Table 3. Availability of Pediatric Subspecialists Across Hospital Referral Regions and Ratio of Pediatric Subspecialists to Children, 2003 vs 2019.
| Subspecialty | HRRs with a pediatric subspecialist, %a | HRR subspecialist-to-child ratio per 100 000 children | Absolute change from 2003 to 2019 | Percent change from 2003 to 2019 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 2003 | 2019 | Absolute change from 2003 to 2019 | 2003 | 2019 | Mean (SD) | CV | Mean (SD) | CV | |||
| Mean (SD) | CV | Mean (SD) | CV | ||||||||
| ABP certificationsb | |||||||||||
| Adolescent medicinec | 40 | 46 | 6 | 0.37 (0.61) | 167 | 0.44 (0.78) | 175 | 0.07 (0.17) | 7.7 | 20.1 (27.2) | 4.6 |
| Child abuse pediatrics | NA | 43 | NA | NA | NA | 0.32 (0.53) | 163 | NA | NA | NA | NA |
| Developmental-behavioral pediatrics | 37 | 53 | 16 | 0.30 (0.55) | 186 | 0.70 (1.06) | 150 | 0.40 (0.51) | −35.8 | 134.9 (92.4) | −19.3 |
| Neonatal-perinatal medicine | 88 | 96 | 8 | 4.10 (3.10) | 76 | 5.57 (4.05) | 73 | 1.47 (0.95) | −3.4 | 35.8 (30.5) | −4.4 |
| Pediatric cardiology | 68 | 74 | 6 | 1.51 (1.78) | 118 | 2.54 (3.02) | 119 | 1.03 (1.24) | 0.9 | 68.4 (69.9) | 0.8 |
| Pediatric critical care medicine | 56 | 69 | 13 | 0.99 (1.23) | 125 | 2.43 (2.67) | 110 | 1.44 (1.44) | −15.2 | 145.8 (117.3) | −12.2 |
| Pediatric emergency medicinec | 48 | 62 | 14 | 0.89 (1.32) | 147 | 2.03 (2.80) | 138 | 1.14 (1.48) | −9.3 | 128.2 (111.8) | −6.3 |
| Pediatric endocrinology | 54 | 62 | 8 | 0.79 (1.10) | 138 | 1.27 (1.52) | 120 | 0.48 (0.42) | −18.2 | 60.6 (38.2) | −13.2 |
| Pediatric gastroenterology | 53 | 66 | 13 | 0.67 (0.90) | 135 | 1.40 (1.66) | 119 | 0.73 (0.76) | −16.1 | 108.9 (84.9) | −11.9 |
| Pediatric hematology-oncology | 64 | 68 | 4 | 1.41 (1.71) | 121 | 2.17 (2.84) | 130 | 0.76 (1.13) | 9.5 | 54.1 (65.8) | 7.8 |
| Pediatric infectious diseases | 54 | 61 | 7 | 0.77 (1.04) | 135 | 1.08 (1.44) | 133 | 0.31 (0.40) | −1.8 | 40.4 (38.4) | −1.4 |
| Pediatric nephrology | 43 | 49 | 6 | 0.49 (0.76) | 156 | 0.60 (0.93) | 157 | 0.11 (0.17) | 0.5 | 21.9 (23.0) | 0.3 |
| Pediatric pulmonology | 51 | 58 | 7 | 0.62 (0.96) | 154 | 0.98 (1.31) | 133 | 0.36 (0.35) | −20.8 | 58.2 (36.1) | −13.5 |
| Pediatric rheumatology | 26 | 36 | 10 | 0.16 (0.35) | 218 | 0.35 (0.72) | 206 | 0.19 (0.37) | −11.9 | 117.2 (104.6) | −5.4 |
| Joint board certifications | |||||||||||
| Allergy and immunologyd | 57 | 65 | 8 | 0.64 (0.80) | 124 | 1.10 (1.31) | 119 | 0.46 (0.51) | −5.1 | 71.8 (63.4) | −4.1 |
| Hospice and palliative medicinec | NA | 40 | NA | NA | NA | 0.3 (0.63) | 206 | NA | NA | NA | NA |
| Medical toxicologyc | NA | 10 | NA | NA | NA | 0.02 (0.08) | 394 | NA | NA | NA | NA |
| Sleep medicinec | NA | 39 | NA | NA | NA | 0.27 (0.44) | 165 | NA | NA | NA | NA |
| Sports medicinec | 19 | 41 | 22 | 0.09 (0.26) | 287 | 0.28 (0.51) | 184 | 0.19 (0.25) | −103.1 | 210.1 (97.4) | −35.9 |
| Transplant hepatologyc | NA | 17 | NA | NA | NA | 0.08 (0.24) | 304 | NA | NA | NA | NA |
Abbreviations: ABP, American Board of Pediatrics; CV, coefficient of variation; HRR, hospital referral region; NA, not applicable or not available.
a
A total of 306 HRRs were analyzed.
b
As of 2007, neurodevelopmental disabilities certification was no longer offered by the American Board of Medical Specialties and is now solely offered by the American Board of Psychiatry and Neurology.
c
Certification was offered by 1 or more boards within the American Board of Medical Specialties. Analysis included only subspecialists certified by the ABP.
d
Analysis included only physicians who were currently certified in general pediatrics and allergy/immunology.