American Pediatric Surgical Association Members Research Articles

The pediatric surgeon-scientist: An evolving breed or endangered phenotype?

IntroductionNational Institute of Health (NIH) funding is a “gold-standard” of achievement; we examined trends in NIH-funded pediatric surgeons. MethodsNIH Research Portfolio Online Reporting Tools (RePORT) was queried for American Pediatric Surgical Association (APSA) members (2012 vs 2022). Demographics and time-to-award (TTA) from fellowship were compared. Number of grants, funding allotment, award classification, administering institutes/centers, research type were studied. ResultsThirty-eight (4.6%) APSA members were NIH-funded in 2012 compared to 37 (2.9%) in 2022. Of funded surgeons in 2022, 27% were repeat awardees from 2012. TTA was similar (12 vs 14years, p=0.109). At each point, awards were commonly R01 grants (40 vs 52%, p ​= ​0.087) and basic science-related (76 vs 63%, p = ​0.179). Awardees were predominantly men (82% in 2012 vs 78% in 2022, p=0.779) and White (82% in 2012 vs 76% in 2022, p=0.586). Median amount per grant increased: $254,980 (2012) to $364,025 (2022); by $96,711 for men and $390,911 for women. Median awards for White surgeons increased by $215,699 (p=0.035), and decreased by $30,074 for non-White surgeons, though not significantly (p=0.368). ConclusionThe landscape of NIH-funded pediatric surgeons has remained unchanged between time points. With a substantial number of repeat awardees, predominance of R01 grants, and a median TTA over a decade after fellowship graduation, the phenotypes of early career pediatric surgeon-scientists are facing academic endangerment.

Attitudes Toward Surgical Innovation Research in the Pediatric Surgery Fellowship Match

IntroductionPediatric surgery applicants are increasingly pursuing research in non-traditional fields including surgical innovation. This study aims to evaluate the relative value that pediatric surgeons involved in fellow selection place on innovation experience compared to traditional research. MethodsA cross-sectional web-based survey of American Pediatric Surgical Association members involved in the selection of pediatric surgical fellows was conducted. Respondents reported their own innovation experience and were asked to identify valuable traits of applicants who completed an innovation fellowship. They rated the value of traditional research metrics including publications, presentations, and advanced degrees compared to patents and other innovation-related metrics. Comparisons were made between those with and without innovation experience with respect to gender, years in practice, and institutional role. ResultsOne hundred thirty respondents were involved in pediatric surgery fellow selection. Innovation work was felt to be equal to or more valuable than basic science by 75% of respondents (84% vs. clinical/outcomes, 93% vs. other non-traditional, 72% vs. other clinical fellowships). Commonly cited concerns included “fewer publications” (21%) and “preoccupation with financial reward” (19%). The most valuable innovation-related metrics were “developing a novel surgical procedure” (67%) and “developing a novel device” (58%). When asked if the respondent would advise a junior resident to pursue an innovation fellowship, 49% would, 9% would not, and 43% were unsure. Seventeen percent expressed concern for match success. ConclusionInnovation experience is generally viewed positively by pediatric surgeons involved in fellow selection. However, applicants and mentors would benefit from focusing on traditional academic outputs to ensure competitiveness. Type of StudyCross-sectional observational study. Level of EvidenceIII.

Dollars and Sense: The Business of Pediatric Surgery

IntroductionThis study evaluated North American pediatric surgeons’ opinions and knowledge of business and economics in medicine and their perceptions of trends in their healthcare delivery environment. MethodsWe conducted an elective online survey of 1119 American Pediatric Surgical Association members. Over 8 mo, we iteratively developed the survey focused on four areas: opinion, knowledge, current practice environment, and trends in practice environment over the past 5 y. ResultsWe received 227 (20.3%) complete surveys from pediatric surgeons. One hundred ninety four (85.5%) perceive healthcare as a business and most (85.9%) believe healthcare decisions may affect patients’ out-of-pocket expenses. More than half (51.1%) of surgeons believe it has become more challenging to perform emergent cases and most believe staff quality has decreased for elective (56.4%) and emergent (63.0%) cases over the past 5 y. ConclusionsPediatric surgeons recognize that medicine is a business and have concerns regarding the decreasing quality of operating room staff and the increasing difficulty providing surgical care over the last 5 y.

