O2012: Association of Lifetime Earning Potential and Workforce Distribution in Developmental and Behavioral Pediatrics

Background: Developmental disorders, such as such as autism spectrum disorders, attention-deficit hyperactivity disorder, intellectual disability, and specific learning disorders, are common, affecting 15-25% of children in the United States. However, the developmental and behavioral pediatrics (DBP) workforce is small, with less than 1000 physicians certified nationally, and there is wide recognition by many stakeholders that the DBP workforce is not adequate to meet current or future clinical demands. In this study, we examine economic drivers of the DBP workforce by comparing lifetime earning potential (LEP) for DBPs to general pediatricians and pediatric subspecialists and evaluating the association of LEP for DBPs with measures of workforce distribution.

Methods: Using compensation and debt data from national physician surveys for 2018-2019, we estimated LEP for DBPs and compared it to that of general pediatricians and pediatric subspecialists. We evaluated potential effects of eliminating educational debt, shortening length of fellowship training, and implementing a loan repayment program for pediatric subspecialists. We evaluated the association of LEP for DBP with measures of workforce distribution, including distance to subspecialists, percentage of hospital referral regions (HRR)s with a subspecialist, ratio of subspecialists to regional child population, and fellowship fill rates.

Results: LEP was lower for DBPs than for general private practice pediatricians ($1.9 million less), general academic pediatricians ($1.1 million less), and all other pediatric subspecialists. The model showed that LEP of DBP could be improved by shortening the length of fellowship training or implementing a loan repayment program. LEP for subspecialists, including DBPs, was associated with distance to subspecialists (-0.5 miles/$100,000 increase in LEP, 95%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 2014-2018 fellowship fill rates (+1% spots filled/$100,000 increase in LEP, 95%CI 0.25-1.65).

Conclusion: DBP has the lowest LEP of all pediatric fields. As with other lower LEP subspecialties, low LEP for DBPs is associated with workforce shortages. However, a variety of interventions could improve LEP and potentially promote workforce growth.