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The Future of Pediatrics: 10 Things to Know About Early

Career Pediatricians

Lynn Olson, PhD AAP Department of Research

Adapted for the SC Chapter Annual Meeting

Jane M. Foy, MD AAP District IV Chair

June, 2016

Anticipating changes in the

profession:

Are we ready?

DATA DRAWN FROM AAP RESEARCH STRUCTURES

• Since 1987

• Random sample, U.S. AAP Members

Periodic Survey of Fellows

• Since 1997

• Random sample, graduating pediatric residents

Graduating Resident Survey

• Since 2012

• Longitudinal cohort study: 2002-04 and 2009-11 residency graduates

• Members and non-members

PLACES

1

Early career pediatricians are likely to be women • Substantial shift last 25 years

• 62% of non-retired AAP Fellows are women

• 74% of Pediatric graduating residents 2014-15 are women

1987-89

4%

6%

12%

13%

10%

8%

7%

5%

3%

1%

4%

5%

7%

5%

4%

2%

1%

1%

<1%

<1%

Women Men

5%

11%

9%

9%

7%

7%

5%

3%

<1%

<1%

Women

2%

4%

5%

5%

5%

6%

6%

5%

3%

1%

Men

2011-13

Source: AAP Periodic Survey 1987-2013

> 71y

66-70y

61-65y

56-60y

51-55y

46-50y

41-45y

36-40y

31-35y

< 30y

> 71y

66-70y

61-65y

56-60y

51-55y

46-50y

41-45y

36-40y

31-35y

< 30y

AGE & GENDER DISTRIBUTION OF US AAP MEMBERS

Age

Gro

up

A

ge G

rou

p

Percent of Membership

Less likely to be pursuing a career in primary care • From about 70% of residents in 1998 to 40%

today

• Similar trend for men and women

• Subspecialists less likely to become members

2

% OF GRADUATING PEDIATRIC RESIDENTS WHOSE CAREER GOAL IS PRIMARY CARE BY GENDER

Source: AAP Graduating Resident Survey, 1997-2015

0

10

20

30

40

50

60

70

80

90

100

1997 1999 2001 2003 2005 2007 2009 2011 2013 2015

% Women

Men

3

Likely to be an employee and work in larger practice settings • Clear trend away from 1-2 person practices

• 80% of PLACES pediatricians are employees

TRENDS IN PEDIATRICIANS’ PRACTICE TYPE (GENERALISTS) 1987-2013

Source: AAP Periodic Survey 1987-2013, excludes residents

0

10

20

30

40

50

60

70

% o

f Pe

dia

tric

ian

s

Group

Solo/two

Hosp/clinic

1987-89 1990-92 1993-95 1996-98 1999-01 2002-04 2005-07 2008-10 2011-13

% OF PLACES PEDIATRICIANS WHO ARE EMPLOYEES, OWNERS OR CONTRACTORS

Source: AAP PLACES Annual Survey, 2014 (post-training pediatricians) (n=1362)

70%

84%

88%

25%

4%

5%

5%

12%

7%

0% 20% 40% 60% 80% 100%

General Pediatrics

Hospitalist

Subspecialist

Employee Full- or part-owner Independent contractor/other

4

Educational debt continues to grow at a high rate • About ¼ have no debt

• Average among those with debt = $243,000 (2015)

• Average starting salary (inflation adjusted) into general pediatrics nearly flat

AVERAGE EDUCATIONAL DEBT AMONG GRADUATING PEDIATRIC RESIDENTS WITH DEBT

(2015 DOLLARS)

*Includes spouse's/partner's educational debt Source: AAP Graduating Resident Survey, 1997-2015

2015 Mean =

$243,000

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Survey Year

AVERAGE STARTING SALARY* FOR GRADUATING RESIDENTS (2015 DOLLARS)

*Salary excludes bonuses and benefits; includes both full-time and part-time Source: AAP Graduating Resident Survey, 2003-2015

2015 Mean=$145,0

00

$0

$50,000

$100,000

$150,000

$200,000

$250,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Survey Year

General Pediatric Practice Positions

5

Many likely to have a global perspective brought to the U.S. • Among PLACES participants:

• 22% born in another country

• 40% have a parent born in another country

PLACES PEDIATRICIANS: % RACE AND IMMIGRANT BACKGROUNDS*

61

21 9 6 0

20

40

60

80

100

White Asian Hispanic Black

%

71%

% with Immigrant Background (all=40%)

16%

96%

42%

*Pediatrician or a parent was born outside the U.S. Source: AAP PLACES Annual Survey, 2013 (n=1649)