Surgeon perceptions of volume threshold and essential practices for pediatric thyroidectomy✰

IntroductionThe topics of sub-specialization and regionalization of care have garnered increased attention among pediatric surgeons. Thyroid surgeries are one such sub-specialty and are commonly concentrated within practices. A national survey was conducted examining current surgeon practices and beliefs surrounding pediatric thyroid surgery. MethodsNon-resident members of the American Pediatric Surgical Association (APSA) were surveyed in October 2020. Respondents were stratified based on self-reported thyroid surgical experience. Those who performed thyroid surgery were asked about surgical technique and operative practices; those who did not were asked about referral patterns. All respondents were asked about perceptions surrounding the volume-outcome relationship for pediatric thyroid surgery. ResultsAmong 1015 APSA members, 405 (40%) responded, with 79% (317/400) practicing at academic hospitals, 58% (232/401) practicing in major metropolitan area, and 41% (161/392) with over 10 years of attending pediatric surgery experience. Most respondents (88%, n = 356) agreed that thyroid surgery volume affects outcome, though wide variation was reported in the annual case threshold for “high volume” surgery. Eighty-four respondents (21%) reported performing ≥ 1 pediatric thyroid surgery in the past year. Of these, 82% routinely use recurrent laryngeal nerve monitoring, 32% routinely send hemithyroidectomy patients home the same day, and there was little consensus surrounding postoperative hypocalcemia management. The majority of respondents endorse performing thyroid procedures with a colleague. ConclusionsPediatric thyroid surgery appears to be performed by a subset of active pediatric surgeons, most of whom endorse the use of a dual operating team. More evidence is needed to build consensus around additional perioperative practices.

A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric surgeons in the U.S.

Background/PurposeTo determine the prevalence of compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) and identify potential predictors of these phenomena in pediatric surgeons. MethodsThe Compassion Fatigue and Satisfaction Self-Test and a survey of personal/professional characteristics were distributed electronically to American Pediatric Surgical Association members. Linear regression models for CF, BO, and CS as a function of potential risk factors were constructed. ResultsThe analyzeable study response rate was 25.7%. The prevalence of CF, BO, and CS was 22%, 24% and 22, respectively, which were similar to prevalences previously identified in pediatric subspecialists. Higher CF scores were significantly associated with: higher BO scores; solo practice; compensation; ≥5 operating days/week; current distress about a ‘clinical situation’; mental health-care for work-related distress; and history of childhood surgery. Lower CF scores were significantly associated with ‘talking with a life partner’ about work-related distress. Higher BO scores were significantly associated with: higher CF scores; current distress about ‘coworkers’; and ‘keeping lawsuits confidential’. Lower BO scores were significantly associated with higher CS scores. ConclusionsCF, BO, and CS are distinct but highly related entities. Pediatric surgeons experience these phenomena at similar rates to other pediatric subspecialists. Establishing local channels for physician peer support may be particularly impactful.

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Diversity, Equity, and Inclusion: A strategic priority for the American Pediatric Surgical Association

Analyzing a follow-up needs assessment: Increased use of internet-based APSA educational programs by pediatric surgeons

