The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being

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Pediatric subspecialists are critical to ensuring quality care and pursuing research to improve prevention, diagnosis, and treatment for children. However, there are substantial disincentives to pursuing a career as a pediatric subspecialist, which are often heightened for individuals from groups underrepresented in medicine, and more effective collaboration with primary care clinicians is needed. Changing health care needs, increasing care complexity, and access barriers to pediatric subspecialty care have raised concerns about the current and future availability of pediatric subspecialty care and research.

In response, the National Academies, with support from a coalition of sponsors, formed the Committee on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being to recommend strategies and actions to ensure an adequate pediatric subspecialty physician workforce to support broad access to high quality subspecialty care and a robust research portfolio to advance the health and health care of infants, children, and adolescents. This report outlines recommendations that, if fully implemented, can improve the quality of pediatric medical subspecialty care through a well-supported, superbly trained, and appropriately used primary care, subspecialty, and physician-scientist workforce.

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Publication information

384 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-70840-0
ISBN Ebook: 0-309-70841-9
DOI: https://doi.org/10.17226/27207

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2023. The Future Pediatric Subspecialty Physician Workforce: Meeting the Needs of Infants, Children, and Adolescents. Washington, DC: The National Academies Press.

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Frederick P. Rivara

Frederick P. Rivara M.D., M.P.H. (chair), is the holder of the Seattle Children’s Guild Association Endowed Chair in Pediatric Outcomes Research, Vice chair and Professor of Pediatrics and adjunct Professor of Epidemiology at the University of Washington. Dr. Rivara earned a bachelor’s degree at the College of the Holy Cross in Worcester, MA and received his MD from the University of Pennsylvania and an MPH from the University of Washington. He completed residencies at the Children’s Hospital Medical Center in Boston and the University of Washington and was a Robert Wood Johnson Clinical Scholar at the University of Washington. He is editor-in-chief of JAMA Network Open after serving for 17 years as editor-in-chief of JAMA Pediatrics.

He has received numerous honors including the Charles C. Shepard Science Award from the Centers for Disease Control and Prevention, the American Public Health Association, Injury Control and Emergency Health Services Section Distinguished Career Award, and the American Academy of Pediatrics, Section on Injury and Poison Prevention, Physician Achievement Award, the UW School of Public Health Distinguished Alumni Award, and the UW Medicine Minority faculty Mentoring Award. Dr. Rivara was elected to the Institute of Medicine (now National Academy of Medicine) in 2005. He was awarded the Joseph St. Geme, Jr Leadership award from the Federation of Pediatric Organizations in 2021.

Dr. Rivara previously was the chair of the Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention, Institute of Medicine, Chair of the Committee on Oral Health Access to Care, member of the Committee on Adolescent Health Care Services and Models of Care, Institute of Medicine, and Vice-chair of the Committee on Sports Related Concussions in Youth, Institute of Medicine.

Kelly Betts

Kelly Betts, Ed.D., RN, APRN, PCPNP-BC, CNE is currently the Assistant Dean for the University of NE Medical Center (UNMC) College of Nursing in Scottsbluff Nebraska. She is also a practicing Primary Care Pediatric Nurse Practitioner at a Federally Qualified Health Center (FQHC) in Gering, NE. In her clinical practice, she cares for minority and underserved children in the panhandle of rural Nebraska. Currently at UNMC, she was awarded funding for an lnterprofessional grant with the UNMC Dental Hygiene program to integrate oral health risk assessment into pediatric well-child visits. Dr. Betts is also trained as a Sexual Assault Nurse Examiner (SANE) and provides these services as needed to the rural counties in the Panhandle. Dr. Betts has over 15 years teaching nursing students at both the undergraduate and graduate level. She received her Educational Doctorate from Walden University and her APRN Post Masters Certificate as a Pediatric Nurse Practitioner at the University of Arkansas for Medical Sciences. She is a member of Sigma Theta Tau International Nursing Society, The National Association of Pediatric Nurse Practitioners, Nebraska Nurse Practitioner Association, and the National League for Nursing.

