The Pediatric Workforce: Recent Data

Trends, Questions, and Challenges for

the Future
Robert J. Vinci, MD

The future of the pediatric workforce has been the subject of significant abstract
dialogue in the pediatric community and generated much discussion in the
academic literature. There are significant concerns regarding the ability of
pediatricians to meet the growing demands of our pediatric population. Over
the past 5 years, there has been a decline in the percentage of doctor of
osteopathic medicine students who pursue a career in pediatrics but an equally
important increase in the number of pediatric positions that are filled by doctor
of osteopathic medicine students and international medical graduates. Although
there has been an increase in the number of pediatric positions offered in the
National Resident Matching Program, the last 4 years have seen a significant
increase in the number of unfilled pediatric positions. A number of pediatric
subspecialties struggle to fill their training positions, and those with low match
rates may have 20% to 40% fewer applicants than positions. The pediatric
vision for the future must include a commitment to a comprehensive strategic
planning process with the many organizations involved across the multiple
stages of the educational continuum. It is time to elucidate and address the
questions raised by the workforce data. Developing solutions to these questions
will require a careful planning process and a thoughtful analysis of the pediatric
workforce data. Establishing this as an important priority will require a major
collaborative effort between pediatric academic and professional organizations, Department of Pediatrics, Boston Medical Center and
but the future benefit to the nation’s children will be significant. Boston University School of Medicine,, Boston,
Massachusetts

Dr Vinci conceptualized and designed the study, drafted

the initial manuscript, reviewed and revised the
manuscript, approved the final manuscript as
The future of the pediatric workforce services required to deliver optimal submitted, and agrees to be accountable for all aspects
has been the subject of significant child health. of the work.

dialogue in the pediatric community DOI: https://doi.org/10.1542/peds.2020-013292

and generated much discussion in
the academic literature. Both the
Academy of Pediatrics (AAP) and the
Federation of Pediatric Organizations
have described the complex
challenges that need to be addressed
to provide care to our nation’s
Despite these organizational
recommendations, there continue to
be significant concerns regarding our
ability to meet the growing demands
of the population, especially in the
pediatric medical subspecialties.1
Current estimates suggest that by the
Accepted for publication Mar 3, 2021
Address correspondence to Robert Vinci, MD, Department
of Pediatrics, Boston Medical Center and School of
Medicine, Boston University, 801 Albany St, Boston, MA
02119. E-mail: bob.vinci@bmc.org
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-
4275).
Copyright © 2021 by the American Academy of Pediatrics

children.1,2 A key component of the
future of pediatric care will be the
development of a workforce that is
responsive to the changing landscape
of our communities while remaining
focused on the goal of providing
comprehensive and high-quality
year 2032, there will be major
workforce shortages in the primary
care disciplines as well as in many
specialty disciplines.3 Functional
shortages in the pediatric workforce
have been described by the
Children’s Hospital Association in
FINANCIAL DISCLOSURE: The author has indicated he
has no financial relationships relevant to this article to
disclose.
To cite: Vinci RJ. The Pediatric Workforce: Recent
Data Trends, Questions, and Challenges for the
Future. Pediatrics. 2021;147(6):e2020013292

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 which data reveal long wait times
for subspecialty services. Almost
50% of children’s hospitals reported
vacancies in developmental and
behavioral pediatrics and adolescent
and child psychiatry, and >30% of
children’s hospitals reported
vacancies in child neurology and
genetics.4 A 2015 survey of almost
10 000 US pediatric subspecialists
found that subspecialists devote less
time in direct patient care compared
with data from the 1998 Future of
Pediatric Education Project.5,6
Concerns have been raised that the
needs of children living in rural
areas are not being met and that the
current workforce does not reflect
the diversity of our patients.7–9
In response to expected shortages in
the workforce, there have been
recommendations to increase the
number of residency positions,
especially as components of the
pediatric workforce approach the
age of retirement.10,11 The
increasing numbers of generalist
and subspecialty pediatricians
working part-time may also
exacerbate workforce
shortages.12–14 Many of the pediatric
subspecialties have also raised
concerns about workforce
shortages.15–21 With the recognition
that pediatric physician scientists
have been the cornerstone for
advances in genomics, precision
medicine, and biomedical research,
the decline in the physician-scientist
workforce adds further
vulnerability. Physician scientists
represent only 1.5% of the
workforce, and organizational
strategies have been developed to
improve the pipeline of adult and
pediatric physician scientists.22–24
The future of any discipline is
strongly aligned with the ability to
attract qualified applicants to its
training programs. Strategies to
strengthen the pediatric applicant
pool must include discussions of
workforce diversity, the geographic
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maldistribution of the workforce,
and understanding factors that
impact the career decisions of
trainees. It is imperative to
undertake a comprehensive review
of the pediatric workforce to meet
the clinical, research, and public
health goals we have established as
an academic community. The
current and future generations of
trainees provide the foundation for
our discipline, and the ultimate
trajectory of their career paths into
general and pediatric subspecialties
will establish the degree to which
we meet our most important
mission, namely, the care required
by our nation’s children.
