Primary Care Pediatrician Assessment of Access Barriers and Local Supply of Pediatric Subspecialists

We aimed to examine primary care pediatricians' experiences with availability of pediatric subspecialists in their practice area. We further aimed to compare the experiences of pediatricians in rural and nonrural areas.

We analyzed weighted 2024 data from 471 primary care pediatrician respondents to the American Academy of Pediatrics (AAP) Periodic Survey, a national survey of AAP members. Questions focused on barriers to subspecialty care and availability of specific subspecialties. Responses were analyzed descriptively for the overall sample, and Chi-squares tests were used to compare responses for pediatricians from rural and nonrural areas.

Primary care pediatricians reported that for patients needing subspecialty care, moderate or significant barriers included long waiting times for appointments (88%), too few pediatric subspecialists (72%), and long travel times to subspecialists (53%). Respondents identified many specific subspecialty areas as having a shortage (% of pediatricians choosing "too few"): child/adolescent psychiatry (97%), developmental-behavioral pediatrics (96%), pediatric dermatology (76%), child abuse pediatrics (76%), and pediatric rheumatology (75%). Rural pediatricians were significantly more likely than those from nonrural areas to report shortages for 20 of the 28 subspecialty areas.

Primary care pediatricians provide an important perspective concerning the subspecialty care needs of their patients, and they report shortages for many subspecialty areas. The shortages are more pronounced in rural areas.