the adolescent medicine certification examination. Of these applicants, 79% were women and 87% were AMG fellows. Approximately 66% of these applicants plan to practice exclusively in adolescent medicine in an academic setting. An additional 5.3% plan to practice exclusively in adolescent medicine, but in a combined private practice and academic setting.Certified DiplomatesAs a pediatric subspecialty, adolescent medicine is the 11th largest ABP discipline, with more than 500 certified practitioners. The mean age of certified adolescent medicine physician is 49.6 years, with roughly 98% ranging from 31 to 65 years old.The ratio of current ABP-certified adolescent medicine physicians to children younger than 18 years in each of the 50 states and the District of Columbia is shown in Table II (available at www.jpeds.com). The population of children listed in the table is based on the US Census Bureau Population Estimates and includes all children younger than 18 years.2US Bureau of the Census. Population estimates by state. Revised July 1, 2004. Available at http://www.census.gov/popest/states/asrh/SC-est2004-02.html. Accessed April 18, 2005.Google Scholar These numbers are based on a list of ABP-certified adolescent medicine physicians with known addresses in 1 of the 50 states or the District of Columbia. Anyone older than the average retirement age of 65 years was excluded. On the basis of these adjustments, the total number of ABP-certified adolescent medicine physicians categorized in Table II is 438.Table IINumber of ABP-certified adolescent medicine diplomates by stateStateNumber of ABP diplomates in adolescent medicineChild populationPhysician to child ratio (per 100,000 children)Alabama⁎State with an adolescent medicine training program. (1)21,094,5330.2Alaska0188,2290Arizona41,547,2600.3Arkansas2676,5500.3California⁎State with an adolescent medicine training program. (3)499,596,4630.5Colorado⁎State with an adolescent medicine training program. (1)81,178,8890.7Connecticut3838,7880.4Delaware2193,5061District of Columbia⁎State with an adolescent medicine training program. (1)4109,5473.7Florida⁎State with an adolescent medicine training program. (1)114,003,2900.3Georgia92,332,5670.4Hawaii2298,6930.7Idaho1372,4110.3Illinois183,238,1500.6Indiana⁎State with an adolescent medicine training program. (1)51,600,2950.3Iowa1680,4370.1Kansas4683,4910.6Kentucky3980,1870.3Louisiana31,164,9610.3Maine3282,1291.1Maryland⁎State with an adolescent medicine training program. (1)241,394,8081.7Massachusetts⁎State with an adolescent medicine training program. (1)391,464,1892.7Michigan112,533,4390.4Minnesota⁎State with an adolescent medicine training program. (1)61,240,2800.5Mississippi1749,5690.1Missouri41,384,5420.3Montana0208,0930Nebraska0434,5660Nevada0603,5960New Hampshire2304,9940.7New Jersey162,156,0590.7New Mexico3492,2870.6New York⁎State with an adolescent medicine training program. (5)704,572,3631.5North Carolina62,118,4920.3North Dakota0138,9550Ohio⁎State with an adolescent medicine training program. (2)222,779,2120.8Oklahoma1859,8700.1Oregon7852,3570.8Pennsylvania⁎State with an adolescent medicine training program. (2)202,837,0090.7Rhode Island8243,8133.3South Carolina61,024,7000.6South Dakota0190,8740Tennessee111,391,2890.8Texas⁎State with an adolescent medicine training program. (3)196,266,7790.3Utah1740,1140.1Vermont0134,8940Virginia61,804,9000.3Washington⁎State with an adolescent medicine training program. (1)121,486,0200.8West Virginia⁎State with an adolescent medicine training program. (1)3384,6410.8Wisconsin61,307,9860.5Wyoming0116,932043873,277,9980.6Numbers of 12/31/2005.The number in parentheses indicates the number of programs tracked in the 2005-2006 academic year. State with an adolescent medicine training program. Open table in a new tab Eight states (Alaska, Montana, Nebraska, Nevada, North Dakota, South Dakota, Vermont, and Wyoming) do not have a practicing ABP-certified adolescent medicine physician. Only 7 states have a adolescent medicine physician-to-child ratio of at least 1:100,000. The District of Columbia has the largest ratio (3.7 per 100,000), followed by Rhode Island (3.3 per 100,000). The 25 US adolescent medicine training programs are distributed across 15 states and the District of Columbia, as noted by the asterisk in Table II. The number in parentheses denotes the number of accredited training programs that were tracked in 2005.DiscussionAlthough many studies have projected physician workforce needs, it was not until the Future of Pediatric Education II (FOPE II) task force report that a recent and detailed study focused exclusively on pediatrics, both at the generalist and subspecialty levels.