To advance a discussion of the
pediatric workforce, the author
reviewed multiple data sources,
including the annual data provided
by the National Resident Matching
Program (NRMP) (also referred to
as “the Match”), the American Board
of Pediatrics (ABP) physician
tracking system, and data obtained
from the Association of American
Medical Colleges (AAMC). The goal
of this article is to provide a
comprehensive review of workforce
data and highlight recent trends in
the pediatric training workforce.
These data can be used to stimulate
discussion within pediatric
organizations, refine strategies to
enhance the pediatric workforce,
and offer guidance on future areas
of investigation.
METHODS
Data were extracted from the
2010–2020 NRMP annual data
reports for both the Main Residency
Match and the Fellowship
Match.25,26 The NRMP provides
discipline-specific data, including the
total number of positions in the
Match, overall match rate,
breakdown of applicants by
categories, and annual changes in
each category. The NRMP uses
discrete definitions to track trainees,
thus allowing for comparison of
year-to-year variations. An MD
senior is a fourth-year medical
student in a US MD medical school,
accredited by the Liaison Committee
on Medical Education with a
graduation date after July 1 in the
year before the Match. An MD
graduate is a graduate of an Liaison
Committee on Medical Education
accredited US MD medical school
with a graduation date before July 1
in the year before the Match. A DO
senior is a fourth-year medical
student in a US DO medical school,
accredited by the Commission on
Osteopathic College Accreditation
with a graduation date after July 1
in the year before the Match. A DO
graduate is a graduate of a
Commission on Osteopathic College
Accreditation accredited US DO
medical school with a graduation
date before July 1 in the year before
the Match. When the number of DO
graduates is small compared with
the number of DO seniors, the 2
groups have been combined in this
article into a single group referred
to as DO medical students.
International medical graduates
(IMGs) are assigned to 1 of 2
categories. A US IMG is a US citizen
who attended an international
medical school, and a non-US IMG is
a non-US citizen who attended an
international medical school.25
Additional data were obtained by
reviewing the interactive ABP
Workforce Data System.27 This data
system tracks the general pediatrics
residency and subspecialty fellow
workforce and provides annual
trends of the number of trainees in
residency and fellowship training
programs. The ABP data collection
begins in the first year of residency
training by using data submitted
annually at the time of the General
Pediatrics In-Training Examination.
Trainees who enter subspecialty
training programs continue to be
tracked by using data provided to
VINCI
 the ABP by their subspecialty
fellowship training program
directors.28
To understand trends in the career
trajectory of graduates of MD
medical schools, the AAMC provided
an annual summary of the
percentage of MD medical students
who entered pediatric training each
year from 2008 to 2018.
RESULTS
The 2020 Main Residency Match
had 44 959 registrants, the highest
number recorded by the NRMP.
Since 2015, the number of
applicants in the Match continues to
grow, with the majority of growth
limited to MD seniors (7% growth)
and DO medical students (143%).