6

Are highly satisfied with their career decisions and positions • Nearly all report they would choose

pediatric residency again

• High measures of satisfaction with career and position

% OF GRADUATING PEDIATRIC RESIDENTS WHO REPORT THEY WOULD CHOOSE A CATEGORICAL PEDIATRIC

RESIDENCY AGAIN

Source: AAP Graduating Resident Survey, 2003-2015

94 93 93 94 94 94 94 94 94 96 96 94 93

0

10

20

30

40

50

60

70

80

90

100

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

%

SATISFACTION: JOB % OF PLACES PEDIATRICIANS REPORTING “STRONGLY AGREE” OR

“AGREE” THAT THEY ARE SATISFIED WITH CURRENT JOB

87%

88%

88%

91%

88%

89%

0% 20% 40% 60% 80% 100%

Gender

Cohort

Specialty

Men

Women

General Pediatrics

Subspecialty

2009-11 Graduates

2002-04 Graduates

Source: AAP PLACES Annual Survey, 2014 (n=1626)

7

But, a significant minority are likely to report burnout

• More than a quarter of PLACES pediatricians

• Lower than most specialties

PLACES PARTICIPANTS REPORTING CURRENT BURNOUT AT WORK

Source: AAP PLACES Annual Survey, 2013 (n=1666)

4

24 23

38

10

0

10

20

30

40

50

60

70

Strongly Agree Agree Neutral Disagree StronglyDisagree

%

28% Report Current Burnout

8

Are very busy starting families and starting careers

• Most are parents of young children

• Most in two career couples

• Multiple life transitions

EARLY CAREER PEDIATRICIANS AS PARENTS

Source: AAP PLACES Annual Survey, 2013 and Graduating Resident Survey, 2012-2015

Starting Families

• 31% are parents at residency graduation

• 61% are parents 2-4 years out of residency

• 87% are parents 9-11 years out of residency

Two-Career Couples

• About 1/3 are in two-physician couples

• 82% are in two-parent working families

•91% of women •60% of men

WORK-LIFE BALANCE: LIFE EVENTS % OF PLACES PEDIATRICIANS WHO EXPERIENCED

LIFE EVENT

Source: AAP PLACES Annual Survey, 2012-14 (2009-2011 Residency Graduate Cohort; n=901)

Major life changes after

residency

Ever experienced from 2012 to 2014

Started New Job 67%

Moved to New Area 56%

Pregnant or Had/ Adopted Child 56%

Financial Difficulties 20%

9

Place high priority on work-life balance

“I love being a pediatrician and would

recommend this field of medicine to

anyone. My toughest challenge is

finding balance” (PLACES participant)

Source: AAP PLACES Annual Survey, 2012

PRIORITY TOPICS ON THE MINDS OF PLACES PARTICIPANTS: WHAT SHOULD WE BE ASKING YOU? 2015

Source: AAP PLACES Annual Survey, 2015 (n=1572)

Women

Men

Work-life balance 45% 42%

Burnout at work 36% 34%

Rewards and challenges with raising own children

36% 25%

Career development and transitions

25% 23%

Personal health and well-being 20% 23%

WORK-LIFE BALANCE: STRESS PERCEIVED AMOUNT OF STRESS BALANCING WORK AND PERSONAL

RESPONSIBILITIES

Source: AAP PLACES Annual Survey, 2015 (n=1619)

17 10

39 32

0

10

20

30

40

50

60

70

Women Men

%

Very stressed Moderately stressed

56%

42%

10

Likely to work part- time • Members overall have plateaued at

25% part-time • Women more likely to work part-

time • Men are increasingly likely to choose

part-time late in their careers

PERCENTAGE OF PEDIATRICIANS WORKING PART TIME 2006-’13 (N=10,268)

Age group Female pediatricians

Male pediatricians

Under 40 years old 34% 4%

40-49 years old 40% 5%

50-59 years old 42% 5%

60 years and older 32% 20%

Source: Pooled data from the AAP Periodic Survey 2006-13

IN SUMMARY: 10 THINGS TO KNOW ABOUT EARLY CAREER PEDIATRICIANS

1. Likely to be women 6. Highly satisfied with career & position

2. Less likely to pursue primary care

7. Significant minority with burn-out

3. Likely to be an employee 8. Very busy starting families

4. High educational debt 9. High priority on work-life balance

5. Many with international background

10. Likely to work part-time

January 2016

QUESTIONS

• What are the opportunities coming from these generational shifts?

• What do young pediatricians need to survive and thrive?