OBJECTIVE. Because of the increase in both the prevalence and complexity of chronic diseases in children, there is heightened awareness of the need for general pediatricians to be prepared to comanage their patients with chronic disorders with subspecialists. It is not known currently how well prepared general pediatricians believe themselves to be for these roles after residency training. This study was conducted to determine the perspectives of recently trained general pediatricians in practice regarding their decisions on residency choice, career choice, and adequacy of training.METHODS. A random sample of 600 generalists whose initial application for general pediatric certification occurred between 2002 and 2003 (4 -5 years out of training) and 600 generalists who applied for board certification between 2005 and 2006 and who were not currently enrolled in or had completed subspecialty training (1-2 years out of training) received a structured questionnaire by mail. The survey focused on decision-making in selection of residency programs, strength of residency training in preparation for clinical care, and scope of practice.RESULTS. The overall response rate was 76%. The majority of generalists reported that their residency training was adequate in most subspecialty areas. However, a large proportion of generalists indicated that they could have used additional training in mental health (62% [n ϭ 424]), sports medicine (51% [n ϭ 345]), oral health (52% [n ϭ 356]), and developmental/behavioral pediatrics (48% [n ϭ 326]). Most generalist respondents reported that they are comfortable comanaging cases requiring subspecialty care with a subspecialist. However, generalist respondents without local access to subspecialists were more likely to report that they are comfortable managing patients who require subspecialty care.CONCLUSIONS. The training of general pediatricians, and the needs for their adequate preparation to care for patients, should be a dynamic process. As the nature and epidemiology of pediatric care change, our educational system must change as well. Pediatrics 2009;123:S38-S43 T HE SCOPE AND manner of residency training and physician decision-making regarding career choice for pediatricians was last assessed systematically in 1995 as part of the Future of Pediatric Education II (FOPE II) Project. 1 However, that project relied mostly on expert opinion and small-scale, limited research studies to assess nationally the then-current educational programs. 2 Since the FOPE II Project, there have not been significant changes in the structure of pediatrics resident education. However, the prevalence of the types of patients encountered by pediatricians today is different from at the time of the FOPE II Project. Currently, pediatricians provide care to more children with chronic illnesses than in years past. 3 In addition, new technologies have created the need for pediatricians to be aware of new genetic and other types of recently discovered illnesses and conditions. 4 Because of the increase in ...

OBJECTIVE. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. As part of a dedicated process of reexamining the structure of residency training in pediatrics, the American Board of Pediatrics sought information to better understand the influences, process, and sequencing of both residency program selection and career decision-making among residents.METHODS. All pediatrics resident physicians in all training programs in the United States and Canada (N ϭ 8290) received the survey as part of the general pediatrics in-training examination. The survey focused on exploring how and when pediatrics residents make career choices and assessed perceived flexibility of their individual pediatrics residency program.RESULTS. The response rate was 95%. Location was the most important factor in selecting a residency program for 42% of all residents. Almost half of the pediatrics residents planned to pursue fellowship training after residency, a proportion that changed little across the 3 training years (level 1: 47%; level 2: 49%; level 3: 47%). Those who planned to pursue a general pediatrics career (either with or without inpatient care) were more likely than those who intended to pursue fellowship training to report that lifestyle was the most important factor in their career choice (63% vs 21%).CONCLUSIONS. Not surprisingly, different priorities motivate pediatricians to pursue specific programs for training and specific career options. The finding that those with the highest priority regarding lifestyle are more likely to pursue generalist training has implications for the generalist workforce, because those persons may also be more likely to seek part-time employment. Lifestyle concerns may need to be addressed in subspecialty training and subsequent subspecialty careers to ensure a continued flow of residents into fellowship training. Pediatrics 2009;123:S26-S30 T HE DECISION-MAKING PROCESS of residents regarding their future career paths is believed to be associated with a variety of factors. Little is known regarding at what point during the training period residents in pediatrics make decisions on their future career choices. Previous studies have attempted to examine potential predictors during medical school through residency. [1][2][3] It is likely that there are particular subgroups of residents for whom specific influences and experiences have greater influence than others.It is also unknown whether residents choose specific training programs because of their perceived flexibility, whether they desire additional flexibility in their training experiences, and whether such flexibility would have an affect on career choice and the decision to pursue subspecialty fellowship training.Residency training, with respect to duty hours, has changed considerably with the advent of the 80-hour workweek requirements. However, the fundamental structure of pediatrics programs, their mix of inpatient and outpatient care, and their degre...