PurposeNeeds assessment is a critical component of educational program design. Follow-up is important for improvement. Two electronic educational programs, Exam-based Pediatric surgery Educational Reference Tool (ExPERT) and Pediatric Surgery Not a Textbook (NaT), offered by the American Pediatric Surgical Association (APSA) have been functional for over three years, allowing for follow-up assessment. MethodsA 22-question survey was distributed via email to APSA members. Questions included practice demographics, learning preferences and APSA material use. Mann–Whitney analysis was performed (p<0.05). Results294 members responded. 43% were in academic practice with a pediatric surgery fellowship. Top preferences for obtaining/maintaining medical knowledge were national meetings (27%), ExPERT (24%), and the NaT (20%). Comparatively, in a 2014 assessment, electronic programs were less desired (16%). Cost was cited by >1/3 for not subscribing to ExPERT or NaT. Question discussions were often read regardless of response. >86% would subscribe to APSA resources if there were no CME requirement. The most frequently cited knowledge gap was fetal therapy (30%). ConclusionsThis is the first publication documenting increased acceptance of electronic educational platforms for pediatric surgeons. Well-utilized and valued, the data justify and encourage continued development of electronic educational resources. Room for improvement exists in affordability, knowledge gaps, and individualizing curriculum development. Level of evidenceIV

Advanced providers in pediatric surgery: Evaluation of role and perceived impact

IntroductionThe shortage of medical doctors in certain geographies and certain disciplines, resident work hour limitations and the demonstrated positive impact of advanced providers (nurse practitioners, physician assistants and clinical nurse specialists) on the quality and efficiency of care in numerous specialties have led to broader integration of advanced providers in healthcare organizations. With regard to pediatric surgery, some tertiary centers have successfully implemented 24/7 nurse practitioner coverage for their inpatient services. However, pediatric surgery practices vary throughout North America and the broader presence and function of advanced providers among all practice types and settings has not been characterized previously. The purpose of this survey is to conduct a descriptive evaluation of current pediatric surgical practices in North America with regard to advanced provider coverage and their perceived impact on care delivery and patient satisfaction. MethodsA 14-item online survey, approved by the American Pediatric Surgical Association (APSA) Outcomes and Evidence-Based Practice Committee, was distributed to all full APSA members (N = 1189, opening rate of 56%), representing the vast majority of pediatric surgeons in North America. The survey investigated the practice characteristics of the responding surgeon, the presence and role of advanced providers in their practice and their perceived impact on patient care. Descriptive statistics were performed to characterize the function of advanced providers in pediatric surgery practices. Further analysis was performed to assess for geographic differences in staffing practices using United States Census Divisions. ResultsA total of 266 pediatric surgeons completed the survey (response rate 22% and 40% considering “email send out” and “email opening” rates respectively), with 47.6% employed at free standing children's hospitals and 41.1% employed at a children's hospital within an adult hospital. Nearly all respondents (N = 244, 91.7%) reported the presence of advanced providers in their practice with nurse practitioners (N = 216) and physician assistants (N = 101) most commonly represented. The majority of advanced providers (N = 189, 77.8%) covered both general surgery and trauma patients. Advanced providers worked nearly equally in the outpatient (N = 219, 89.8%) and inpatient setting (N = 232, 95.1%), though less often in the neonatal (N = 131) or pediatric (N = 126) intensive care unit. Fifteen percent of surgeons (N = 40) reported that advanced providers provided 24/7 coverage within their surgical practice. Surgeons reported that advanced providers had a very positive (75%) or positive (21%) impact on their clinical practice, with none reporting a negative impact. Surgeons also reported that advanced providers had a very positive (74%) or positive (21%) impact on perceived patient satisfaction. The main area in which surgeons reported the most significant impact of associate providers was continuity of care (N = 77), efficiency of service (N = 66) and education of parents and patients (N = 53). ConclusionPediatric surgical practices of all types are broadly utilizing advanced providers. Surgeons report that the integration of advanced providers across inpatient and outpatient settings has positively impacted care, advancing both continuity of care and efficiency of service.Advanced providers likely represent part of the solution to delivering quality care in current delivery systems. Study TypeProspective Study/ Survey Level of EvidenceIV

Current state of renal tumor surgery among pediatric surgeons and pediatric urologists: A survey of American Pediatric Surgical Association (APSA) and Society for Pediatric Urology (SPU) members

