Pediatric Orthopaedic Workforce in 2022: Current Workforce, Projections, and Trends in the United States.

Overview

abstract

BACKGROUND: Accurate workforce projections are critical for any market seeking to appropriately match supply with demand. Recently, the Pediatric Orthopaedic Society of North America (POSNA) convened a workforce taskforce to analyze the supply of, demand for, and distribution of pediatric orthopaedic surgeons (POSs) within the United States. The purpose of this analysis is to determine if we are training the appropriate number of POSs, if the distribution of POS meets current and future demands, to compare our data to previous analyses, and to report and disseminate our findings. METHODS: Databases and surveys (POSNA, SF Match, KID, MGMA) were utilized to determine current pediatric orthopaedic workforce supply, demand, and distribution. Projections based on pediatric population growth and POS in practice were performed. RESULTS: The membership (Active + Candidate) of POSNA has increased from 904 in 2014 to 1125 in 2022. The mean number of recent pediatric orthopaedic fellows trained per year is 57.5, with 73 positions offered per year through the San Francisco Match as of 2022. In addition, a significant volume of pediatric orthopaedic surgery is performed by adult orthopaedic surgeons. Growth of the pediatric population (children <18 years) has slowed over time and is estimated to slightly decrease each year moving forward. Accounting for retirement projections, it appears that we are currently overtraining new POSs by 8.5 new fellows per year. Although pediatric orthopaedic surgeon demand is met in many areas of the US, there continue to exist "surgical deserts" within the country where the population remains underserved. DISCUSSION: While difficult to determine the exact number of POS that are necessary for the service demand in the United States, we have made estimates as to the supply and demand for POS in the near future based on demographic factors, increasing surgical subspecialization, and expected training and attrition rates of POS. Based on a slightly negative expected population growth rate of children in the United States, increasing subspecialization of POS, and expected POS attrition, we estimate that current and future demand will be met by training approximately 49 new POS fellows each year. CONCLUSIONS: The current training rate of 57.5 pediatric orthopaedic fellows per year may eventually lead to a slight surplus of POS, especially in urban areas. It is important to follow these trends over time, especially regarding subspecialization within pediatric orthopaedics. The modeling described in this manuscript is designed to facilitate future comparisons. KEY CONCEPTS: (1)The supply of POS and physician extenders continues to increase. Growth of the number of POS in the United States is expected to occur with the current rate of 57.5 fellows trained per year.(2)Based on our model, a rate of 49 fellows trained per year shows neither an increase nor decrease in POS supply in the United States. Thus, there is projected to be a slight surplus of POS supply over the next decade.(3)Because of the age-gender distribution of the POS workforce, as well as the increasing proportion of females entering the specialty, gender parity is expected by 2050.(4)The population of children under 18 years of age will likely continue to decline because of declining birth and immigration rates. This decrease in demand may possibly be offset by the increasing amount of subspecialization among nonpediatric orthopaedic surgeons and the subsequent decrease in pediatric cases performed by them, leading to more surgical cases being available for POS over time.(5)There continues to be an expansion in the scope of practice of POS, most commonly in sports, hand, and spine surgery. There is also a trend toward treatment of traditionally pediatric orthopaedic conditions through early adulthood (transitional care), which can lead to an expansion in the number of patients available for the pediatric orthopaedist. LEVEL OF EVIDENCE: Level II, (economic and decision analysis).