Pediatric subspecialty training, certification, and practice: who's doing what.

OBJECTIVE

To examine the extent of pediatric subspecialty training, certification, and practice among general and subspecialty pediatricians and to determine how the diversity of pediatric careers may affect physician workforce supply estimates.

METHOD

A sample of 4,000 self-designated pediatricians and pediatric subspecialists from the American Medical Association's Physician Masterfile were surveyed in 1991 by the American Academy of Pediatrics. Seventy-six percent of the sample responded to the 6-page questionnaire on practice characteristics, training, and demographic information.

RESULTS

Two-thirds of pediatricians are not subspecialty trained (66.3%), 15.1% are certified subspecialists, 11.3% are trained but not subboard certified, and 7.3% are subspecialty trained in an area with no certification exam. Subspecialty training did not always predict subspecialty practice; 19% of pediatricians without subspecialty training spend some time in a subspecialty, and 13% of those who are subspecialty trained practice general pediatrics exclusively. Certified subspecialists and those who cannot as yet become certified are most likely to practice their subspecialty. One-fourth of those trained in a certifiable subspecialty but who remain uncertified practice general pediatrics exclusively. The proportion of direct patient care time spent overall, and the proportion of direct patient care time spent in the subspecialty are also related to subspecialty certification and training/practice consistency.

CONCLUSION

Pediatric workforce supply projections should incorporate more than certification and training information in calculating estimates, as the practice of general and subspecialty pediatrics is very diverse and accommodating of integrative styles.