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google ScholarAs aforementioned, the number of adolescent medicine physicians in training (training years 1-3) decreased by 10.8% from the previous year, with the number of adolescent medicine physicians entering training decreasing from 24 to 19 fellows, resulting in the smallest entering class since the beginning of tracking.The data in Table II indicate the ABP-certified adolescent medicine physician-to-child ratio. However, the data do not indicate who is working full-time or part-time, nor do they include the number of adolescent medicine physicians certified through ABFM or ABIM. In addition, the ratios provided in the table are based on all children younger than 18 years, not just adolescents. Currently, there are approximately 170 ABFM- or ABIM-certified adolescent medicine physicians.General pediatrics research has shown an increasing trend toward part-time work, particularly with the increase in the number of women entering pediatrics.5Brotherton S.E. Mulvey H.J. O’Conner K.G. Women in pediatric practice: trends and implications.Pediatr Ann. 1999; 28: 177-183Crossref PubMed Scopus (23) Google Scholar, 6Freed G.L. Nahra T.A. Wheeler J.R. Predicting the pediatric workforce: use of trend analysis.J Pediatr. 2003; 143: 570-575Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar There are no current data to indicate that this is the case in adolescent medicine, but further research is needed. Although the proportion of women entering this specialty has increased, studies have reported that women are equally likely to work full time and treat an equal number of patients as their male colleagues.6Freed G.L. Nahra T.A. Wheeler J.R. Predicting the pediatric workforce: use of trend analysis.J Pediatr. 2003; 143: 570-575Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 7Mayer M.L. Preisser J.S. The changing composition of the pediatric medical subspecialty workforce.Pediatrics. 2005; 116: 833-840Crossref PubMed Scopus (23) Google ScholarAlthough it is important to have an adequate number of physicians, where these physicians practice is just as critical in determining whether appropriate care is available to all children. As aforementioned, currently 8 states do not have an ABP-certified adolescent medicine physician. In addition, the FOPE II survey results indicate that only 7% of adolescent medicine physicians practice in rural areas.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google ScholarAlso contributing to a growing need for adolescent medicine physicians is an increase in referrals.4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar The FOPE II survey indicates that 30% of adolescent medicine physicians believe that the volume of referrals has increased, and 32% also believe that the referral complexity has increased. However, approximately 54% of pediatric adolescent medicine physicians anticipate that their communities will not need additional subspecialists in the next 3 to 5 years.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google ScholarAs Stoddard et al note, the FOPE II study provides the supply-side perspective.4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar The ABP data in this report provide the same perspective. These data are useful not only to those studying workforce trends, but also to medical students and pediatric residents making career decisions. However, these data do not address or gauge the need for medical services.Although workforce studies are not new, attention to workforce issues for pediatric subspecialties is relatively new. It is important that workforce research continues, from both the supply and demand perspectives. Only then can we be sure that the goal of providing all children with access to high-quality care be met.References available atwww.jpeds.com. This report, which is part of a series discussing workforce trends for general pediatrics and related subspecialty areas, highlights the American Board of Pediatrics’ (ABP) workforce data for adolescent medicine. Readers are encouraged to read the initial report1Althouse L.A. Stockman J.A. Pediatric workforce: a look at general pediatrics data from the American Board of Pediatrics.J Pediatr. 