The Current State of Combined Pediatric Anesthesiology–Critical Care Practice: A Survey of Dual-Trained Practitioners in the United States

Abstract

Background: Combined practice in pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM) was historically common but has declined markedly with time. The reasons for this temporal shift are unclear, but existing evidence suggests that length of training is a barrier to contemporary trainees. Among current practitioners, restriction in dual-specialty practice also occurs, for reasons that are unknown at present. We sought to describe the demographics of this population, investigate their perceptions about the field, and consider factors that lead to attrition. METHODS: We conducted a cross-sectional, observational study of physicians in the United States with a combined practice in PA and PCCM. The survey was distributed electronically and anonymously to the distribution list of the Pediatric Anesthesia Leadership Council (PALC) of the Society for Pediatric Anesthesia (SPA), directing the recipients to forward the link to their faculty meeting our inclusion criteria. Attending-level respondents (n = 62) completed an anonymous, 40-question multidomain survey. RESULTS: Forty-seven men and 15 women, with a median age of 51, completed the survey. Major leadership positions are held by 44%, and 55% are externally funded investigators. A minority (26%) have given up one or both specialties, citing time constraints and politics as the dominant reasons. Duration of training was cited as the major barrier to entry by 77%. Increasing age and faculty rank and lack of a comparably trained institutional colleague were associated with attrition from dual-specialty practice. The majority (88%) reported that they would do it all again. CONCLUSIONS: The current cohort of pediatric anesthesiologist–intensivists in the United States is a small but accomplished group of physicians. Efforts to train, recruit, and retain such providers must address systematic barriers to completion of the requisite training and continued practice.

Benefits and challenges of combined pediatrics‐anesthesiology residency programs: A qualitative study

“…One challenge includes the long duration of combined residency and fellowship training and the associated opportunity costs. The perceived lack of autonomy that comes with inflexible schedules can be difficult as trainees navigate their professional and personal priorities, findings that align with existing literature 1,7 . Themes regarding social challenges also corroborate prior findings, 6 suggesting opportunities to improve a sense of relatedness among combined residents by facilitating peer and faculty mentoring.…”

“…Interestingly, these prior studies of current combined residents and attendings who have completed both residencies demonstrate that 80%–88% would pursue dual specialty training again 1,5 . These findings suggest educational and professional value in pursuing combined training beyond the ultimate outcome of board certification in anesthesiology or pediatric subspecialties.…”

“…Additional challenges of combined residency have been identified, including social isolation and impaired sense of belonging in one or both specialties 6 . Similarly, Welch et al found that 26% of attending physicians trained in both pediatric anesthesiology and PCCM restricted their practice to one specialty or neither specialty and believed that the largest barrier for trainees wishing to pursue dual subspecialty practice was length of training, 1 a sentiment that has been emphasized multiple times in the literature 2,4,5,7 …”

“…The combined residency program in pediatrics and anesthesiology was created by the American Board of Anesthesiology and American Board of Pediatrics in 2011 with the goal of providing an integrated pathway for individuals interested in careers combining both specialties, notably pediatric anesthesiology and pediatric critical care medicine (PCCM) 1,2 . Other career trajectories facilitated by this combined residency program include pediatric pain medicine, pediatric cardiac anesthesiology, and others 3 .…”

National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time

“…5,6 This is in contrast to a survey of current dual-trained practitioners, where the majority remain practicing in both PA and PCCM, and an even higher percentage would choose the path of dual training again. 7…”