Interview with Dr. Jeff Sawyer - The Pediatric Orthopedic Workforce

There has been a recent increase in the number of graduates from pediatric orthopedic fellowship programs. With the increased  supply of pediatric orthopedic surgeons comes a question that “Are we training too many?” We interviewed the chief of the Practice Management Committee at POSNA, Dr. Jeff Sawyer, on this issue.  

Q: There has been an increase in the number of applicants for pediatric orthopedic fellowships; why do you think more people are choosing pediatric orthopedics?

A: There are several reasons. First is that the members of POSNA surveyed chief residents a few years ago and asked them about why they chose or did not choose pediatrics.  We found that orthopaedic residents were concerned about the longer work hours (call), greater medicolegal liability and decreased reimbursement in peds ortho.  Since that time, POSNA and its members have made a concerted effort to show residents the positives about pediatric orthopaedics and why we get so much satisfaction from it.   This as well as improved compensation packages and other factors has caused us to see an increase in the number of applicants applying and matching each year.

Q: Has this increased number of pediatric orthopedic graduates affected the number of jobs available?

A: We have some preliminary data that shows, similar to the adult trauma programs, that as the number of fellowship graduates increases the number of job ads in major journals decreases.  This is a rough surrogate as many jobs are never advertised in major journals.  It may be changing the types of positions available. We feel that a lot of the growth in pediatric orthopaedics may be in different areas than the classical ones such as pediatric sports, hand and trauma.

Q: Do you believe we are training more pediatric orthopedic surgeons than we need?

A: I think it really depends on what we call a pediatric orthopedist. If we consider that person as someone who treats things that are classically treated by pediatric orthopaedists such as DDH and clubfoot then there are some concerns that there may be too many. If we expand the scope of pediatric orthopaedics to include pediatric sports, trauma, and hand surgery then the answer is maybe not. We know from the latest AAOS survey that while the number of pediatric fellows trained continues to grow that the number of orthopaedic surgeons who consider themselves to have a specialty of pediatrics has decreased from 10.9% in 2006 to 3.9% in the most recent 2012 survey.  We may need more pediatric orthopaedists if fewer children are being cared for by general orthopaedic surgeons.  We are continuing to study this question, which is really being asked by all specialties in and out of orthopaedics.  We will have more information coming. This will also need to be monitored closely over the next few years prospectively.

Q: Recently there has been an increase in the number of pediatric orthopedic jobs available in non academic settings; could you please describe what you have found in your observations?

A: We do not have any data yet on this but should have some in the next year or so.  From a big picture view, there is relatively small pediatric population growth predicted over the next decade which is related to a lot of factors including US GDP.  If you consider that there are really a fixed number of academic positions across the US and a relatively stable rate of turnover then there will probably not be enough academic jobs for all of the graduating fellows.  This may lead to growth in non-academic centers/positions.

Q: How do you see the job market for pediatric orthopedics change as we increase the number of graduates?

A: This is an ongoing analysis.  It really depends on how you define a pediatric orthopaedist.  The other issue is that the workforce analysis takes into account large national trends and demand for pediatric orthopaedics may be more local.  For example, there are places where there are a large number of pediatric orthopaedic surgeons competing for work (oversupply) and other areas that are probably underserved. There is a mismatch between our surgeon supply and US pediatric population which leads to these differences.

Q: Could you please briefly describe how you did the work force analysis?

A: This was done by the Practice Management Committee Board of Directors. It has been a team effort looking at macroeconomic trends such as projected US GDP growth and US pediatric population growth as well as other local factors. We have analyzed the current POSNA membership in terms of age and gender and made projections based on current fellowship trends. We have looked at demand for our services, which is more difficult to do, using the KIDS database as well as surveys of recent graduates of fellowships and AAP members.  One key thing is that this workforce analysis needs to be an ongoing process due to the rapidly changing nature of health care. These projections are just that, not predictions. A lot of our supply and demand factors are local ones and cannot be determined using large databases.  This has been a team effort with a lot of people working very hard on this.

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