Kendall M. Campbell

Kendall M. Campbell, M.D., FAAFP, is Professor and Chair of the department of Family Medicine at the University of Texas Medical Branch. Prior to this appointment he served as the Senior Associate Dean for Academic Affairs and Director of the Research Group for Underrepresented Minorities in Academic Medicine at the Brody School of Medicine in North Carolina. His research expertise includes issues impacting the recruitment and retention of underrepresented minority students and faculty. He is well published in this area and nationally known for his contributions. He co-founded and is faculty in the Society of Teachers of Family Medicine Leadership through Scholarship fellowship, a writing fellowship to promote profession advancement for early career academic family medicine physicians who are underrepresented in medicine. Dr. Campbell is a member of the National Academy of Medicine (NAM) roundtable on health equity and was elected to the NAM in 2021. He completed his medical school training at the University of Florida College of Medicine and residency training at Tallahassee Memorial Healthcare.

Kecia N. Carroll

Kecia N. Carroll, M.D., M.P.H., is Chief of the Division of General Pediatrics and Professor of Pediatrics and Environmental Medicine & Public Health at the Icahn School of Medicine at Mount Sinai. Dr. Carroll is a research-fellowship trained epidemiologist, clinical-researcher, and board-certified pediatrician. She is a former recipient of early career investigator awards from the Parker B. Francis Fellowship Program in Pulmonary Medicine and the National Institutes of Health (NIH) and her current NIH-funded research program investigates how prenatal and early life environmental exposures influence childhood asthma risk with the long-term goal to decrease morbidity or prevent disease. Dr. Carroll also has a focus on research mentor training and creating and fostering inclusive environments in academic medicine and served as the Director of Inclusion and Diversity for the Pediatric Office of Faculty Development at Vanderbilt University Medical Center. She is the Inaugural Senior Mount Sinai Biomedical Laureate in Clinical/Translational Research- a program created to foster inclusive research and mentoring environments. She obtained her undergraduate degree at Vassar College and completed medical school at Vanderbilt University School of Medicine, pediatric residency at the University of California, San Francisco, and an Academic General Pediatrics Fellowship at Vanderbilt.

Candice Chen

Candice Chen, M.D., M.P.H., is an Associate Professor of Health Policy and Management at the Fitzhugh Mullan Institute for Health Workforce Equity in the Milken Institute School of Public Health at the George Washington University. Her work focuses on health workforce equity, which includes diversity, social mission of health professions schools, workforce distribution, service to vulnerable populations, training for new models of care, and equity for the workforce. Her research has examined medical school outcomes in primary care, practice in underserved communities, and diversity; graduate medical education “imprinting” on the cost practice patterns of physicians; and identifying the workforce providing high need services in reproductive health services and to Medicaid populations. Dr. Chen serves on the American Board of Pediatrics’ Research Advisory Committee and is a board member for Authority Health GME and the Accreditation Council for Graduate Medical Education, International. Dr. Chen was previously the Director of the Division of Medicine and Dentistry in the Bureau of Health Workforce at the Health Resources and Services Administration, where she led programs to enhance training in primary care, oral health, and geriatrics, including graduate medical education programs in children’s hospitals and Teaching Health Centers. Dr. Chen is a board-certified pediatrician. She received her medical degree from Baylor College of Medicine and her Master of Public Health from the George Washington University with a concentration in Community Oriented Primary Care.

Christopher B. Forrest

Christopher B. Forrest, M.D., Ph.D., is a pediatrician and health services and outcomes researcher. He is the Director of PEDSnet (pedsnet.org), a national pediatric learning health system with 11 children’s hospital members. PEDSnet has created a longitudinal electronic health record database for >12 million children, and the network conducts observational research and pediatric clinical trials across all pediatric subspecialty areas. Chris serves as the Director of the CHOP Applied Clinical Research Center, which is the institutional home for PEDSnet, and the Program Director for PEDSnet Scholars, an AHRQ/PCORI funded K12 faculty development program. His research group has developed numerous pediatric patient-reported outcome measures, both child self-report and parent-proxy versions. He co-edited the new Handbook of Life Course Health Development, which has been downloaded over 700,000 times from the Springer web site. Forrest received his BA and MD degrees from Boston University and his PhD (Health Policy and Management) from Johns Hopkins University.