Since 2015, there has been a 3%
growth in the number of US IMGs
but a 6% decline in the number of
non-US IMGs. The 2020 match rate
for MD seniors was 93.7%, a
percentage consistent with the usual
match rate for MD seniors. The
match rate for DO seniors was
90.7%, the highest rate recorded for
DO seniors. The match rates for US
IMGs (61%) and non-US IMGs
(61.1%) were the highest recorded
by the NRMP since 1991 and 1990,
respectively.
In 2020, there were 2864 first-year
categorical pediatric positions in the
Match, the highest number of
positions ever offered and an
increase of 17 positions compared
with the 2019 Match. The 2020
Match represented a 7% increase
from the number of categorial
pediatric positions offered in 2015.
During this same time, other
disciplines had significant increases
in the number of positions offered
in the Match, including emergency
medicine (46%), family medicine
(46%), and internal medicine (28%)
(Table 1).
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Data obtained from the AAMC reveal
a decline in the percentage of
graduates of MD-granting medical
schools pursuing pediatric training.
In 2010, 9.7% of graduating US MD
medical students entered residency
training in pediatrics, but with the
graduating class of 2018, the
percentage decreased to 8.2%29
(Fig 1). The NRMP data confirm the
decline in the number of MD seniors
pursuing pediatrics. With the 2020
Match, the absolute number of MD
seniors is 8% lower than the
number matched in 2015. Over the
same 5-year period, other
disciplines have increased the
number of matched MD seniors,
including emergency medicine
(19%), family medicine (10%),
internal medicine (5%), obstetrics
and gynecology (9%), psychiatry
(47%), and surgery (6%) (Table 2).
The number of applicants who
matched into categorical pediatric
positions has increased each year as
more programs and positions are
added to the Match. In 2020,
pediatrics had an absolute increase
of 158 matched applicants into
categorical pediatric programs
compared with 2015. However, the
growth in pediatrics lags behind
other disciplines. During this same
period, remarkable growth in filled
first-year positions occurred in
internal medicine (1626 positions),
family medicine (1274 positions),
emergency medicine (839
positions), psychiatry (499
positions), surgery (309 positions),
and obstetrics and gynecology (185
positions). The 2020 match rate for
family medicine was 92.5% and for
internal medicine was 95.7%.
Pediatrics had a match rate of
98.2%, whereas emergency
medicine, psychiatry, surgery, and
obstetrics and gynecology had
match rates $98.9%. Thus, not only
have other disciplines significantly
expanded the number of training
positions, but they have also
continued to fill the majority of
these additional positions in the
Match.
The number of pediatric positions
that have been filled by DO medical
students as well as US and non-US
IMGs is at an all-time high. Although
the number of MD seniors who have
matched into pediatrics has
decreased by 158 since 2015, the
number of DO medical students who
have matched into pediatrics has
increased by 185 and the number of
IMGs (both foreign and US born) has
increased by 134 (Table 3). Since
2015, there have been dramatic
increases in the number of DO
medical students who match into
first-year training programs. In
2015, DO medical students filled
8.9% of first-year training positions
in the Main Residency Match, and by
2020, that number had increased to
19.2% of first-year training
positions.
Although there has been an increase
in the number of pediatric positions
offered in the Match, the last 4 years
has witnessed a significant increase
in the number of unfilled pediatric
positions. From 2017 to 2020, there
was a total of 223 categorical first-
year pediatric positions that were
not filled in the Main Residency
Match, with the 2019 Match
representing the highest number of
unfilled positions in a decade. In the
4 previous years (2013–2016), there
were only 51 unfilled categorical
pediatric positions (Table 4).
In 2020, a total of 1658 pediatric
subspecialty positions were listed in
the NRMP Fellowship Match. Of
these, 1390 were filled for an
overall match rate of 84%, similar to
the overall match rate of 86% in
2015. The majority of positions
(65%) were filled by graduates of
US MD medical schools. The
remaining positions were filled by
non-US IMGs (13%), graduates of US
DO medical schools (13%), and US
71
 TABLE 1 Number of Postgraduate Year–1 Positions Offered Annually by Each Discipline
2015
Emergency medicine 1821
Family medicine 3195
Internal medicine 6770
Obstetrics-gynecology 1255
Psychiatry 1353
Surgery 1224
Pediatrics 2668
IMGs (8%) (Table 5). Although there
are minor differences between
subspecialties, each pediatric
subspecialty had a first-year match
consisting of 50% to 75% US MD
graduates, 10% to 20% US DO
graduates, and 15% to 25% IMGs,
most of whom are non-US IMGs.26
In 2020, a number of pediatric
subspecialties filled #70% of
available positions, including child
abuse, developmental and
behavioral pediatrics, endocrinology,
infectious disease, nephrology,
pulmonology, and rheumatology.
