Bridging the gaps: a holistic approach to strengthening the pediatric medical and surgical workforce

The pediatric surgical workforce in the United States faces increasing strain due to a limited supply of specialists, geographic maldistribution, and rising complexity in pediatric cases. Rural and underserved communities experience the greatest gaps in access to timely, specialized care. Additionally, existing literature lacks integration of osteopathic perspectives in workforce development discussions, despite the holistic and preventive contributions of osteopathic medicine to patient care and physician well-being.

This review analyzes current gaps in the pediatric surgical workforce and propose actionable solutions through an osteopathic lens, including the integration of osteopathic principles such as whole-person care, preventive health, and osteopathic manipulative treatment (OMT).

A narrative literature review was conducted utilizing peer-reviewed publications, workforce data, policy reports, and the 2023 National Academies of Sciences, Engineering, and Medicine (NASEM) report on the pediatric subspecialty workforce. The review considered sources published between 2003 and 2024. Search terms included combinations of "pediatrics," "pediatric surgical workforce," "osteopathic medicine," "OMT," "healthcare disparities," and "surgical access," and they were applied to PubMed, Google Scholar, and gray literature databases. Inclusion criteria prioritized national US data on workforce distribution, diversity, burnout, and training. Then the studies were selected. No formal meta-analysis was conducted.

Approximately 1,150 board-certified pediatric surgeons practice in the United States, equating to approximately 18.2 surgeons per one million children. Access remains concentrated in urban academic centers, leaving rural regions dependent on general surgeons or patient transfers. Minority and uninsured children experience significantly lower rates of surgical intervention. Workforce burnout and limited training pipelines exacerbate shortages. Although no formal outcomes synthesis was performed, osteopathic contributions such as OMT for postoperative care and holistic, team-based education models were identified as underutilized assets in existing workforce strategies.

The pediatric surgical workforce must be expanded and diversified to meet growing and unevenly distributed care needs. Integrating osteopathic principles - including whole-person care, OMT, and provider wellness - into training, recruitment, and care delivery offers a holistic framework for sustainable improvement. Future workforce strategies should incorporate these perspectives to enhance both patient outcomes and provider resilience.