Elena Fuentes-Afflick

Elena Fuentes-Afflick, M.D., M.P.H., is Professor of Pediatrics and Vice Dean for Zuckerberg San Francisco General Hospital, University of California, San Francisco. An academic generalist, Dr. Fuentes-Afflick’s expertise is in the fields of perinatal epidemiology, acculturation, Latino health, professionalism, misconduct, and diversity in academic medicine. Dr. Fuentes-Afflick has served as President of the Society for Pediatric Research, the American Pediatric Society, is an elected member of the National Academy of Medicine and the American Academy of Arts and Sciences. Currently, she serves as Home Secretary of the National Academy of Medicine. She previously served on the American Board of Pediatrics’ New Subspecialties Committee (2017-2019) and the Research Advisory Committee (2018-2021). Dr. Fuentes-Afflick completed her undergraduate and medical school education at the University of Michigan and a Masters in Public Health at the University of California, Berkeley. She has served on numerous consensus committees, most recently on the underrepresentation of women and women of color in STEMM fields.

Rachel L. Garfield

Rachel Garfield, M.H.S., Ph.D., is Executive Director of the Vermont Child Health Improvement Program (VCHIP) and Associate Professor in the Department of Pediatrics at the University of Vermont Larner College of Medicine. VCHIP is a maternal and child health services research and quality improvement program that aims to optimize child and family health through measurement-based efforts to enhance child health practice. Prior to her current position, Garfield was a vice president at the Kaiser Family Foundation and co-director for its Program on Medicaid and the Uninsured; other previous roles have included assistant professor in the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health, policy analyst in state and federal Medicaid/CHIP policy, and research consultant for hospital operations and management. Garfield has over two decades of experience in Medicaid policy research and is an expert in data analysis on insurance coverage and access to care for low-income populations. She also has expertise in behavioral health policy, particularly public financing for behavioral health services. Garfield holds a B.A. degree from Harvard College, a Master of Health Science degree from the Johns Hopkins Bloomberg School of Public Health, and a Ph.D. in health policy from Harvard University.

Kristin H. Gigli

Kristin Hittle Gigli, M.S.N., Ph.D., CPNP-AC, is an acute care pediatric nurse practitioner and health services researcher. She is an Assistant Professor of Graduate Nursing in the College of Nursing at Health Innovation at the University of Texas at Arlington. Her research examines roles of the hospital-based advanced practice provider workforce in providing care and health outcomes of hospitalized children. She earned her nurse practitioner degree from the University of Pennsylvania, her PhD in Nursing from Vanderbilt University and completed a post-doctoral fellowship in the Department of Critical Care Medicine CRISMA Center at the University of Pittsburgh. In addition to her research, Kristin has 15 years of experience work in pediatric critical care and holds a clinical appointment in the Pediatric Intensive Care Unit at Children’s Health Dallas. She is a past board member of the National Association of Pediatric Nurse Practitioners and currently a liaison to the American Academy of Pediatrics Committee on Hospital Care and the Association of Medical Schools Pediatric Department Chairs Pediatrics 2025: AMSPDC Workforce Initiative.

Javier A. Gonzalez del Rey

Javier A. Gonzalez del Rey, M.D., M.Ed., is currently Professor of Pediatrics, Chair Graduate Medical Education (GME), Designated Institutional Officer for ACGME (DIO), Associate Chair for Education and Director of the Cincinnati Children’s Pediatric Education Center at Cincinnati Children’s Hospital Medical Center. He is currently the Past - President at the Association of Pediatric Program Directors (APPD), and Past - Chair for the Executive Committee for the Section of Emergency Medicine at the American Academy of Pediatrics (AAP). He received his university and medical school education at the National University Pedro Henriquez Ureña (UNPHU) in the Dominican Republic, completed his pediatric residency at the University of Connecticut Pediatric Primary Care Program, and Fellowships training in General Academic Pediatrics and Pediatric Emergency Medicine at the Cincinnati Children’s Hospital Medical Center. He is currently certified in Pediatrics and Pediatric Emergency Medicine. He completed a Master’s of Medical Education and advance training in Quality Improvement Methodology (I2S2). Dr. Gonzalez del Rey’s major areas of interests include resident and subspecialty medical education – PEM national and for Latin America, and improvement science methodology applied to medical education and training.