This pattern, which has been
consistent since 2015, is in stark
contrast to the majority of pediatric
subspecialties that fill $80% of
positions each year. The
subspecialties that fill $80% of
their subspecialty positions often
have $1 applicant per available
position. In 2020, developmental
and behavioral pediatrics,
endocrinology, infectious disease,
Percentage of Graduates
FIGURE 1
Percentage of graduates of MD medical schools entering pediatrics: 2008–2018. Data are
courtesy of special report from AAMC data warehouse.29
72
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that “to achieve optimal health and
2016 2017 2018 2019 2020 2015–2020 Growth, n (%) well-being for all infants, children,
adolescents, and young adults,
1895 2047 2278 2488 2665 844 (46)
3238 3356 3629 4107 4662 1467 (46) sufficient numbers of appropriately
7024 7233 7542 8116 8697 1927 (28) trained primary care pediatricians,
1265 1288 1336 1395 1443 188 (15) pediatric medical subspecialists, and
1384 1495 1556 1740 1858 505 (37) pediatric surgical specialists … must
1241 1281 1319 1432 1536 312 (25)
be available to provide care.”1 To
2689 2738 2768 2847 2864 196 (7)
ensure that children receive the
clinical care, scientific advances,
nephrology, and pulmonology had research, and advocacy that is
#0.7 applicants per available required for optimal child health, it
position (Table 6). is imperative that pediatric leaders
use workforce data to guide
Similar to the differences between strategic planning and visioning for
the NRMP and the ABP tracking of the future.
first-year categorical pediatrics
residents, there are also differences The past decade has witnessed an
between the number of first-year unprecedented growth in
subspecialty positions filled in the postgraduate training opportunities
Match and the number of first-year in a variety of disciplines. The
subspecialty fellows tracked by the growth in the number of candidates
ABP. Comparing data from 2018, the pursuing training and the
ABP tracks 82 first-year fellows in availability of postgraduate year–1
pediatric endocrinology, whereas the positions are at an all-time high. The
NRMP data listed 64 first-year expansion of training positions is in
positions as being filled in the Match. response to many factors, including
Similar discrepancies are seen for the the increased complexity of clinical
majority of pediatric subspecialties, services within academic medical
with the ABP tracking more first- centers, the regulatory requirements
year fellows than are reported to limiting work hours, the
have matched by the NRMP.30 development of new residency
programs, and the recently
DISCUSSION completed single accreditation
system for MD and DO medical
In their most recent workforce
students. The growth in internal
policy statement, the AAP concluded
medicine and family medicine over
the past 2 years must be interpreted
with caution because the single
accreditation system has been a
major factor in expanding the
number of training positions in
these disciplines. However, in the 5
years (2020–2015) before the
development of the single
accreditation system, the growth in
family medicine (23%) and internal
medicine (35%) still exceeded the
growth in pediatrics (10%).
The overall expansion of the
workforce raises many important
questions for pediatrics. The
disproportionate growth of many
clinical disciplines in comparison
VINCI
 TABLE 2 Number of Matched MD Seniors by Disciplines
2015 2016
Emergency medicine 1438 1486
Family medicine 1405 1467
Internal medicine 3317 3291
Obstetrics-gynecology 1002
Psychiatry 774
Surgery 979
Pediatrics 1889 1829
with pediatrics should advance the
ongoing dialogue about whether
pediatrics is “right sized” to meet
the needs of our nation’s children.
