1. The Med-Peds Workforce What can we tell people about us? Michael J. Donnelly, M.D., FACP, FAAP Associate Professor of Medicine and Pediatrics Medstar Georgetown University Hospital

2. Sources of workforce info- The 5 A’s AMA Masterfile AAMC 2014 Physician Specialty Data Book AAMC 2015 Report on Residents AAP Workforce Survey Allen

3. Problems with these sources AMA Masterfile ▫Survey-Are the respondents representative? AAMC 2014 Physician Specialty Data Book ▫Relies on AMA Masterfile AAMC 2015 Report on Residents ▫Relies on Masterfile, AAMC faculty roster, GME track survey, MSQ and GQ (coming and going from medschool), MCAT, USMLE and Student Records System. AAP Workforce Survey ▫Relies on AAP and SHM registries, and response rate.

4. How many of us are there, really? Denominator- best guesses: AMA- 2012-- 5246 physicians AAMC 2013--4396 Physicians Allen- Estimates 8000 grads from programs Photo credit : allthingsd.com Minion Crowd Photo allthingsd.com

5. From the AAMC We are Small

6. We have a greater proportion of women than other specialties. AMA Masterfile:50.9%

7. We are among the youngest. Photo from:http://www.halloweenoutfitsforcheap.com/ infant-doctor-halloween-costumes/

8. Grads Practicing in Underserved Areas Residents Who Last Completed Training, 2003-12. From the AAMC resident survey NumberPercentTotal Family Medicine5,65221.925,866 Internal Medicine5,94022.226,808 Pediatrics3,05622.613,531 Internal Medicine/Pediatrics42727.11,577 Total of ALL trainees in survey44,85321.7%206,376 Source: AAMC 2015 Report on Residents. Accessed at: https://www.aamc.org/data/421300/residentsreport.html

9. Physician Retention in State of Residency Training, 2004-2013 41% of Med-Peds residents leave the state where they trained. Overall 42.5% of women finishing residency move out of state, compared to 50.9% of men. Please note: Californians are least likely to move (22%) Source: AAMC 2015 Report on Residents. Accessed at: https://www.aamc.org/data/421300/residentsreport.html

10. AAP Workforce Survey  Core developed by AAP Workforce Division, added questions for Med-Peds added by the SOMP Survey committee.  Sent to 3378 AAP and SHM members listed as Med-Peds from 9/2013-2/2014 via SurveyMonkey  N=1321; Response rate 39% (combined response rate for AAP SOMP and SHM Med-Peds members)

11. Race White79.0% Asian13.5% AfricanAmerican4.6% Hispanic3.8% NativeHawaiian/Pac Isl.0.9% NativeAmer./Alaskan0.8% Other3.5% Years since med school graduation- mean 14.1 years range (0-37)- So about 10 years into practice USMG- 93.5% 92.2% see both adults and children in practice 34.8% of patient load was pediatric (mean of all respondents)

12. Do you consider yourself a PCP? 63.2% a Hospitalist? 22.5% (~50% of the hospitalists said they were both PCP’s and hospitalists.) ABMS Subspecialty Certified 20.1%

13. Where do you work? Main employment siten% Medical school/hospital/parent university39933.8% Multispecialty group22719.3% Community/staff model hospital16113.7% Non-profit community health center or health department867.3% Specialty group practice716.0% Solo practice625.3% Pediatric group practice322.7% HMO staff/group model322.7% Uniform health services clinic40.3% Other1058.9%

14. How many hours do you work in a week?

15. 55% of Respondents hold an Academic Appointment

16. What percent of your patients are in the following age groups? mean response +/- 1SD Historical 18-64 yr group was 43.2%, this data set had 47.8% from Characteristics of Medicine-Pediatrics Practices: Results From the National Ambulatory Medical Care Survey Fortuna, Ting, Kaelber, and Simon.

17. How many times have you changed jobs since residency?

18. Effect on salary

19. Satisfaction with Training 92.9% of respondents were somewhat or very satisfied with training. 85.1% are very or somewhat likely to do it again and 10.7% would not.