2006; 148: 166-169Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar in the series, because it provides information about general pediatrics and summary information about other ABP subspecialties. The adolescent medicine certificate was developed in collaboration with the American Board of Family Medicine (ABFM) and the American Board of Internal Medicine (ABIM). The ABP issues the certificate to pediatricians, and the ABFM and ABIM issue the certificate to family medicine and internal medicine physicians, respectively. The tracking data in this report include all fellows in training, regardless of whether they are pediatricians, family medicine physicians, or internal medicine physicians. However, the certification numbers, unless otherwise noted, include only those physicians who are certified by the ABP. In 1994, adolescent medicine became the eleventh ABP subboard to offer a certification examination, with the first examination yielding 209 board-certified adolescent medicine physicians. Today, >500 pediatricians have been certified by the ABP as adolescent medicine physicians. The focus of this report is to provide a snapshot of the current ABP workforce data for this subspecialty. The full ABP workforce data are available on the ABP Web site at www.abp.org. MethodsAs described in the initial report, the ABP uses 3 primary methods to collect and maintain data about workforce numbers: tracking of residents and fellows, examination application surveys, and continual maintenance of the ABP master database as individuals become certified.Tracking for first-year fellows began in 1995. By the 1997-1998 academic year, all subspecialty fellows in all training levels were tracked. In 2005, the ABP contacted all accredited adolescent medicine training programs in the United States (n = 25) to obtain tracking information. All programs contacted returned their tracking information, for a 100% response rate. As described in the initial report, the ABP uses 3 primary methods to collect and maintain data about workforce numbers: tracking of residents and fellows, examination application surveys, and continual maintenance of the ABP master database as individuals become certified. Tracking for first-year fellows began in 1995. By the 1997-1998 academic year, all subspecialty fellows in all training levels were tracked. In 2005, the ABP contacted all accredited adolescent medicine training programs in the United States (n = 25) to obtain tracking information. All programs contacted returned their tracking information, for a 100% response rate. ResultsAdolescent Medicine Fellow TrackingTable I provides the number of fellows in training since the 1997-1998 academic year, with a breakdown by sex and medical school. Although the number of fellows enrolled in adolescent medicine has increased by 24.5% since 1997, there was 10.8% drop in total trainees from 2004 to 2005. The total percentage of women fellows is at a current peak of 83.3%. Since 1997, the total percentage of American Medical School Graduates (AMG) fellows has increased from 74.1% to 87.9%.Table ITotal number of adolescent medicine fellows in training since 1997YearTotalFemaleMaleAMGIMG1997-19985364.8%35.2%74.1%25.9%1998-19996464.1%35.9%76.6%23.4%1999-20006866.2%33.8%83.8%16.2%2000-20016361.9%38.1%82.5%17.5%2001-20026468.8%31.3%81.3%18.8%2002-20037474.3%25.7%81.1%18.9%2003-20047280.6%19.4%86.1%13.9%2004-20057479.7%20.3%91.9%8.1%2005-20066683.3%16.7%87.9%12.1%These data include all fellows in training, regardless of whether they will become certified through ABP, ABFM, or ABIM. Open table in a new tab The figure illustrates the number of fellows in training at each level. Since 1997-1998, the average dropout rate from training year 1 to training year 3 has been 23.0%. The decline may be attributed to many factors, such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, non-pediatric physicians are eligible for certification by ABFM and ABIM after completion of 2 years of training. These various factors make it difficult to ascertain whether the dropout rate is a true reflection of those actually leaving the subspecialty.Adolescent Medicine Career DataThe ABP has 2 primary opportunities to gather information about career interest in adolescent medicine: a survey given to all first-time applicants for the general pediatrics certification examination and a survey given to all first-time applicants for the adolescent medicine certification examination. This section highlights results from both the 2005 general pediatrics and adolescent medicine applications.Of the 2994 first-time candidates applying for the general pediatrics certification examination in 2005, 866 (29%) indicated an interest in 1 of the subspecialty areas in which the ABP awards or jointly awards certificates. Adolescent medicine was selected by 1.4% of these 866 applicants. Currently, of these 16 pediatric subspecialty choices, adolescent medicine is the 15th most-selected option, ahead only of medical toxicology.The adolescent medicine certifying examination is given every 2 years. In 2005, there were 38 first-time ABP applicants for the adolescent medicine certification examination. Of these applicants, 79% were women and 87% were AMG fellows. Approximately 66% of these applicants plan to practice exclusively in adolescent medicine in an academic setting. An additional 5.3% plan to practice exclusively