Gorelick Marc H, Schremmer Robert, Ruch-Ross Holly, Radabaugh Carrie, Selbst Steven
The Departments of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI.
Children's Mercy Hospital, Kansas City, MO.
Acad Emerg Med. 2016 Jan;23(1):48-54. doi: 10.1111/acem.12845. Epub 2015 Dec 31.
Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998.
An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics.
Of 2,120 surveys mailed, 895 responses were received (40.8% response). Over half (53.7%) of respondents were female, compared with 44% in 1998. The majority (62.9%) practiced in the emergency department (ED) of a free-standing children's hospital. The distribution of professional activities was similar to that reported in 1998, with the majority of time (60%) spent in direct patient care. Half indicated involvement in research, and almost half had dedicated time for other activities, including emergency medical services (7.3%), disaster (6.9%), child abuse (5.0%), transport (3.6%), toxicology (2.3% of respondents), and other (13.6%); additionally, 21.3% had dedicated time for quality/safety. Respondents were highly satisfied (95.6%) with fellowship preparation for clinical care, but less satisfied with preparation for research (49.2%) and administration (38.7%). However, satisfaction with nonclinical training was higher for those within 10 years of medical school graduation. Forty-six percent plan to change clinical activity in the next 5 years, including reducing hours, changing shifts, or retiring. Overall, 11.9% of all respondents, including 20.1% of women and 2.6% of men (p < 0.001), report currently working part time. Large majorities endorsed feeling burned out at work (88.5%) or more callous toward people as a result of work (67.5%) at least monthly, with one in five reporting such feelings at least weekly.
While satisfaction with fellowship preparation for professional activities in PEM is improving, gaps remain in training in nonclinical skills. Symptoms of burnout are prevalent, and there is likely to be substantial attrition of PEM providers in the near future.
医疗服务提供方式的改变以及毕业后医学教育对儿科急诊医学（PEM）的劳动力队伍产生了重要影响。本研究将PEM劳动力队伍的职业准备情况和潜在人员流失情况与1998年的先前评估进行了比较。
通过电子邮件向美国儿科学会（AAP）急诊医学分会成员以及获得PEM专科认证的非AAP成员发送了调查问卷。使用标准描述性统计方法分析了有关人口统计学、执业特征和专业活动、职业准备、未来计划以及职业倦怠（使用两个经过验证的筛查问题）的信息。
在邮寄的2120份调查问卷中，共收到895份回复（回复率为40.8%）。超过半数（53.7%）的受访者为女性，而1998年这一比例为44%。大多数（62.9%）在独立儿童医院的急诊科工作。专业活动的分布与1998年报告的情况相似，大部分时间（60%）用于直接患者护理。半数受访者表示参与研究，近半数有专门时间用于其他活动，包括急诊医疗服务（7.3%）、灾难救援（6.9%）、虐待儿童（5.0%）、转运（3.6%）、毒理学（2.3%的受访者）以及其他（13.6%）；此外，21.3%有专门时间用于质量/安全方面。受访者对临床护理专科培训的满意度很高（95.6%），但对研究培训（49.2%）和管理培训（38.7%）的满意度较低。然而，医学院毕业10年内的人员对非临床培训的满意度更高。46%的人计划在未来5年内改变临床活动，包括减少工作时长、更换班次或退休。总体而言，所有受访者中有11.9%，包括20.1%的女性和2.6%的男性（p<0.001）报告目前从事兼职工作。绝大多数人认可至少每月在工作中感到倦怠（88.5%）或因工作对他人更加冷漠（