20. What effect did duty hours regulations have on your training? Frequency Valid Percent I did not train under duty hours regulations. 56447.5 Very negative effect141.2 Somewhat negative effect13111.0 Neutral effect30025.3 Somewhat positive effect15913.4 Very positive effect201.7

21. In general, how satisfied are you with your work life balance? FrequencyPercent Very satisfied34429.0 Somewhat satisfied52844.6 Neither satisfied nor unsatisfied 685.7 Somewhat unsatisfied 19116.1 Very unsatisfied544.6

22. Conclusions: We don’t have great workforce data. I didn’t do this alone, special thanks to: AAP- ▫Katy LermanCarrie Radabaugh ▫Holly Ruch-Ross ▫Allen Friedland and J. Thomas Cross Survey and/or writing help- ▫Michael Lukela, David Kaelber, Amy Burke ▫Jason Umans, Sarah Thornton, Lauren Lubrano (and my wife for her eternal patience when I am working on stuff like this on our couch at night)

26. The Pipeline Source http://www.dispatchcrude.com/blog/pipeline-capacity-squeeze-reroutes-crude-oil The Med-Peds Pipeline

27. Scores and Experience of Interns ACGME-Accredited Specialties Description of Test or ExperienceNAverage Standard Deviation50th Percentile Family MedicineMCAT Score2,71327.05.227.0 *STEP 1 Score1,488215.217.8213.0 *STEP 2 CK Score1,489229.618.3229.0 # research experiences3,1561.31.41.0 # volunteer experiences3,1566.04.65.0 Internal MedicineMCAT Score6,15529.75.130.0 STEP 1 Score4,773229.319.0231.0 STEP 2 CK Score4,786241.318.2243.0 #research experiences8,3572.11.92.0 # volunteer experiences8,3575.34.05.0 Internal Medicine/ Pediatrics MCAT Score33430.34.430.0 STEP 1 Score308229.017.0231.0 STEP 2 CK Score308243.016.3244.0 # research experiences3502.11.72.0 # volunteer experiences3507.94.77.0 PediatricsMCAT Score2,33329.44.529.0 *STEP 1 Score1,933222.418.6222.0 *STEP 2 CK Score1,935237.918.3239.0 # research experiences2,7382.01.72.0 # volunteer experiences2,7387.04.56.0 Source: AAMC 2015 Report on Residents. Accessed at: https://www.aamc.org/data/421300/residentsreport.html

28. Reduce Med-Peds workload FrequencyValid Percent Yes19517.0 No78368.4 Don't know16614.5 Retire from Med-Peds FrequencyValid Percent Yes252.2 No103791.5 Don't know716.3 Move into a non-clinical role in medicine FrequencyValid Percent Yes847.4 No88677.9 Don't know16714.7 Pursue another specialty FrequencyValid Percent Yes353.1 No102790.6 Don't know726.3 Pursue a career outside of medicine FrequencyValid Percent Yes383.4 No94083.3 Don't know15113.4 In the next 5 years do you plan to: (28.5% of respondents will be reducing workload in next 5yrs)

29. Q56 - Reasons for leaving Medpeds(rank up to three) The hours are too long. FrequencyValid Percent Most important10742.1 2nd most important10942.9 3rd most important3815.0 The practice is too stressful. FrequencyValid Percent Most important9537.1 2nd most important10139.5 3rd most important6023.4 I like Med-Peds, but I have better opportunities outside the field. FrequencyValid Percent Most important6338.7 2nd most important3420.9 3rd most important6640.5 I will reach retirement age. FrequencyValid Percent Most important2337.7 2nd most important58.2 3rd most important3354.1 I expect to lose my job due to downsizing or other market factors. FrequencyValid Percent Most important916.7 2nd most important1120.4 3rd most important3463.0

32. Instead of 1 Medpeds doc per 20,760 children, we are really 1 Med-Ped/71,913 total patients according to population calculations

33. Full-Time Faculty Appointments Graduates from 2004-2013 Specialty Current Faculty Appointment Prior Faculty Appointment No Faculty Appointment Ever Total NumberPercentNumberPercentNumberPercent Family Medicine1,1474.05982.126,92793.928,672 Internal Medicine3,23710.51,3924.526,25985.030,888 Pediatrics1,71511.48605.712,48582.915,060 Med-Peds32216.5995.11,52778.41,948 Source: AAMC 2015 Report on Residents. Accessed at: https://www.aamc.org/data/421300/residentsreport.html Specialty Professor Associate Professor Assistant ProfessorInstructor Other Rank No Appointment NumberPercentNumberPercentNumberPercentNumberPercent Medicine/Pediatrics00.040.225913.3583.00.183.5

34. AMA Master file 2013 Total Active Physicians- 4396 ▫Patient Care-4014 91.3% ▫Teaching-431.0% ▫Research-290.6% ▫Other-3107.1%