Although the 7% increase in
number of first-year categorical
pediatric positions offered in the
Match between 2015 and 2020 is
encouraging, we must contrast this
to the dramatic growth in other
clinical disciplines. Over the past 10
years, the pediatric footprint in the
Match has diminished as growth in
other disciplines has far exceeded
the growth in pediatrics. The
expansion of adult-focused
disciplines is aligned with the
health care demands of a country
that is expected to have more
adults than children for the first
time in US history by the year
2034.31 However, despite a falling
birth rate, pediatrics must prepare
for increases in the number of
children living in the United States
and the increased survival of
children with complex medical
conditions.32,33 Our workforce
demands are further exacerbated
by the demand for general and
subspecialty pediatric care in many
rural areas of the country and a
growing commitment to the global
community.34
TABLE 3 Number of Applicants by Categories Matching Into Pediatrics
2015
MD seniors 1889
MD graduates 32
DO medical students 303
US IMG 174
Non-US IMG 254
Totala 2654
a
Total includes a small number of Canadian medical students.
medicine physicians and advanced
2017 2018 2019 2020 2015–2020 Growth, n (%) practice providers. It is estimated
that family medicine physicians
1601 1606 1617 1713 275 (19)
1513 1628 1601 1543 138 (10) provide 20% of the physician
3245 3195 3366 3496 179 (5) visits for US children.37 However, a
981 1049 1051 1049 1089 87 (9) recent cross-sectional survey of
850 923 982 1054 1138 364 (47) family medicine physicians reveals
948 1005 1005 1053 1033 54 (6)
1849 1746 1715 1731 –158 ( 8) that the number of family
physicians providing care to
children is decreasing.38,39 This
As we respond to the changing trend is noteworthy because the
demographics of our population, we geographic maldistribution of
can no longer focus on the absolute pediatricians in many rural areas of
numbers of trainees as a predictor the country has been offset by the
of workforce stability and must presence of family medicine
consider factors that impact the physicians.38 Equally concerning is
functional capacity of our workforce. a recent analysis of all-payer claims
The increasing administrative data from Vermont in which
demands on physician time has led researchers found that an
to a decrease in the percentage of increasing rural location of a child
time subspecialists devote to direct was associated with decreasing
patient care, a finding consistent odds of receiving care in a family
with AAP data that identified a
medicine practice.40 Any hope that
downward trend in the number of
pediatric advanced practice
hours worked by primary care
providers will augment the
pediatricians.5,35 The functional
pediatric and family medicine
capacity of the workforce is
workforce is challenged by an
impacted by the number of
impending critical shortage of the
clinicians working part-time.
pediatric nurse practitioners. Of the
Although the number of
>270 000 licensed nurse
pediatricians who work part-time
practitioners, only 5% are certified
appears to have leveled off, almost
in pediatrics.41,42 Certification data
30% of graduating residents seek
from the National Commission on
part-time work at the end of their
the Certification of Physician
training.12,13 The gender disparities
Assistants reveal only 1.9% of the
that have been described in the
physician assistant workforce focus
literature must also be addressed to
their practice on the care of
support the growing number of
children.43
women in the pediatric workforce.36
The functional capacity of the
To enhance our discussion of the
pediatric workforce must be viewed
functional capacity of the pediatric
from the perspective of the patient
workforce, we must understand the
and must address the geographic
important contributions to the care
maldistribution of the pediatric
of children made by family
workforce. In a study of general
pediatricians and family physicians,
Shipman et al44 identified significant
2016 2017 2018 2019 2020 disparities in access to primary care
1829 1849 1746 1715 1731 physicians for children. Almost 15
41 24 29 34 31 million children living in areas with
353 361 403 502 488
a low penetration of physicians
201 204 218 222 222
250 253 315 305 340 serving children were 6 times less
2675 2693 2711 2778 2812 likely to have access to primary care
physicians compared with those

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 TABLE 4 Number of Pediatric Programs, Unfilled Programs, and Unfilled Pediatric Positions
2013 2014
Total No. programs 191 194
No. programs unfilled 6 4
Total No. available positions 2616 2640
Total No. filled positions 2606 2627
No. unfilled positions 10 13
children living in areas with a high
penetration of physicians serving
children, and almost 1 million
children lived in areas without
access to primary care physicians
for children. Although there have
been recent improvements in access
to pediatric subspecialty care, there
continue to be significant gaps for
many of the pediatric
subspecialties.45 With a recent study
describing a higher degree of
medical complexity for rural
children admitted to children’s
hospitals in comparison with urban
children, our workforce discussions
must consider strategies to reach
children in rural areas of our
country.46
Another important question to
include in our workforce discussion
is alignment with and recognition of
the important workforce
contributions of graduates of DO
medical schools. Until the recent
growth in osteopathic medical
schools, pediatrics and most other
disciplines relied on graduates of
MD medical schools to populate
their training programs. The recent
decline in graduates of MD medical
schools pursuing pediatrics has
occurred during the time in which
the AAMC reports a 1.5% annual
increase in the number of graduates
TABLE 5 Who is Filling Pediatric Subspecialty Positions?