Shafali S. Jeste

Shafali Spurling Jeste, M.D., is a child neurologist with expertise in neurodevelopmental disorders (NDDs). She is Chief of Neurology and Co-Director of the Neurological Institute at Children’s Hospital, Los Angeles (CHLA), and Professor of Pediatrics and Neurology at the USC Keck School of Medicine. Her research, funded by NIH, the Department of Defense, and the Simons foundation, is focused on improving precision health in NDDs, through biomarkers, clinical endpoints and scalable clinical trials. Her clinical expertise lies in the diagnosis and management of infants and children with NDDs, particularly those with complex medical needs. At CHLA and through the Child Neurology Society, she is actively engaged in efforts to expand the pediatric workforce by cultivating early clinical research careers. She is on the Board of Directors of the American Brain Foundation and the National Organization for Rare Disorders, and she is on the Programmatic Panel of the DoD TSC Research Program. In 2019 she was awarded the Presidential Early Career Award for Scientists and Engineers. In 2022 she was named a Woman of Influence in Health Care by the LA Business Journal. She earned her BA in Philosophy from Yale University and her MD from Harvard Medical School. She completed her child neurology residency and behavioral neurology fellowship at Boston Children’s Hospital.

Ophir D. Klein

Ophir D. Klein, M.D., Ph.D., serves as the inaugural executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health. He is also Adjunct Professor of Orofacial Sciences and Pediatrics at the University of California, San Francisco (UCSF), where he was previously the Larry L. Hillblom Distinguished Professor in Craniofacial Anomalies and the Charles J. Epstein Professor of Human Genetics. Until 2022, he served as Director of the Institute for Human Genetics, Chief of the Division of Medical Genetics, Chair of the Division of Craniofacial Anomalies, and Director of the Program in Craniofacial Biology at UCSF. Dr. Klein was educated at the University of California, Berkeley, where he earned a B.A. in Spanish Literature. He subsequently attended Yale University School of Medicine, where he received a Ph.D. in Genetics and an M.D. He then completed residencies at Yale-New Haven Hospital in Pediatrics and at UCSF in Clinical Genetics. Dr. Klein has received several honors, including a New Innovator Award from the NIH and the E. Mead Johnson Award from the Society for Pediatric Research. Dr. Klein was elected to the American Society for Clinical Investigation, the American Association of Physicians and the National Academy of Medicine, and he is a Fellow of the American Association for the Advancement of Science. Dr. Klein’s research focuses on understanding how organs form in the embryo and how they regenerate in the adult, with a particular emphasis on the processes underlying craniofacial and dental development and renewal as well as understanding how stem cells in the intestinal epithelium enable renewal and regeneration.

Victoria F. Norwood

Victoria Fay Norwood, M.D., is the Robert J Roberts Professor of Pediatrics at the University of Virginia where she has practiced as a pediatric nephrologist for her entire career following her MD degree and Pediatric Residency training at Tulane University. She completed her pediatric nephrology fellowship at UVA and began her tenure at UVA as a physician scientist focused on developmental nephrology. Since that time she served as Division Chief of Nephrology for 17 years, Program Director of the Peds Nephrology Fellowship for 25 years and Vice-Chair for Academic Affairs in the Department of Pediatrics. Outside of UVA she has been deeply involved in the activities of the American Society of Pediatric Nephrology of which she was President in 2014-2016. She was the founding Chair of the Council of Pediatric Subspecialties on 2007-2010 and has served on the Review Committee for Pediatrics at ACGME. Most recently, after many years and roles with the American Board of Pediatrics she served as Chairman of the ABP and ABP Foundation Boards of Directors in 2020. She also currently serves on the Governance Committee for ABMS. Dr. Norwood received the Henry L. Barnett Award for Lifetime Achievement in Pediatric Nephrology from the Section on Nephrology of the American Academy of Pediatrics in 2020. Dr. Norwood’s academic career has been and continues to be focused around issues of subspecialty pediatrics including education, training, initial and continuing certification, credentialing, and workforce.