Anecdotally, renal tumor (RT) surgery makes up a limited portion of the practice for most pediatric urologists and pediatric surgeons. Data are lacking on the current perceptions of RT surgery, both volume of surgery and issues related to surgical practice, among pediatric surgeons (PS) and pediatric urologists (PU). To describe practice patterns of pediatric renal tumor (RT) surgery and identify factors related to higher reported volumes of RT surgery. The survey was developed and pilot-tested by the Children's Oncology Group (COG) RT surgery committee. The survey was distributed to APSA and SPU members. Logistic regression was performed to correlate surgeon-reported factors with higher reported volumes of RT surgery. The survey was sent to 1,282 APSA and 426 SPU members, 367 (21.5%) surveys were completed from eligible responders, 244 (65.2%) and 123 (32.9%) from APSA and SPU invitations, respectively. Overall, 33.9% reported being part of a practice group in which RT surgical care is sub-specialized. A majority (50.7%) of respondents reported personally performing one to two RT surgeries annually, and 16.7% reported performing none. Multivariate logistic regression identified the following significant factors associated with increased individual RT surgical volume: group sub-specialization, COG/SIOP membership, regular tumor board attendance, and annual institutional volume >10 RT surgeries (Table). Accurate responses on the need for lymph node (LN) sampling in RT surgery were reported by 89.9%. Overall, 15.8% and 24.5% of respondents failed to correctly correlate local stage III disease in Wilms tumor (WT) with open or percutaneous biopsy, respectively (p<0.001). While we found that reported RT surgery volume is low among both pediatric urologists and surgeons, we did identify surgeon-specific factors which correlated with higher RT surgical volume. Interested pediatric urologists and surgeons may use these data to tailor their practice if their goal is to increase RT surgery volume. Additionally, based on less than ideal rates of correct responses to nuance in the staging and treatment of WT, there are clear opportunities to increase education in this content area. However, the study is limited by use of a non-validated survey instrument and the relatively low response rates. Reported individual RT surgery volume is low. Factors associated with increased volume include sub-specialty practice, tumor board involvement, and higher institutional volume. Responses on LN sampling and biopsy in WT demonstrate opportunities for educational initiatives.

Survey of the American Pediatric Surgical Association on cannulation practices in pediatric ECMO

AimsExtracorporeal membrane oxygenation (ECMO) is a commonly used modality of life support for children with cardiopulmonary failure. Consensus on pediatric cannulation strategies and management does not currently exist. The goal of this study was to investigate individual surgeon approaches towards ECMO cannulations in children. MethodsA 21-question online survey was developed and disseminated to the American Pediatric Surgical Association (APSA) membership. Participant responses were summarized as counts and percentages. Effect of ECMO volume and surgeon experience on responses was assessed. ResultsThere were 252 APSA members who participated in this study for a response rate of 21%, with 225 (89.3%) performing ECMO. Sixty respondents (28.3%) reported using neck vessels exclusively for cannulation regardless of age or weight of the patient. After neck decannulation, 13 (6.6%) repaired the carotid artery for all patients, and 21 (10.7%) repaired only for children older than 5years. Of those performing femoral cannulation, 56 (26.4%) would perform at 5years or older and 66 (31.1%) at 12years. The most common challenge for femoral cannulation was the need for distal perfusion (n=119; 59.8%). Assistance from vascular surgery was requested by 32 (16.4%) for distal perfusion catheter placement, and by 79 (40.5%) for decannulation. Regarding femoral cannulation, lack of training was more likely to be a challenge if performing <5 cannulations per year (25.2% vs 12.5%; p=0.03). Surgeons with <10years of experience were more likely to consult vascular surgery compared to those with >10years of experience (18.5% vs 8%; p=0.03). ConclusionConsiderable variation exists in individual surgeon cannulation practices in pediatric ECMO, in particular in the management of school age and adolescent VA ECMO. Mixed approaches across several ECMO management case study questions indicate that further work is needed to evaluate specific risks with cannulations in children. Level of evidenceIV

