Funding Sources and Financial Insecurity in Pediatric Fellowship Programs

Transcription

1 Funding Sources and Financial Insecurity in Pediatric Fellowship Programs Pnina Weiss, MD, Angela L. Myers, MD, MPH, Kathleen A. McGann, MD, Katherine E. Mason, MD, Jennifer C. Kesselheim, MD, Med, Geoffrey M. Fleming, MD, Christine Barron, MD, Ann Klasner, MD, MPH, Melvin B. Heyman, MD, Doria L. Weiss, Elizabeth Mauer, MS, Linda M. Gerber, PhD, Erika L. Abramson, MD S L I D E 0

2 Background Critical shortages in many pediatric subspecialties In some subspecialties, inadequate recruitment of new fellows to replace the retiring physicians Challenges to developing pediatric physician scientists Committee on Pediatric Workforce. Pediatrics. 2013; Mayer ML. Pediatrics. 2006; Pletcher et al. J Pediatr. 2010; Hayes. Chest. 2014; Primack, et al. Am J Kidney Dis. 2015; ABP Pediatric Physicians Workforce Data Book ; Shurin SB. Arch Pediatr Adolesc Med S L I D E 1

3 AAP Committee on Pediatric Workforce The current system of funding graduate medical education (GME).provides insufficient financial support to address the current and future pediatrician workforce needs of the nation s.children Financing Graduate Medical Education to Meet the Needs of Children and the Future Pediatrician Workforce. Pediatrics. 2016;137 S L I D E 2

4 Hypothesis In pediatric subspecialty fellowships, funding constraints limit program size and educational resources and lead to financial insecurity S L I D E 3

5 Methods Survey to fellowship program directors (FPD) Nov 1, Feb 9, 2017 APPD and Council of Pediatric Subspecialty (CoPS) listservs Statistical analysis Chi-square/Fisher s Exact tests Multivariate analysis R version S L I D E 4

6 Results- Response rates by subspecialty Program Responded % Total programs Adolescent Medicine Cardiology Child Abuse Critical Care Developmental Behavioral Emergency Medicine Endocrinology Gastroenterology Hematology- Oncology Infectious Disease Neonatalogy- Perinatalogy Nephrology Pulmonology Rheumatology Total S L I D E 5

7 Funding sources of fellows salary S L I D E 6

8 Lack of funding limited access to educational resources in fellowship programs Resource % of programs without funding (N=519) Research supplies 12 Journals/books 10 Courses 17 Advanced degrees 36 Society membership 20 Travel to meetings 2 In training exam 3 S L I D E 7

9 Insufficient funding limited the size of fellowship programs 7% had to decrease the number of fellows 16% couldn t increase the number of fellows S L I D E 8

10 Definition of insecurity Indicate how secure you feel about funding for fellow salary this year and future years S L I D E 9

11 Definition of insecurity Indicate how secure you feel about funding for fellow salary this year and future years Insecure < 1.5 S L I D E 10

12 Insecurity in fellowship programs by academic year Academic year % of programs that are insecure (N=519) and later 19 S L I D E 11

13 Insecurity (2018 and later) by size and type of program Number of fellows Program type No. of programs % Insecure P > Hospital- based Nonhospital-based Hospital-based Neonatology Emergency Medicine Critical Care S L I D E 12

14 Independent predictors for insecurity (2018 and later) Size OR (95% CI) P >7 fellows Funding source Hospital or GME/CHGME Extramural Division Not: funding from department or T32 or program type S L I D E 13

15 Limitations Low response rate in 3 subspecialties Insecurity perceived by FPD may not reflect actual funding Salary sources of trainees, not FPD administrative time S L I D E 14

16 Conclusions In fellowship programs, insufficient funding has Limited recruitment and educational resources Led to financial insecurity Fellowships at high risk of insecurity Small (< 6 fellows) Funded by extramural sources or division Lack hospital or GME/CHGME funding S L I D E 15

17 Implications More stable funding of fellowship programs is critical to maintaining an adequate pediatric subspecialty workforce Restructuring of fellowship programs may need to be considered Advocacy for fellowship programs is crucial! Particularly for those that are most at risk! S L I D E 16

18 Thanks! Angela L. Myers, MD, MPH Kathleen A. McGann, MD Katherine E. Mason, MD Jennifer C. Kesselheim, MD, Med Geoffrey M. Fleming, MD Christine Barron, MD Ann Klasner, MD, MPH Melvin B. Heyman, MD Doria L. Weiss Elizabeth Mauer, MS Linda M. Gerber, PhD Erika L. Abramson, MD, MSc S L I D E 17

19 S L I D E 18

20 Funding sources for educational resources S L I D E 19

21 Geographic regions of programs Region N % total programs Midwest Northeast Southeast Southwest 42 8 West S L I D E 20

22 Differences between hospital-based and nonhospitalbased programs based on size and source of salary Hospital -based programs Nonhospital-based programs P value > 7 fellows 58% 19% <0.001 Source of salary Hospital 73% 57% <0.001 T32 11% 25% <0.001 Pediatric dept 27% 37% 0.04 Extramural 8% 24% <0.001 Division 35% 30% NS Hospital-based Neonatology Emergency Medicine Critical Care S L I D E 21

23 Funding by T32 S L I D E 22

24 Security 2018 and later by Program Key 1 Adolescent Medicine 2 Cardiology 3 Child abuse 4 Critical Care 5 DBP 6 EM 7 Endocrinology 8 GI 9 Heme/Onc 10 ID 11 Neonatology 12 Nephrology 13 Pulm 14 Rheum S L I D E 23

25 Indicate how secure you feel about funding for fellow salary n mean SD median % insecure and later S L I D E 24

26 Security 2018 and later by number of fellows Number of fellows Insecure (26%) (26%) (13%) > 9 7 (10%) * p = 0.04 S L I D E 25

27 Insecurity/Security Insecure < 1.5 Secure > 2.5 S L I D E 26

28 Predictors for security (>2.5) OR (95% CI) P value >7 fellows Hospital or GME/CHGME Extramural Division Non-hospital S L I D E 27

29 In what other ways has insufficient funding impacted your program? Recruitment Scholarly activity Educational resources Statistical support for research Travel to conferences Limited 4 th year fellows Increased reliance on international fellows Increased time and energy devoted to obtaining the funds S L I D E 28