Eliana M. Perrin

Eliana M. Perrin, M.D., M.P.H., is Bloomberg Distinguished Professor of Primary Care in the Schools of Medicine and Nursing at Johns Hopkins. Previously she served as Associate Vice Chancellor for Research at UNC-Chapel Hill and as Division Chief of Primary Care, Director of the Center for Childhood Obesity Research and Director of the National Clinician Scholars Program at Duke. She is a general pediatrician and researcher with expertise in obesity, patient-oriented prevention, health services, and health disparities and collaborates with other pediatrics disciplines (endocrine, pulmonary, NICU, hospital medicine, cardiology) and beyond. As a Division Chief she oversaw a robust clinical enterprise and bolstered interdisciplinary research. She is a multiple PI of the Greenlight obesity prevention project funded by two NIH R01s and PCORI. She served as chair of the national research committee of the Academic Pediatrics Association, was elected to the Society of Pediatric Research and American Pediatric Society, and is a Fellow of the American Academy of Pediatrics where she serves on the Committee on Pediatric Research. She earned her MD (AOA honors) from the University of Rochester, completed residency at Stanford, and was a Robert Wood Johnson Clinical Scholar and earned an MPH at UNC-Chapel Hill.

Samir S. Shah

Samir S. Shah, M.D., MSCE, MHM, is Director, Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center where he holds the James M. Ewell endowed chair. He is also Professor of Pediatrics at the University of Cincinnati College of Medicine and Editor-in-Chief of the Journal of Hospital Medicine, an official journal of the Society of Hospital Medicine. He practices clinically as both a pediatric hospitalist and a pediatric infectious diseases physician. Dr. Shah’s research focuses on improving the efficiency and effectiveness of care in the hospital setting with emphasis on common, serious childhood infections. He co-developed an ACGME certified 3-year pediatric hospital medicine fellowship and has served as a mentor or co-mentor to 7 federal K-series grant awardees. Dr. Shah has been recognized for his research and mentorship with numerous national awards including the Excellence in Research Award (2009) and the Excellence in Teamwork in Quality Improvement Award (2014) from the Society of Hospital Medicine, the Excellence in Research Award (2020) and the Miller-Sarkin Mentorship Award (2015) from the Academic Pediatric Association, and the Pediatric Hospital Medicine Award for Excellence in Research (2015), jointly awarded by the American Academy of Pediatrics, the Academic Pediatric Association, and the Society for Hospital Medicine. In 2019, he received the Masters in Hospital Medicine, a lifetime achievement award, from the Society of Hospital Medicine. Following medical school at Yale, Dr. Shah completed pediatrics residency as well as fellowships in both Academic General Pediatrics and Pediatric Infectious Diseases at the Children’s Hospital of Philadelphia. He also received a Master of Science in Clinical Epidemiology from the University of Pennsylvania School of Medicine.

Christopher Stille

Christopher Stille, M.D., M.P.H., is Professor of Pediatrics and Section Head of General Academic Pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado. He leads a very active group of roughly 55 pediatric faculty, practices and teaches primary care pediatrics, and conducts pediatric health services research and quality improvement focused on improving systems of care for children and youth with special health care needs (CYSHCN) in the Medical Home. He has a particular interest in improving coordination of care between primary care clinicians, subspecialists and family members, generated by his first years in private practice but continuing over time. He has led projects funded by the U.S. Maternal and Child Health Bureau (MCHB), the Robert Wood Johnson Foundation, the Lucile Packard Foundation for Children’s Health, and local and regional funders to pursue this investigation. Since 2017, he has been Principal Investigator of a MCHB-funded national network to conduct health systems research for CYSHCN, CYSHCNet (www.cyshcnet.org). Much of this network’s work addresses partnerships between the “medical neighborhood” and families. He is a co-chair of the Standing Committee on Patient Experience and Function of the National Quality Forum. He is Membership Chair and a member of the Executive Committee of the Council on Children with Disabilities of the American Academy of Pediatrics.