in adolescent medicine, but in a combined private practice and academic setting.Certified DiplomatesAs a pediatric subspecialty, adolescent medicine is the 11th largest ABP discipline, with more than 500 certified practitioners. The mean age of certified adolescent medicine physician is 49.6 years, with roughly 98% ranging from 31 to 65 years old.The ratio of current ABP-certified adolescent medicine physicians to children younger than 18 years in each of the 50 states and the District of Columbia is shown in Table II (available at www.jpeds.com). The population of children listed in the table is based on the US Census Bureau Population Estimates and includes all children younger than 18 years.2US Bureau of the Census. Population estimates by state. Revised July 1, 2004. Available at http://www.census.gov/popest/states/asrh/SC-est2004-02.html. Accessed April 18, 2005.Google Scholar These numbers are based on a list of ABP-certified adolescent medicine physicians with known addresses in 1 of the 50 states or the District of Columbia. Anyone older than the average retirement age of 65 years was excluded. On the basis of these adjustments, the total number of ABP-certified adolescent medicine physicians categorized in Table II is 438.Table IINumber of ABP-certified adolescent medicine diplomates by stateStateNumber of ABP diplomates in adolescent medicineChild populationPhysician to child ratio (per 100,000 children)Alabama⁎State with an adolescent medicine training program. (1)21,094,5330.2Alaska0188,2290Arizona41,547,2600.3Arkansas2676,5500.3California⁎State with an adolescent medicine training program. (3)499,596,4630.5Colorado⁎State with an adolescent medicine training program. (1)81,178,8890.7Connecticut3838,7880.4Delaware2193,5061District of Columbia⁎State with an adolescent medicine training program. (1)4109,5473.7Florida⁎State with an adolescent medicine training program. (1)114,003,2900.3Georgia92,332,5670.4Hawaii2298,6930.7Idaho1372,4110.3Illinois183,238,1500.6Indiana⁎State with an adolescent medicine training program. (1)51,600,2950.3Iowa1680,4370.1Kansas4683,4910.6Kentucky3980,1870.3Louisiana31,164,9610.3Maine3282,1291.1Maryland⁎State with an adolescent medicine training program. (1)241,394,8081.7Massachusetts⁎State with an adolescent medicine training program. (1)391,464,1892.7Michigan112,533,4390.4Minnesota⁎State with an adolescent medicine training program. (1)61,240,2800.5Mississippi1749,5690.1Missouri41,384,5420.3Montana0208,0930Nebraska0434,5660Nevada0603,5960New Hampshire2304,9940.7New Jersey162,156,0590.7New Mexico3492,2870.6New York⁎State with an adolescent medicine training program. (5)704,572,3631.5North Carolina62,118,4920.3North Dakota0138,9550Ohio⁎State with an adolescent medicine training program. (2)222,779,2120.8Oklahoma1859,8700.1Oregon7852,3570.8Pennsylvania⁎State with an adolescent medicine training program. (2)202,837,0090.7Rhode Island8243,8133.3South Carolina61,024,7000.6South Dakota0190,8740Tennessee111,391,2890.8Texas⁎State with an adolescent medicine training program. (3)196,266,7790.3Utah1740,1140.1Vermont0134,8940Virginia61,804,9000.3Washington⁎State with an adolescent medicine training program. (1)121,486,0200.8West Virginia⁎State with an adolescent medicine training program. (1)3384,6410.8Wisconsin61,307,9860.5Wyoming0116,932043873,277,9980.6Numbers of 12/31/2005.The number in parentheses indicates the number of programs tracked in the 2005-2006 academic year. State with an adolescent medicine training program. Open table in a new tab Eight states (Alaska, Montana, Nebraska, Nevada, North Dakota, South Dakota, Vermont, and Wyoming) do not have a practicing ABP-certified adolescent medicine physician. Only 7 states have a adolescent medicine physician-to-child ratio of at least 1:100,000. The District of Columbia has the largest ratio (3.7 per 100,000), followed by Rhode Island (3.3 per 100,000). The 25 US adolescent medicine training programs are distributed across 15 states and the District of Columbia, as noted by the asterisk in Table II. The number in parentheses denotes the number of accredited training programs that were tracked in 2005. Adolescent Medicine Fellow TrackingTable I provides the number of fellows in training since the 1997-1998 academic year, with a breakdown by sex and medical school. Although the number of fellows enrolled in adolescent medicine has increased by 24.5% since 1997, there was 10.8% drop in total trainees from 2004 to 2005. The total percentage of women fellows is at a current peak of 83.3%. Since 1997, the total percentage of American Medical School Graduates (AMG) fellows has increased from 74.1% to 87.9%.Table ITotal number of adolescent medicine fellows in training since 