2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department

Abstract

Each year, more than 30 million children visit U.S. emergency departments (EDs). Although the number of pediatric emergency medicine specialists continues to rise, the vast majority of children are cared for in general EDs outside of children's hospitals. The diverse workforce of care providers for children must possess the knowledge, experience, skills, and systemic support necessary to deliver excellent pediatric emergency care. There is a crucial need to understand the factors that drive the professional development and support systems of this diverse workforce. Through the iterative process culminating with the 2018 Academic Emergency Medicine consensus conference, we have identified five key research themes and prioritized a specific research agenda. These themes represent critical gaps in our understanding of the development and maintenance of the pediatric emergency care workforce and allow for a prioritization of future research efforts. Only by more fully understanding the gaps in workforce needs, and the necessary steps to address these gaps, can outcomes be optimized for children in need of emergency care. BACKGROUNDO ver four decades, emergency medicine (EM) has evolved from a fledgling specialty to a pillar for acute care for patients of all ages. The evolution of pediatric emergency medicine (PEM) has mirrored the evolution of EM itself, with subspecialization possible following either pediatrics or EM residency training. However, with just over 2,000 board-

Addressing Shortages in Pediatric Emergency Care—The Evolution of Health Care Access

“…More than 30 million children visit emergency departments (EDs) annually. 2 Physicians with pediatric EM fellowship training are concentrated in larger urban areas with dedicated children's hospitals and medical centers, yet more than 85% of children seeking emergency care are seen in nonpediatric EDs. 3 There are numerous challenges to distributing adequate resources and personnel with specific pediatric emergency training across the country to meet demand.…”

“…5 A number of barriers remain for EM-trained physicians to pursue additional training in pediatric EM, including the opportunity costs of additional fellowship training and potential salary cut if working on a relative value unit or pediatric pay scale. 2 Staffing rural EDs with pediatrics-trained EM physicians is challenging given lower pediatric volumes, the inconsistent demand for services, and the limited flexibility to care for adult patients. Such challenges may further exacerbate the unequal distribution of physicians with specialized pediatric EM training.…”

“…6 Eighteen percent of the pediatric EM workforce was older than 60 years and was nearing retirement. 2 Attrition that was associated with part-time status has been amplified by shifts in the proportion of men and women in the workforce and the disparities in household and other nonclinical responsibilities. 6 The findings by Bennett et al 1 highlighted that, although the numbers of pediatric EM physicians and fellowship training programs have increased, the numbers of pediatric EM subspecialists who are clinically active are nowhere near the quantity needed to staff every ED in the United States.…”

“…The growth of pediatric EM reflects many of the challenges of an evolving workforce, the changing geographic distribution of the US population, expanded health care delivery models, and the crucial need for experience and training in the delivery of high-quality pediatric care. More than 30 million children visit emergency departments (EDs) annually . Physicians with pediatric EM fellowship training are concentrated in larger urban areas with dedicated children’s hospitals and medical centers, yet more than 85% of children seeking emergency care are seen in nonpediatric EDs .…”

“…Taking care of pediatric emergencies is within the scope of residency-trained emergency physicians, but few of these physicians are currently practicing in rural areas . A number of barriers remain for EM-trained physicians to pursue additional training in pediatric EM, including the opportunity costs of additional fellowship training and potential salary cut if working on a relative value unit or pediatric pay scale . Staffing rural EDs with pediatrics-trained EM physicians is challenging given lower pediatric volumes, the inconsistent demand for services, and the limited flexibility to care for adult patients.…”