Quality and Extent of Locum Tenens Coverage in Pediatric Surgical Practices

The prevalence and quality of locum tenens coverage in pediatric surgery have not been determined. An Internet-based survey of American Pediatric Surgical Association members was conducted: 1) practice description; 2) use and frequency of locum tenens coverage; 4) whether the surgeon provided such coverage; and 5) Likert scale responses (strongly disagree, disagree, neutral, agree, strongly agree) to statements addressing its acceptability and quality (two × five contingency table and χ(2) analyses, significance at P < 0.05). Three hundred sixteen of 1163 members (27.2% response rate) responded. One-fourth (24.1%) used a locum tenens regularly. Reasons were long-term inability to recruit a full-time surgeon (35.2%) and short-term vacancies (32.4%). One-fifth (20.4%) did locum tenens work; one-fourth (27.0%) plan to do so in the future. Two-thirds (64.2%) believe that surgical care in a locum tenens situation does not provide the same level of care as a full-time community-based surgeon. Most support locum tenens for short-term coverage (87.3%) and recruitment problems (72.1%), but not long-term vacancies (38.8%; P < 0.001) or permanent coverage (27.0%; P < 0.001). locum tenens coverage is an established feature of pediatric surgery. Most view it as a stopgap solution to the surgical workforce shortage.

Variations in pre-operative management of adolescents undergoing elective surgery

ObjectiveTo understand whether preoperative care of adolescent patients differs according to two different pediatric subspecialties with respect to patient pregnancy status, drug use, and patient assent.To understand how preoperative care of adolescent patients varies with length of practice and practice setting. MethodsA cross-sectional study surveyed 51 American Society of Pediatric Otolaryngology (ASPO) members and 108 American Pediatric Surgical Association (APSA) members. Outcomes included how often (‘always’, ‘sometimes’, ‘never’) participants ask adolescents (ages 12–18 years) about substance use, pregnancy, and assent for surgery. Differences according to physicians’ practice duration and setting were also examined. Fisher's exact tests and Cochran–Armitage tests were applied for statistical analysis. ResultsAlthough ASPO and APSA members did not differ significantly in how often they ask adolescent patients about pregnancy, ASPO members were more likely to ‘always’ cancel elective surgery in a pregnant patient (p<0.007). ASPO members were also more likely to ‘always’ ask about substance use, although this difference was not significant (p<0.06). APSA members were more likely to proceed with surgery despite an adolescent's refusal (p<0.007). Physicians in both specialties with <5 years in practice were most likely to ‘always’ ask about pregnancy, and physicians with fewer adolescent patients in their practice were more likely to ‘always’ ask about substance use. Physicians in differing practice settings varied in their responses about proceeding with elective surgery in a pregnant patient (p<0.03). ConclusionASPO and APSA members differ in their preoperative management of adolescent patients. Newer physicians and those with fewer adolescent patients also differ from physicians with more extensive experience with adolescents.

Interest in international surgical volunteerism: results of a survey of members of the American Pediatric Surgical Association

Purpose This study assesses interest in international volunteer work by members of the American Pediatric Surgical Association (APSA) and attempts to identify demographics, motivations, obstacles, and institutional issues of the respondents. Methods An online survey service was used to send a 25-question survey to all APSA members with email addresses in November 2009. An answer to all questions was not required. Written comments were encouraged. Results The survey was sent to 807 members of whom 316 responded, for a response rate of 39%. International work had been done previously by 48% of respondents, whereas 95% stated that they were interested or perhaps interested in doing so. Most (83%) were interested in operating with local surgeons to teach them how to perform procedures. Altruism was the chief motivation in 75% of respondents. Primary obstacles to doing international work were family obligations and lack of time, although 37% stated that a lack of information about volunteer opportunities was an issue. A significant number of respondents (48%) stated that their institution had no established international collaborations. Conclusion This study suggests that there is interest in international volunteerism among many members of APSA. Understanding the issues surrounding surgical volunteerism may facilitate humanitarian involvement among pediatric surgeons.

