Дефицит педиатрических дерматологов: треть программ обучения остается без кандидатов

Pediatric dermatology continues to experience workforce shortage Key takeaways: - Despite the availability of many fellowship programs, there are a limited number of board-eligible fellowship applicants. - This has resulted in nearly a third of programs failing to match positions. The need for pediatric dermatologists continues to exceed the available workforce as multiple fellowship programs remain unfilled, according to a study published in Pediatric Dermatology. Despite the availability of numerous fellowship programs, the limited number of board-eligible fellowship applicants has resulted in 32% of programs failing to match positions, according to the study. “In the post-pandemic years, more families have moved away from urban areas, leading to a 6% cumulative decrease in children under age 5 in urban cities,” Christina Druskovich, MD, a resident physician at the University of Utah, and colleagues wrote in the study background. “This shift exacerbates the maldistribution of subspecialists across the country and creates larger gaps in access to specialized care offered by pediatric dermatologists. There is little awareness by the lay public and medical community regarding this increasing demand and lack of clinicians to fill this role, as well as the type of training and certification required to become a board-certified pediatric dermatologist.” Applicant data; match trends For the retrospective study, the researchers examined pediatric dermatology fellowship applicant data and match rate trends from 2009 to 2023. They also assessed the quantity of board certification among new pediatric dermatologists from 2010 to 2023 as well as current workforce trends. The study included 277 applicants recorded in the Society of Pediatric Dermatology and San Francisco Match database. On the applicant level, results showed the mean number of applicants per year was 19, ranging from the least active year totaling 11 applicants in 2020 to the highest totaling 25 in 2022. The applicant match rate across 15 years was 96%; however, researchers noticed a substantial decline to 81% in 2023. In 2020, the first non-board-eligible applicant — defined as an applicant who is not anticipated to have a primary American Board of Dermatology certification at the time of fellowship completion — participated in the official San Francisco Match. This set the trend for another non-board-eligible application in 2021, followed by three in 2022 and eight in 2023. Half of non-board-eligible applicants matched in 2023 compared with 93% of board-eligible applicants, according to the study. At the program level, the average match rate was 68% from 2009 to 2023, with the lowest rate being 46% and the highest 91%. The greatest number of pediatric dermatology programs matched in 2014, totaling 21. The average unmatched program rate was 32%. According to the study, 2018 saw the highest unmatched program rate at 55% as well as the lowest position fill rate at 9%. The average position fill rate was 57%. The five programs that matched the most applicants were the University of California San Diego, University of California San Francisco, Children’s Hospital of Philadelphia, Boston Children’s Hospital and Lurie Children’s/Northwestern. The location of these programs corresponded to the distribution of the current pediatric dermatologist workforce, according to the researchers. “The most popular regions to remain after fellowship were the Pacific, followed by East North Central and then Middle Atlantic,” the researchers wrote. More than half of the 307 pediatric dermatologists who became board certified between 2010 and 2023 practiced in the same region as their prior training. Seventy-five percent of pediatric dermatologists remained in an academic setting, whereas 24.5% transitioned to private practice (0.5% were unaccounted for). ‘More equitable’ compensation needed According to the researchers, there are multiple factors that likely influence the pediatric dermatology workforce shortage and maldistribution. “Compensation models that emphasize individual productivity and collections typically disadvantage pediatric dermatologists who perform fewer procedures and see a disproportionate share of children on Medicaid,” the researchers wrote. “To potentially increase the number of dermatologists subspecializing in pediatric dermatology, compensation needs to be more equitable between general dermatologists and pediatric dermatologists.” The American Board of Dermatology recently implemented new pathways to increase the number of pediatric dermatologists in the U.S., including a 3-year dermatology residency track with a pediatric dermatology focus within select residency training programs, leading to board certification in general dermatology. A subsequent 1-year pediatric dermatology fellowship is required to become subspecialty certified. The board also created a pathway for international medical graduates who are full-time faculty members in a department of dermatology for at least 5 consecutive years at the same institution in the U.S. or Canada, with the academic rank of assistant professor or higher. “With the small number of applicants, efforts should be made to increase interest in pediatric dermatology fellowship, with the aim to expand the current subspecialty workforce,” the researchers wrote. “More access to pediatric dermatology means more equitable care for children.”