Total No. positions in the NRMP Match, N
Total No. positions filled in the subspecialty Match, N (%)
US MD graduates, n (%)
US DO graduates, n (%)
US IMG, n (%)
Non-US IMG, n (%)
Canadian graduate, n
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2015 2016 2017 2018
196 199 204 211
7 8 13 23
2668 2689 2738 2768
2654 2675 2693 2711
14 14 45 57
of US medical schools and overall
reports a 31% increase in the
number of graduates since 2002.47
Approximately 25% of our nation’s
medical students are enrolled in
osteopathic medical schools, and the
annual growth in DO medical
students is increasing well beyond
the growth of MD medical students.
In 2018, first-year enrollment in US
DO medical schools increased by
5.7% compared with the previous
year, significantly higher than the
1.3% increase in first-year
enrollment in US MD medical
schools.47,48 DO medical students
make important contributions to the
pediatric workforce, and survey data
from DO medical schools for the
2019–2020 entering class reveal
that 3% (n = 219) will pursue
general pediatrics and an additional
6% (n= 423) will pursue a career in
a pediatric subspecialty.49 The
pathway of DO pediatric residents
into the pediatric specialties will be
important to monitor as current
data suggest little 5-year change in
the percentage of pediatric
subspecialty positions filled by
graduates of DO medical schools
(Table 5). The practice pattern of
DO medical students has the
potential to impact the geographic
maldistribution of pediatrics care
because 50% of entering DO medical
2015
1417
1214 (86)
786 (65)
129 (11)
111 (9)
187 (15)
1 1
students plan to practice in an
2019 2020 underserved area, almost equally
split between urban and rural areas
220 222
29 24 of the country.49 The important
2847 2864 contributions of DO medical
2778 2812 students to the pediatric workforce
69 52 will require a much deeper
partnership with pediatric leaders at
DO medical schools.
IMGs, both US and foreign born,
constitute another important
component of the pediatric
workforce, with data suggesting that
25% of all practicing pediatricians
are IMGs.50 American Medical
Association data reveal that 62% of
IMGs are primary care physicians, a
rate much higher than graduates of
MD medical schools. IMGs fill an
important gap in the rural
workforce and add significant
diversity to our discipline.51–54 One
large residency program has noted
their success with recruiting IMGs, a
goal that they have now achieved
for almost 20 years.55 Recently,
Chakraborty et al56 have discussed
the important role of IMGs in our
workforce and called for programs
to address known challenges in
preparing non–US-born IMGs for
residency training.
Given the important contributions of
the many individuals who comprise
the pediatric workforce, it will be
crucial to understand the process by
which career decisions are made by
trainees.57 The factors that impact
career decisions of trainees may
change throughout their educational
journey. A recent qualitative study
of medical students who entered
medical school with an interest in
pediatrics highlighted the
interaction of intrinsic factors, such
as perceived personal happiness
2020
with a career in pediatrics, and
1658 extrinsic factors, such as exposures
1390 (84)
909 (65)
to pediatrics both before and during
185 (13) their clerkship training, as
108 (8) contributing to the complex process
187 (13) of making decisions regarding future
career plans.58 As training
VINCI
 TABLE 6 Pediatric Subspecialties With Low Match Rates and 2020 Ratio of Applicants/Position from these areas must be included