Research interests and funding of members of the American Pediatric Surgical Association: report from 2010 American Pediatric Surgical Association Outcomes and Clinical Trials Committee

ObjectiveThere is lack of data relating to the research interests and funding of pediatric surgeons within the United States and Canada. These data may be helpful in promoting basic and clinical research among pediatric surgeons. MethodsThe American Pediatric Surgical Association (APSA) Outcomes and Clinical Trials Committee developed and administered an online survey via e-mail to the APSA membership to help characterize research activities and funding. The survey was available for completion during December of 2009. The survey contained 10 items with a drop-down menu for multiple choice answers and required 5 to 10 minutes to complete. Results based on research interests as well as funding sources were compiled and analyzed. ResultsA total of 275 members, which comprises 27.4% of the APSA membership, completed the survey. Of the respondents, 177 (64%) described being in an academic practice, 44 (16%) in an academically associated private practice, 9 (3.3%) in a private solo practice, 17 (6.2%) in private group practice, and 3 (1%) in the military. A total of 189 (68.7%) respondents stated that they participated in formal research. Respondents also categorized their research interests, and the following were the most common subjects of study (decreasing order of frequency): appendicitis, trauma and critical care, outcomes, minimally invasive surgery, and congenital diaphragmatic hernia. Of those participating in research, 64.5% stated that they have no formal financial support. Of those supported through the National Institutes of Health, funding grants achieved were as follows: R01 (n = 29), K08 (n = 9), K23 (n = 2), and U01 (n = 8). ConclusionsResearch activities are common among APSA members and encompass a wide range of pediatric surgery topics. Strikingly, the overall financial support of these efforts is limited, predominantly supported by the surgeons themselves. Funded respondents attained grants through Public Health Service grants, departmental grants, or private institutions.

Pediatric surgery workforce: supply and demand

Introduction Recent studies report a shortage of pediatric surgeons in the United States. We surveyed members of the American Pediatric Surgical Association (APSA) to estimate current workforce and demand and to provide data for workforce planning. Methods We conducted a survey of 849 APSA members to provide workforce data on their communities as follows: the number of active, retired, or inactive APSA surgeons; non-APSA fellowship graduates; surgeons without accredited fellowship training; and the estimated demand for additional pediatric surgeons. Internet search engines identified surgeons and practices offering pediatric surgical services. The US Census Metropolitan Statistical Areas (MSAs) defined service areas with populations of 100,000 or more. Results Of 137 MSAs with APSA members in practice, we obtained data from 113 (83%), with 247 (29%) of 849 surgeons responding. We estimate that the current pediatric surgical workforce consists of 1150 surgeons, with APSA members in active practice (60%) forming the single largest group, followed by general surgeons (21%). The percentage of active APSA surgeons was greater than the percentage of general surgeons in the 50 largest MSAs (76% vs 2%, respectively), whereas the opposite was observed in the smaller MSA ranked more than 51 in population (37% vs 46%, respectively). American Pediatric Surgical Association respondents estimated a national demand for 280 additional pediatric surgeons. Active APSA surgeons plan to delay retirement (8% of respondents) because it would leave their group or community shorthanded; 2% reported that retirement would leave the community without a pediatric surgeon. Discussion Workforce shortage in pediatric surgery is a problem of number and distribution. Incentives to direct trainees to underserved areas are needed. General surgeons provide pediatric services in many communities. Surgical training should include additional training in pediatric surgery.