Bonnie Zima

Bonnie T. Zima, M.D., M.P.H., is Professor-in-Residence, specializing in child and adolescent psychiatry, Vice-Chair for Faculty Development, Associate Chair for Academic Affairs, and Associate Director of the UCLA Center for Health Services & Society at the UCLA-Semel Institute for Neuroscience and Human Behavior. Her research is dedicated to improving the quality of child mental health care, with priority placed on children enrolled in Medicaid-funded outpatient programs and underserved, at risk child populations. Her research spans identification of high unmet need for mental health care among high risk child populations, national pediatric hospitalization resource utilization and costs, validity of national quality measures, pediatric integrated care models, pediatric workforce development, and application of technologies and clinical informatics to improve child mental health care. Her research has received all three national research awards from the American Academy of Child and Adolescent Psychiatry (AACAP). In addition, Dr. Zima is a Member of the U.S. Child and Adult Core Set Annual Review Workgroup for Center for Medicaid and CHIP Services, American Psychiatric Association (APA) Council on Quality Care, Behavioral Health and Substance Abuse Steering Committee for the National Quality Forum, and AACAP Committee on Research. She is Consulting Editor for the Journal of the American Academy of Child & Adolescent Psychiatry, Deputy Editor for the Journal of Child and Adolescent Psychopharmacology, and Distinguished Fellow of AACAP and APA. She was a member of the Committee to Evaluate the Supplemental Security Income Disability Program for Children with Mental Disorders (2014-2016).

Meeting

The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being: Meeting #4

November 14 - 15, 2022

Past

Materials

About

The National Academies of Sciences, Engineering, and Medicine Committee on The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being held a commitee meeting on Monday, November 14 and Tuesday, November 15, 2022.

The Committee held an open session on November 15, 2022 at 1:00 PM ET to hear from Sara Rosenbaum (The George Washington University). View the recording below.

Additional Information

Is it a Closed Session event?

Partially Closed

The following committee members were present at the closed sessions of the event

Candice Chen
Chris Stille
Eliana Perrin
Bonnie Zima
Elena Fuentes-Afflick
Kristin Hittle Gigli
Kendall Campbell
Kelly Betts
Vicky Norwood
Ophir Klein
Shafali Jeste
Chris Forrest
Rachel Garfield
Fred Rivara
Kecia Carroll
Javier Gonzales Del-Ray

The following topics were discussed in the closed sessions:

Review data/evidence status and needs for goals and related chapters
Narrow and refine potential recommendations
Implications of Open Session Presentation

The following materials (written documents) were made available to the committee in the closed sessions:

Briefing Book
Open Session Presentation Slides

Date of posting of Closed Session Summary:

November 17, 2022

Contact

Ruth Cooper

(202) 334-3125
rcooper@nas.edu

Disclaimer

It is essential to the National Academies mission of providing evidence-based advice that participants in any of our meetings or events avoid political or partisan statements or commentary and maintain a culture of mutual respect. The statements and presentations during our meetings or events are solely those of the individual participants and do not necessarily represent the views of other participants or the National Academy of Sciences, which is a non-partisan, tax exempt organization that includes under its Charter the National Academy of Engineering and National Academy of Medicine, and that operates the National Research Council.

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The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being

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The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being

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Featured publication

The Future Pediatric Subspecialty Physician Workforce: Meeting the Needs of Infants, Children, and Adolescents

Description

Contributors

Committee

Sponsors

Staff

Parent projects

Board on Health Care Services

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

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