2020 Ratio in our workforce discussions.
Applicants/
2015, n 2016, n 2017, n 2018, n 2019, n 2020, n Position
CONCLUSIONS
Child abuse 0.8
Positions in the Match 20 19 26 27 20 22 Reviewing workforce data is a
Unfilled positions 7 14 14 13 7 10 complicated undertaking, but as
Developmental and behavioral 0.6 highlighted in this review, it is
pediatrics
Positions in the Match 41 48 44 49 48 46 imperative to understand the
Unfilled positions 11 22 13 16 18 22 changing composition of the
Endocrinology 0.7 pediatric workforce. Our vision for
Positions in the Match 85 83 88 96 99 108 the future can best be achieved by a
Unfilled positions 20 29 28 32 49 41
Infectious disease 0.7 commitment to a comprehensive
Positions in the Match 66 70 77 72 79 73 strategic planning process with the
Unfilled positions 36 25 29 32 42 27 many organizations involved across
Nephrology 0.6 the multiple stages of the
Positions in the Match 58 62 59 58 65 64
Unfilled positions 37 35 27 22 38 26 educational continuum. There are
Pulmonology 0.7 many important considerations to
Positions in the Match 61 66 67 69 74 74 include in this dialogue. The decline
Unfilled positions 31 23 20 22 34 25 in MD medical students pursuing
Rheumatology 0.8
Positions in the Match 40 37 40 41 39 42 pediatric training requires a careful
Unfilled positions 18 12 11 19 20 13 review of medical school curricula
and a concerted effort to augment
progresses, location is often the Understanding this decision-making the pediatric experiences within our
most important factor in selecting a process may offer potential insights medical schools. The important
residency program, whereas other for addressing concerns that have contributions of DO medical
factors, such as lifestyle, prestige of led to the dichotomy between students to our workforce must lead
the program, and patient subspecialty programs that easily fill to a deeper partnership with leaders
populations, become less their training positions and an in osteopathic medicine. We must
important.59 However, in choosing equally important group of enhance the role of IMGs by
positions at the end of general subspecialties that struggle to fill identifying strategies that augment
pediatrics or subspecialty training, their training positions. Solutions to their training experiences.
lifestyle and family considerations the administrative burdens and Understanding the factors that
become more important drivers of regulatory requirements that further impact the career decisions of
decisions.60,61 The impact of debt compromise the goal of delivering trainees may highlight areas for
burden must also be elucidated in clinical care and advancing the potential interventions. Emphasizing
this dialogue as we consider research agenda of the pediatric and improving workforce diversity
solutions such as loan repayment subspecialty workforce must be must be a core foundation of our
programs and salary subsidies.62–64 elucidated.5,15,66,67 work. The important contributions
Understanding that the majority of of pediatricians in clinical care,
residents who matriculate into Finally, it is our moral imperative to scientific discovery, education, and
fellowship make these decisions strengthen representation and public health must be celebrated so
early in training may identify crucial diversity of the pediatric workforce. that trainees understand the impact
stages at which providing guidance We must go beyond acknowledging and advantages of pediatric careers.
about pediatric careers may alter the importance of workforce It is time to focus our efforts and
their career trajectory.65 As diversity and move to action- address the myriad of challenges in
suggested by Querido et al,57 “future oriented strategies that enhance the the pediatric workforce. Establishing
research should focus on detecting diversification of pediatrics and this as one of our highest priorities
interrelations between hypothesized demonstrate our clear commitment will require a major collaborative
predictors and identify the to this work as a core framework effort between our academic and
determinants and interrelations at within pediatrics. Successful models professional organizations, but the
the various stages of the medical must be reviewed, discussed, and future benefit to the nation’s
career decision-making process.” disseminated widely.7,8,68,69 Leaders children will be substantial.

PEDIATRICS Volume 147, Issue 6, June 2021 75

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ABBREVIATIONS
AAMC: Association of American
Medical Colleges
AAP: American Academy of
Pediatrics
ABP: American Board of
Pediatrics
DO: doctor of osteopathic
medicine
IMG: international medical
graduate
MD: doctor of medicine
NRMP: National Resident
Matching Program
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