1997YearTotalFemaleMaleAMGIMG1997-19985364.8%35.2%74.1%25.9%1998-19996464.1%35.9%76.6%23.4%1999-20006866.2%33.8%83.8%16.2%2000-20016361.9%38.1%82.5%17.5%2001-20026468.8%31.3%81.3%18.8%2002-20037474.3%25.7%81.1%18.9%2003-20047280.6%19.4%86.1%13.9%2004-20057479.7%20.3%91.9%8.1%2005-20066683.3%16.7%87.9%12.1%These data include all fellows in training, regardless of whether they will become certified through ABP, ABFM, or ABIM. Open table in a new tab The figure illustrates the number of fellows in training at each level. Since 1997-1998, the average dropout rate from training year 1 to training year 3 has been 23.0%. The decline may be attributed to many factors, such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, non-pediatric physicians are eligible for certification by ABFM and ABIM after completion of 2 years of training. These various factors make it difficult to ascertain whether the dropout rate is a true reflection of those actually leaving the subspecialty. Table I provides the number of fellows in training since the 1997-1998 academic year, with a breakdown by sex and medical school. Although the number of fellows enrolled in adolescent medicine has increased by 24.5% since 1997, there was 10.8% drop in total trainees from 2004 to 2005. The total percentage of women fellows is at a current peak of 83.3%. Since 1997, the total percentage of American Medical School Graduates (AMG) fellows has increased from 74.1% to 87.9%. These data include all fellows in training, regardless of whether they will become certified through ABP, ABFM, or ABIM. The figure illustrates the number of fellows in training at each level. Since 1997-1998, the average dropout rate from training year 1 to training year 3 has been 23.0%. The decline may be attributed to many factors, such as personal leave, visa restrictions, and ABP-approved abbreviated training pathways. In addition, non-pediatric physicians are eligible for certification by ABFM and ABIM after completion of 2 years of training. These various factors make it difficult to ascertain whether the dropout rate is a true reflection of those actually leaving the subspecialty. Adolescent Medicine Career DataThe ABP has 2 primary opportunities to gather information about career interest in adolescent medicine: a survey given to all first-time applicants for the general pediatrics certification examination and a survey given to all first-time applicants for the adolescent medicine certification examination. This section highlights results from both the 2005 general pediatrics and adolescent medicine applications.Of the 2994 first-time candidates applying for the general pediatrics certification examination in 2005, 866 (29%) indicated an interest in 1 of the subspecialty areas in which the ABP awards or jointly awards certificates. Adolescent medicine was selected by 1.4% of these 866 applicants. Currently, of these 16 pediatric subspecialty choices, adolescent medicine is the 15th most-selected option, ahead only of medical toxicology.The adolescent medicine certifying examination is given every 2 years. In 2005, there were 38 first-time ABP applicants for the adolescent medicine certification examination. Of these applicants, 79% were women and 87% were AMG fellows. Approximately 66% of these applicants plan to practice exclusively in adolescent medicine in an academic setting. An additional 5.3% plan to practice exclusively in adolescent medicine, but in a combined private practice and academic setting. The ABP has 2 primary opportunities to gather information about career interest in adolescent medicine: a survey given to all first-time applicants for the general pediatrics certification examination and a survey given to all first-time applicants for the adolescent medicine certification examination. This section highlights results from both the 2005 general pediatrics and adolescent medicine applications. Of the 2994 first-time candidates applying for the general pediatrics certification examination in 2005, 866 (29%) indicated an interest in 1 of the subspecialty areas in which the ABP awards or jointly awards certificates. Adolescent medicine was selected by 1.4% of these 866 applicants. Currently, of these 16 pediatric subspecialty choices, adolescent medicine is the 15th most-selected option, ahead only of medical toxicology. The adolescent medicine certifying examination is given every 2 years. In 2005, there were 38 first-time ABP applicants for the adolescent medicine certification examination. Of these applicants, 79% were women and 87% were AMG fellows. Approximately 66% of these applicants plan to practice exclusively in adolescent medicine in an academic setting. An additional 5.3% plan to practice exclusively in adolescent medicine, but in a combined private practice and academic setting. Certified