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The Right Child/Right Surgeon initiative: A position statement on pediatric surgical training, sub-specialization,
Samuel M Alaish1, David M Powell2, John H T Waldhausen3
1Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD.
Insights
The number of pediatric surgeons is increasing, but access to pediatric surgical care is declining in rural areas. The American Pediatric Surgical Association (APSA) launched an initiative to address this critical issue.
Area of Science:
- Pediatric Surgery
- Surgical Workforce Analysis
- Healthcare Access
Background:
- The field of pediatric surgery has seen significant growth in training programs and practitioners over 50 years.
- A flat child population and birth rate contrast with the increasing number of pediatric surgeons.
- Specialization into 'super specialties' may dilute experience for trainees and practicing surgeons.
Purpose of the Study:
- To analyze the current trends in pediatric surgical workforce and practice distribution.
- To identify challenges in maintaining expertise and ensuring equitable access to pediatric surgical care.
- To introduce the American Pediatric Surgical Association's (APSA) initiative addressing these concerns.
Main Methods:
- Review of trends in pediatric surgical training programs and practitioner numbers.
- Analysis of geographic distribution of pediatric surgeons, noting urban vs. rural disparities.
- Examination of the impact of specialization and lifestyle shifts on the workforce.
Main Results:
- Increased numbers of pediatric surgeons, particularly in urban centers.
- Limited growth of pediatric surgeons in rural and underserved areas, impacting access to care.
- Concerns that the current status quo may lead to a decline in the quality of pediatric surgical care.
Conclusions:
- The American Pediatric Surgical Association (APSA) recognizes a potential decline in pediatric surgical care quality.
- APSA has initiated the 'Right Child/Right Surgeon' initiative to explore solutions.
- Addressing workforce distribution and access is crucial for the future of pediatric surgical care.
Abstract:
The past 50 years have witnessed profound changes in the specialty of pediatric surgery in North America. There has been a marked increase in the number of both pediatric surgical training programs and practicing pediatric general and thoracic surgeons. Despite this trend, the population of children in the United States and the birth rate have recently remained relatively flat. Some pediatric surgeons have become "super specialists", concentrating their practices in oncology or colorectal surgery. This has the potential to result in a dilution of experience for both pediatric surgical trainees and practicing pediatric surgeons, thus limiting their ability to acquire and maintain expertise, respectively. Coincident with this, there has been a relative paradigm shift in recognition that "quality of life" is based more on maintaining a creative balance in lifestyle and is not "all about work". There has been a parallel growth in the number of practicing pediatric general and thoracic surgeons in urban settings, but we have not appreciated as much growth in rural and underserved areas, where access to pediatric surgical care remains limited and fewer pediatric general and thoracic surgeons practice. This is a complex issue, as some underserved areas are economically depressed and geographically sparse, but others are just underserved with adult providers taking care of children in settings that are often under resourced for pediatric surgical care. This problem may extend beyond the boundaries of pediatric general and thoracic surgery to other specialties. As the premier association representing all pediatric surgeons in the United States, the American Pediatric Surgical Association (APSA) has concluded that the quality of pediatric surgical care will likely decline should the status quo be allowed to continue. Therefore, APSA has initiated a Right Child/Right Surgeon initiative to consider these issues and propose some potential solutions. What follows is a brief statement of intent.