Workforce, Work, and Advocacy Issues in Pediatric Orthopaedics *

Abstract

The subspecialization of the orthopaedic surgery profession has led to a division of work; competition among orthopaedic subspecialties with regard to graduating residents seeking fellowships and patients seeking care for problems involving different subspecialties; potential splintering of the profession regarding reimbursement and advocacy initiatives; and disagreement about the role, responsibilities, and work of a so-called general orthopaedic surgeon. The issues of cost and access are now prominent in the ongoing health-care reform discussions and pending legislation, and legislative decisions may profoundly impact patients and physicians. This symposium reviews how these issues are affecting pediatric orthopaedics. In a survey at the 2007 Annual Meeting of the American Orthopaedic Association1, 59% of the audience considered pediatric orthopaedic surgery to be the most undersupplied subspecialty. Trauma was a distant second at 17%, and oncology was third at 8%. The reasons considered for the perceived undersupply include the burden of taking pediatric trauma call, medicolegal liability risks that may extend for many years, the lower pay differential compared with other orthopaedic subspecialties, too much nonoperative time, and dealing with parents. Today, this perception remains. But is pediatric orthopaedics undersupplied at the present time and, if so, why? Statistics from the Annual Meeting of the Pediatric Orthopaedic Society of North America (POSNA) in May 2009 showed continued growth, with 807 members in the United States, sixty-four members in Canada, and seventy-six members from the remaining countries worldwide2. Of the North American POSNA members, however, many have retired or will do so in the next several years. As almost 20% of the members have senior status, 80% of the 871 North American POSNA members can be considered full-time pediatric orthopaedic surgeons. Do these 648 U.S. and forty-nine Canadian full-time practicing pediatric orthopaedic surgeons represent a sufficient number to provide orthopaedic care for …