DiplomatesAs a pediatric subspecialty, adolescent medicine is the 11th largest ABP discipline, with more than 500 certified practitioners. The mean age of certified adolescent medicine physician is 49.6 years, with roughly 98% ranging from 31 to 65 years old.The ratio of current ABP-certified adolescent medicine physicians to children younger than 18 years in each of the 50 states and the District of Columbia is shown in Table II (available at www.jpeds.com). The population of children listed in the table is based on the US Census Bureau Population Estimates and includes all children younger than 18 years.2US Bureau of the Census. Population estimates by state. Revised July 1, 2004. Available at http://www.census.gov/popest/states/asrh/SC-est2004-02.html. Accessed April 18, 2005.Google Scholar These numbers are based on a list of ABP-certified adolescent medicine physicians with known addresses in 1 of the 50 states or the District of Columbia. Anyone older than the average retirement age of 65 years was excluded. On the basis of these adjustments, the total number of ABP-certified adolescent medicine physicians categorized in Table II is 438.Table IINumber of ABP-certified adolescent medicine diplomates by stateStateNumber of ABP diplomates in adolescent medicineChild populationPhysician to child ratio (per 100,000 children)Alabama⁎State with an adolescent medicine training program. (1)21,094,5330.2Alaska0188,2290Arizona41,547,2600.3Arkansas2676,5500.3California⁎State with an adolescent medicine training program. (3)499,596,4630.5Colorado⁎State with an adolescent medicine training program. (1)81,178,8890.7Connecticut3838,7880.4Delaware2193,5061District of Columbia⁎State with an adolescent medicine training program. (1)4109,5473.7Florida⁎State with an adolescent medicine training program. (1)114,003,2900.3Georgia92,332,5670.4Hawaii2298,6930.7Idaho1372,4110.3Illinois183,238,1500.6Indiana⁎State with an adolescent medicine training program. (1)51,600,2950.3Iowa1680,4370.1Kansas4683,4910.6Kentucky3980,1870.3Louisiana31,164,9610.3Maine3282,1291.1Maryland⁎State with an adolescent medicine training program. (1)241,394,8081.7Massachusetts⁎State with an adolescent medicine training program. (1)391,464,1892.7Michigan112,533,4390.4Minnesota⁎State with an adolescent medicine training program. (1)61,240,2800.5Mississippi1749,5690.1Missouri41,384,5420.3Montana0208,0930Nebraska0434,5660Nevada0603,5960New Hampshire2304,9940.7New Jersey162,156,0590.7New Mexico3492,2870.6New York⁎State with an adolescent medicine training program. (5)704,572,3631.5North Carolina62,118,4920.3North Dakota0138,9550Ohio⁎State with an adolescent medicine training program. (2)222,779,2120.8Oklahoma1859,8700.1Oregon7852,3570.8Pennsylvania⁎State with an adolescent medicine training program. (2)202,837,0090.7Rhode Island8243,8133.3South Carolina61,024,7000.6South Dakota0190,8740Tennessee111,391,2890.8Texas⁎State with an adolescent medicine training program. (3)196,266,7790.3Utah1740,1140.1Vermont0134,8940Virginia61,804,9000.3Washington⁎State with an adolescent medicine training program. (1)121,486,0200.8West Virginia⁎State with an adolescent medicine training program. (1)3384,6410.8Wisconsin61,307,9860.5Wyoming0116,932043873,277,9980.6Numbers of 12/31/2005.The number in parentheses indicates the number of programs tracked in the 2005-2006 academic year. State with an adolescent medicine training program. Open table in a new tab Eight states (Alaska, Montana, Nebraska, Nevada, North Dakota, South Dakota, Vermont, and Wyoming) do not have a practicing ABP-certified adolescent medicine physician. Only 7 states have a adolescent medicine physician-to-child ratio of at least 1:100,000. The District of Columbia has the largest ratio (3.7 per 100,000), followed by Rhode Island (3.3 per 100,000). The 25 US adolescent medicine training programs are distributed across 15 states and the District of Columbia, as noted by the asterisk in Table II. The number in parentheses denotes the number of accredited training programs that were tracked in 2005. As a pediatric subspecialty, adolescent medicine is the 11th largest ABP discipline, with more than 500 certified practitioners. The mean age of certified adolescent medicine physician is 49.6 years, with roughly 98% ranging from 31 to 65 years old. The ratio of current ABP-certified adolescent medicine physicians to children younger than 18 years in each of the 50 states and the District of Columbia is shown in Table II (available at www.jpeds.com). The population of children listed in the table is based on the US Census Bureau Population Estimates and includes all children younger than 18 years.2US Bureau of the Census. Population estimates by state. Revised July 1, 2004. Available at