Lifetime Earning Potential and Workforce Distribution in Developmental and Behavioral Pediatrics

Eva Catenaccio; Jonathan M Rochlin; Carol Weitzman; Marilyn Augustyn; Harold K Simon

doi:10.1016/j.acap.2022.09.017

Lifetime Earning Potential and Workforce Distribution in Developmental and Behavioral Pediatrics

Acad Pediatr. 2023 Apr;23(3):579-586. doi: 10.1016/j.acap.2022.09.017. Epub 2022 Oct 1.

Authors

Eva Catenaccio¹, Jonathan M Rochlin², Carol Weitzman³, Marilyn Augustyn⁴, Harold K Simon⁵

Affiliations

¹ Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Philadelphia (E Catenaccio), Philadelphia, PA. Electronic address: catenaccie@chop.edu.
² Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center (JM Rochlin), Brooklyn, NY.
³ Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital/Harvard School of Medicine (C Weitzman), Boston, MA.
⁴ Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine (M Augustyn), Boston, Mass.
⁵ Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta (HK Simon), Atlanta, GA.

PMID: 36191811
DOI: 10.1016/j.acap.2022.09.017

Abstract

Objectives: Compare lifetime earning potential (LEP) for developmental and behavioral pediatrics (DBP) to general pediatrics and other pediatric subspecialties. Evaluate association between LEP for DBP and measures of workforce distribution.

Methods: Using compensation and debt data from 2018 to 2019 and a net present value analysis, we estimated LEP for DBP compared to general pediatrics and other pediatric subspecialties. We evaluated potential effects of eliminating educational debt, shortening length of fellowship training, and implementing loan repayment or forgiveness programs for pediatric subspecialists. We evaluated the association between LEP for DBP and measures of workforce distribution, including distance to subspecialists, percentage of hospital referral regions (HRRs) with a subspecialist, ratio of subspecialists to regional child population, and fellowship fill rates.

Results: LEP was lower for DBP than for general private practice pediatrics ($1.9 million less), general academic pediatrics ($1.1 million less), and all other pediatric subspecialties. LEP of DBP could be improved by shortening fellowship training or implementing loan repayment or forgiveness programs. LEP for subspecialists, including DBP, was associated with distance to subspecialists (-0.5 miles/$100,000 increase in LEP, 95% confidence interval [CI] -0.98 to -0.08), percentage of HRRs with a subspecialist (+1.1%/$100,000 increase in LEP, 95% CI 0.37-1.83), ratio of subspecialists to regional child population (+0.1 subspecialists/100,000 children/$100,000 increase in LEP, 95% CI 0.04-0.17), and average 2014 to 2018 fellowship fill rates (+1% spots filled/$100,000 increase in LEP, 95% CI 0.25-1.65).

Conclusions: DBP has the lowest LEP of all pediatric fields and this is associated with DBP workforce shortages. Interventions to improve LEP may promote workforce growth.

Keywords: developmental and behavioral pediatrics; health services research; workforce.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Fellowships and Scholarships
Humans
Income*
Pediatrics*
Referral and Consultation
United States
Workforce