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The pediatric workforce: Too large, too small—or just right

Are you a part of a busy suburban practice-namely, you and your associates see a steady stream of insured patients, sick children are slotted in promptly, and referrals to subspecialists are easily made? Then the size of the pediatric workforce may seem just about right. But if you work in a rural region, where pediatricians are scarce and patients ravel far to be seen, or in an inner-city clinic where the waiting room is always crammed, you might think the workforce is too small. And if you're a white Anglo and you serve mostly African-American or Hispanic patients, you may conclude that something is wrong not only with the size of the workforce but with its composition.

Odd thing is, all these scenarios are real and the conclusions that follow are true.

Last month, an AAP workforce committee issued a statement to sort out this complex issue (Pediatrics 2005;116[July]:263). Take a macro view, and it's fairly clear that no shortage of pediatricians exists: In fact, the supply has grown faster over the past decade than the number of children younger than 18 years. Plus, the pediatric workforce is bolstered by other professionals who provide care for children: family practitioners, physicians with dual certification in internal medicine and pediatrics, pediatric nurse practitioners, and physician assistants. Focus in close, however, to survey the scene in rural and inner city trenches, and there's equally no doubt that the provision of pediatric health care is inadequate.