http://www.census.gov/popest/states/asrh/SC-est2004-02.html. Accessed April 18, 2005.Google Scholar These numbers are based on a list of ABP-certified adolescent medicine physicians with known addresses in 1 of the 50 states or the District of Columbia. Anyone older than the average retirement age of 65 years was excluded. On the basis of these adjustments, the total number of ABP-certified adolescent medicine physicians categorized in Table II is 438. Numbers of 12/31/2005. The number in parentheses indicates the number of programs tracked in the 2005-2006 academic year. Eight states (Alaska, Montana, Nebraska, Nevada, North Dakota, South Dakota, Vermont, and Wyoming) do not have a practicing ABP-certified adolescent medicine physician. Only 7 states have a adolescent medicine physician-to-child ratio of at least 1:100,000. The District of Columbia has the largest ratio (3.7 per 100,000), followed by Rhode Island (3.3 per 100,000). The 25 US adolescent medicine training programs are distributed across 15 states and the District of Columbia, as noted by the asterisk in Table II. The number in parentheses denotes the number of accredited training programs that were tracked in 2005. DiscussionAlthough many studies have projected physician workforce needs, it was not until the Future of Pediatric Education II (FOPE II) task force report that a recent and detailed study focused exclusively on pediatrics, both at the generalist and subspecialty levels.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google ScholarAs aforementioned, the number of adolescent medicine physicians in training (training years 1-3) decreased by 10.8% from the previous year, with the number of adolescent medicine physicians entering training decreasing from 24 to 19 fellows, resulting in the smallest entering class since the beginning of tracking.The data in Table II indicate the ABP-certified adolescent medicine physician-to-child ratio. However, the data do not indicate who is working full-time or part-time, nor do they include the number of adolescent medicine physicians certified through ABFM or ABIM. In addition, the ratios provided in the table are based on all children younger than 18 years, not just adolescents. Currently, there are approximately 170 ABFM- or ABIM-certified adolescent medicine physicians.General pediatrics research has shown an increasing trend toward part-time work, particularly with the increase in the number of women entering pediatrics.5Brotherton S.E. Mulvey H.J. O’Conner K.G. Women in pediatric practice: trends and implications.Pediatr Ann. 1999; 28: 177-183Crossref PubMed Scopus (23) Google Scholar, 6Freed G.L. Nahra T.A. Wheeler J.R. Predicting the pediatric workforce: use of trend analysis.J Pediatr. 2003; 143: 570-575Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar There are no current data to indicate that this is the case in adolescent medicine, but further research is needed. Although the proportion of women entering this specialty has increased, studies have reported that women are equally likely to work full time and treat an equal number of patients as their male colleagues.6Freed G.L. Nahra T.A. Wheeler J.R. Predicting the pediatric workforce: use of trend analysis.J Pediatr. 2003; 143: 570-575Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 7Mayer M.L. Preisser J.S. The changing composition of the pediatric medical subspecialty workforce.Pediatrics. 2005; 116: 833-840Crossref PubMed Scopus (23) Google ScholarAlthough it is important to have an adequate number of physicians, where these physicians practice is just as critical in determining whether appropriate care is available to all children. As aforementioned, currently 8 states do not have an ABP-certified adolescent medicine physician. In addition, the FOPE II survey results indicate that only 7% of adolescent medicine physicians practice in rural areas.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google ScholarAlso contributing to a growing need for adolescent medicine physicians is an increase in referrals.4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar The FOPE II survey indicates that 30% of adolescent medicine physicians believe that the volume of referrals has increased, and 32% also believe that the referral complexity has increased. However, approximately 54% of pediatric adolescent medicine physicians anticipate that their communities will not need additional subspecialists in the next 3 to 5 years.