The Future of Academic General Pediatrics Stephen Ludwig, MD Children’s Hospital of Philadelphia University of Pennsylvania School of Medicine

No Conflicts of Interest or Disclosures

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Tsedakah = Giving

Tsedakah = Justice

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Tsedakah !!

The Future of Academic General Pediatrics

General Pediatrics Giving – to patients, students, residents. Justice – Child advocacy, child abuse, emergency care.

Academic General Pediatrics - Changing Triangles to Diamonds Patient Care Teaching Patient Care TeachingResearch Advocacy Research

Rudolf Ludwig Karl Virchow  “medical education does not exist to provide students with a way of making a living, but insure the health of the community”  “physicians are the natural attorneys of the poor, and the social problems should largely be solved by them”

General Pediatrics Academic Justice

Ask - Why???

Why does taking care of poor general pediatric patients yield less return?

Departmental Budgets  General Pediatrics –Revenue $200,00 –Chairman’s Tax 24%= $48,000 –Net Revenue $152,000 $152,000  Gastroenterology –Revenue $200,000 –Chairman’s Tax 24%= $48,000 –Net Revenue $152,000 FAIR?

Look More Closely  General Pediatrics –60% medical assistance –20% self pay i.e. no pay i.e. no pay -High no show rate -Heavy teaching burden - No Procedures  Gastroenterology –10% medical assistance –10% no pay –Many lucrative procedures

Shouldn’t the tax and net income reflect the patient population? Or the amount of work?

Why does a pediatric resident have a more difficult time choosing a career in general pediatrics?

Resident A  Going into a pediatric subspecialty  Can find the listing of all the programs  Knows that the programs are accredited by the ACGME  Can easily set up interviews  Enters an organized match  Completes his/her fellowship and becomes ABP Certified

Resident B  Wants- Academic General Pediatrics  Cannot find which programs are available  Is not sure of the uniformity and quality of the programs  Has variable timelines for application and selection  Will receive no certificate for his/her training

If you were a bright eager pediatric - resident which path would you choose?

Proposal  APA becomes the sanctioning body for Academic General Pediatric Fellowship programs  APA set standards for programs  Develop a system to support and enrich existing programs and encourage new programs to develop

 Develop common “marketing” strategies  Try to include any non-boarded AGP area of interest –Academic General Pediatrics –Environmental Health –Child Abuse –Hospital Based Pediatrics –others  Promote advanced scholarship

Fellowship Project Working Group Constance Baldwin, PhD Peter Szilagyi, MD, MPH Lou Bell, MD Bernard Dreyer, MD Tina L. Cheng, MD, MPH Dan Coury, MD Tom deWitt, MD Paul Darden, MD Ray Baker, MD, M.Ed. Ann Duggan, ScD. Stephen Ludwig, MD

It’s All About Pipeline

Work to Date  Developed Goals and Objectives  Developed Program Requirements  Site Visited 7 Programs  Summarized the Data and Feedback about the process  Obtained funding from DHHS-Bureau of Health Professions  Where to next??

ISSUES  Parity and status with other training programs  Academic rigor  Program accreditation or consultation  Required versus voluntary participation  Maintaining flexibility – teaching to strengths  Funding

Why does a general pediatric researcher have a more difficult time finding funding?

Research OR

Research  Microscopic view versus the macroscopic view  People are our basic unit of measure  Scientific principles used for both  Application indirect versus direct  Value and status in the academic milieu

NIH OD-NCI-NEI-NHLBI-NHGRI-NIA- NIAAA-NIAID-NIAMS-NIBIB- NICHD-NIDCD-NIDCR-NIDDK- NIDA-NIEHS-NIGMS-NIMH-NLM- CIT-CSR-FIC-NCCAM-NCMHD- NCRR-CC OD-NCI-NEI-NHLBI-NHGRI-NIA- NIAAA-NIAID-NIAMS-NIBIB- NICHD-NIDCD-NIDCR-NIDDK- NIDA-NIEHS-NIGMS-NIMH-NLM- CIT-CSR-FIC-NCCAM-NCMHD- NCRR-CC

AGP Research  Important issues 2007 and beyond –Safety –Quality –Population based research –Adherence/Change Methodology –Health Disparities –Medical education –Chronic illness –Care coordination

Why do some academic professional societies fail to recognize the Academic General Pediatrician?

The Pediatric Academic Society  Annual registration e.g Meeting –Total registrants = 5114 –Guests = 1964 –Members = 2002 –SPR Only Members –APA Only Members –APS Only Members - 79

PAS  Quality of presentations – high  The meeting itself is great  Our voice is not heard in –the location of the meeting –the expenditures –the transparency of operations

The American Board of Pediatrics  Every subspecialty is represented by a sub-board  The job of the sub-board is to write exam questions  But each also has an opportunity to raise issues and questions that are of concern to pediatrics  Academic General Pediatrics is not represented

The Ambulatory Pediatric Association  Mission Statement

APA Mission The APA fosters the health of children, adolescents and families by promoting generalism in academic pediatrics and academics in general pediatrics.

The Ambulatory Pediatric Association  Mission Statement  Form Bonds with –APPD and student education organizations –Societies for adolescent and developmental peds.  Keep members in the organization –Hospitalists –Pediatric Emergency –Child abuse –Environmental health –Academic generalists

But It Is Not About Complaining  It is about organizing  It is about setting priorities  It is about leadership  It is about filling our pipeline with great young people  It is about doing rigorous meaningful research  It is about taking control of our future  It is not anti-subspecialty - it is pro generalism

It’s about… continued giving continued advocacy and social justice JUSTICE for Ourselves