Supply and Demand of Residency Programs: Systemic Implications for Workforce Trends*
Although the study of workforce trends is not new to the field of pediatrics (1), relatively few studies have examined supply and demand relationships as they pertain to providers within pediatric critical care (2–5). Those, which paved the way for pediatric critical care workforce exploration, have examined variables, including the number of tracked residents and fellows, the number of examination application surveys, and continual maintenance of certification through the American Board of Pediatrics (ABP) certification (3–5). Further, with these data, factors such as the number of pediatric fellows in training, the number of first-time applicants with critical care subspecialty training, and the number of ABP diplomats in critical care (by location and per provider-to-child ratio) can be tracked and accounted for (3–5).
In this issue of Pediatric Critical Care Medicine, van der Velden et al (2) examined one segment of the workforce study model described above, by considering trends in the number of programs, positions, and applications in pediatric critical care from 2004 to 2016 in what they describe as “Part 1” of a workforce study. This current descriptive analysis was based on data obtained from the National Resident Match Program, the Accreditation of Council for Graduate Medical Education, and information from other pediatric subspecialties. During the time frame of the study, van der Velden et al (2) observed a significant expansion in programs, positions, and applicants nationwide consistent with the growth in other pediatric subspecialty training programs. Although this information adds a contemporary and longitudinal perspective, in the postmatch era, to previous workforce research, it is important that these findings are not considered within a vacuum, which is artificially created by a two-part body of work. Specifically, even if a potential “Part 2” of the study addresses adequacy of trainees, including board pass rates, ability for autonomous practice, clinical performance, and employment characteristics, there are still several reasons why the authors have not truly evaluated more than a segment of the pediatric critical care “workforce,” as the title suggests.
First, workforce development needs to be evaluated beyond the perspective of pediatric critical care training programs or the “pipeline” that the authors refer to. Although medical training programs may provide an important component of entrants into the workforce, the incumbent physicians within the discipline are also an important component of the workforce available for the delivery of care and need to be taken into account when addressing workforce supply.