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google ScholarAs Stoddard et al note, the FOPE II study provides the supply-side perspective.4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar The ABP data in this report provide the same perspective. These data are useful not only to those studying workforce trends, but also to medical students and pediatric residents making career decisions. However, these data do not address or gauge the need for medical services.Although workforce studies are not new, attention to workforce issues for pediatric subspecialties is relatively new. It is important that workforce research continues, from both the supply and demand perspectives. Only then can we be sure that the goal of providing all children with access to high-quality care be met.References available atwww.jpeds.com. Although many studies have projected physician workforce needs, it was not until the Future of Pediatric Education II (FOPE II) task force report that a recent and detailed study focused exclusively on pediatrics, both at the generalist and subspecialty levels.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar As aforementioned, the number of adolescent medicine physicians in training (training years 1-3) decreased by 10.8% from the previous year, with the number of adolescent medicine physicians entering training decreasing from 24 to 19 fellows, resulting in the smallest entering class since the beginning of tracking. The data in Table II indicate the ABP-certified adolescent medicine physician-to-child ratio. However, the data do not indicate who is working full-time or part-time, nor do they include the number of adolescent medicine physicians certified through ABFM or ABIM. In addition, the ratios provided in the table are based on all children younger than 18 years, not just adolescents. Currently, there are approximately 170 ABFM- or ABIM-certified adolescent medicine physicians. General pediatrics research has shown an increasing trend toward part-time work, particularly with the increase in the number of women entering pediatrics.5Brotherton S.E. Mulvey H.J. O’Conner K.G. Women in pediatric practice: trends and implications.Pediatr Ann. 1999; 28: 177-183Crossref PubMed Scopus (23) Google Scholar, 6Freed G.L. Nahra T.A. Wheeler J.R. Predicting the pediatric workforce: use of trend analysis.J Pediatr. 2003; 143: 570-575Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar There are no current data to indicate that this is the case in adolescent medicine, but further research is needed. Although the proportion of women entering this specialty has increased, studies have reported that women are equally likely to work full time and treat an equal number of patients as their male colleagues.6Freed G.L. Nahra T.A. Wheeler J.R. Predicting the pediatric workforce: use of trend analysis.J Pediatr. 2003; 143: 570-575Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, 7Mayer M.L. Preisser J.S. The changing composition of the pediatric medical subspecialty workforce.Pediatrics. 2005; 116: 833-840Crossref PubMed Scopus (23) Google Scholar Although it is important to have an adequate number of physicians, where these physicians practice is just as critical in determining whether appropriate care is available to all children. As aforementioned, currently 8 states do not have an ABP-certified adolescent medicine physician. In addition, the FOPE II survey results indicate that only 7% of adolescent medicine physicians practice in rural areas.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar Also contributing to a growing need for adolescent medicine physicians is an increase in referrals.4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar The FOPE II survey indicates that 30% of adolescent medicine physicians believe that the volume of referrals has increased, and 32% also believe that the referral complexity has increased. However, approximately 54% of pediatric adolescent medicine physicians anticipate that their communities will not need additional subspecialists in the next 3 to 5 years.3The Future of Pediatric Education II organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar As Stoddard et al note, the FOPE II study provides the supply-side perspective.4Stoddard J.J. Cull W.L. Jewett E.A. Brotherton S.E. Mulvey H.J. Alden E.R. Providing pediatric subspecialty care: a workforce analysis.Pediatrics. 2000; 106: 1325-1333Crossref PubMed Scopus (81) Google Scholar The ABP data in this report provide the same perspective. These data are useful not only to those studying workforce trends, but also to medical students and pediatric residents making career decisions. However, these data do not address or gauge the need for medical services. Although workforce studies are not new, attention to workforce issues for pediatric subspecialties is relatively new. It is important that workforce research continues, from both the supply and demand perspectives. Only then can we be sure that the goal of providing all children with access to high-quality care be met. References available atwww.jpeds.com.