BackgroundPandemic influenza A(H1N1) (pH1N1) was first identified in North America in April 2009. Vaccination against pH1N1 commenced in the U.S. in October 2009 and continued through January 2010. The objective of this study was to evaluate the cost-effectiveness of pH1N1 vaccination.MethodologyA computer simulation model was developed to predict costs and health outcomes for a pH1N1 vaccination program using inactivated vaccine compared to no vaccination. Probabilities, costs and quality-of-life weights were derived from emerging primary data on pH1N1 infections in the US, published and unpublished data for seasonal and pH1N1 illnesses, supplemented by expert opinion. The modeled target population included hypothetical cohorts of persons aged 6 months and older stratified by age and risk. The analysis used a one-year time horizon for most endpoints but also includes longer-term costs and consequences of long-term sequelae deaths. A societal perspective was used. Indirect effects (i.e., herd effects) were not included in the primary analysis. The main endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted.ResultsFor vaccination initiated prior to the outbreak, pH1N1 vaccination was cost-saving for persons 6 months to 64 years under many assumptions. For those without high risk conditions, incremental cost-effectiveness ratios ranged from $8,000–$52,000/QALY depending on age and risk status. Results were sensitive to the number of vaccine doses needed, costs of vaccination, illness rates, and timing of vaccine delivery.ConclusionsVaccination for pH1N1 for children and working-age adults is cost-effective compared to other preventive health interventions under a wide range of scenarios. The economic evidence was consistent with target recommendations that were in place for pH1N1 vaccination. We also found that the delays in vaccine availability had a substantial impact on the cost-effectiveness of vaccination.

OBJECTIVES. Little is known regarding the factors influencing the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists. This study was conducted to characterize the strengths and weaknesses of residency and fellowship training from the perspective of recently trained pediatric subspecialists and to assess their current and future career goals and intended scope of practice. RESULTS. The overall response rate was 77%. More than half (54%) of the recently trained subspecialists would have shortened either their pediatric residency or fellowship training if given the opportunity, and 7% were unsure. More than one third of the respondents made the decision to pursue subspecialty training before the start of residency (36% [n ϭ 198]), whereas approximately half of them made this decision during the first (19% [n ϭ 106]) or second (27% [n ϭ 150]) year of residency.CONCLUSIONS. Many subspecialists would have been interested in modifications to their pediatric residency and fellowship training programs, which may reflect changing patterns of professional activities or the preferences of a younger generation of subspecialists. Given that a substantial proportion of subspecialists decide to pursue subspecialty training before or early in residency, greater flexibility in configuring some residency experiences to meet their career goals would be feasible. Pediatrics 2009;123:S44-S49 M OST PEDIATRIC SUBSPECIALISTS in practice in the United States have completed 3 years of general pediatrics residency training. A small number of trainees, who wish to combine training in pediatrics with another specialty or focus their future careers in subspecialty-oriented research, complete alternative training pathways that shorten the time spent in residency and allow for a more rapid transition to additional research training and subspecialty clinical experiences. 1 Little is known regarding the factors that influence the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. Previous studies have identified research exposure during residency and academic career goals as important considerations to residents who are contemplating a subspecialist career. [2][3][4] In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists and if such training is viewed by some as simply a necessary prerequisite to enter subspecialty training. A better understanding of the utility of residency training from the perspective of subspecialists may help to guide efforts to modify the structure of residency training to provide the greatest possible relevance for pediatricians who undertake fellowship training.This study was conducted to characterize the strengths and weaknesses of residency and fellows...