Pediatric surgery workforce: population and economic issues

Background Whether a shortage of pediatric surgeons exists in the United States, such as those observed in the total physician and general surgical workforces, is an important issue that will affect decisions regarding training, credentialing, and reimbursement. Our goal was to update information regarding the demand and supply of pediatric surgeons. Methods Online American Pediatric Surgical Association (APSA) membership directory gave numbers of pediatric surgeons and their residence by metropolitan statistical areas (MSA), defined by the US census. Population and economic data were obtained from appropriate US government agencies. Results There were 835 APSA members and 375 MSA. Eliminated were 86 MSA (with 12 APSA members) with incomplete data, 14 MSA (0 members) with populations less than 100,000, and 25 members with listed locations outside an MSA. The remaining 798 members and 275 MSA comprised the study. The number of APSA members in an MSA correlated closely with MSA population ( R 2 = 0.836) and 2006 births ( R 2 = 0.767). Metropolitan statistical areas without an APSA member had a smaller population and birth rate than those with one or more members ( P = .0001). An MSA with 1 APSA member had a higher population ( P = .0003) and births per APSA member ratios ( P = .0014) than MSA with 2 and 3 or more members. The presence of a medical school or a pediatric training program had no effect on population or births-to-APSA member ratios. There was no correlation between numbers of APSA members and state GDP or state GDP per capita. We used a low, medium, and high threshold to predict the need for pediatric surgeons based upon population per APSA member ± 1 SD (272,466 ± 163,386) to predict a need of 82 to 1344 pediatric surgeons, an increase in the APSA membership by 10% to 168%. Conclusion Based on population estimates and APSA membership, a current shortage of pediatric surgeons exists. Measures should be taken to address this workforce issue.

Temporal geomapping of pediatric surgeons in the United States

Several studies have addressed the issue of manpower needs in pediatric surgery. The number of training programs has multiplied dramatically over the past decade. The distribution of surgeons is more significant than the absolute change in numbers--are major metropolitan areas seeing a more dramatic increase than less populated areas? To evaluate the geographic and demographic changes associated with this increase, we used choropleth and geomapping techniques to evaluate the change in number and distribution of American Pediatric Surgical Association (APSA) members (and by proxy, pediatric surgeons) in the United States over the past decade. Data regarding membership were obtained from APSA. In 1996, management companies changed, and accurate data for initial year of membership were only available after 1996. Online sources (www.services.alphaworks.ibm.com/manyeyes/home and www.mapresso.com) were used for data analysis. There was a 175% increase in the number of APSA members over the past decade. The geographic distribution parallels the state population to some extent but is uneven. The number of APSA members by state over time is displayed in color density maps. Predictions of prior manpower studies were generally accurate. The number of pediatric surgeons in the United States has rapidly increased in the past decade, with no sign of diminution in this trend. Increases in the number of surgeons correlates with state population, indicating a tendency for surgeons to reside in more densely populated areas, as expected. Areas with a disproportionately high or low number of surgeons can be identified via choropleth mapping.

Peer assessment of pediatric surgeons for potential risks of radiation exposure from computed tomography scans

Purpose Radiology literature reports potential cancer risk from radiation exposure from computed tomography (CT). We hypothesized that pediatric surgeons' knowledge of potential risks of radiation exposure from CT scan is limited. Methods We used an anonymous, Internet-based peer assessment survey for members of the American Pediatric Surgical Association (APSA). The survey assessed surgeon's knowledge based on potential risks of radiation exposure from CT as well as current practice patterns for use of CT. The χ 2 test of significance was used to detect any differences in responses based on years in training. Results Twenty percent (147/753) of the American Pediatric Surgical Association members completed the survey. About one half (54%) of surgeons believe that the lifetime risk of cancer was increased because of radiation from one abdominal/pelvic CT scan, although more than 75% of respondents underestimated the radiation dose from a CT scan compared to a chest radiograph. Most surgeons generally did not discuss the potential risks of CT scan with their patients. Surgeons demonstrated a range of responses for use of CT for select clinical scenarios. Conclusions Pediatric surgeon's knowledge of potential risks of radiation exposure from CT scan is limited. As the radiology literature indicates an increasing awareness for potential cancer risks from radiation exposure from CT, there is also a need for education of subspecialties outside of radiology.