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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?