Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians.

OBJECTIVES: To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds. STUDY DESIGN: American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled. RESULTS: Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?

Pediatricians Working Part-Time Has Plateaued.

OBJECTIVE: To examine trends in pediatricians working part-time and residents seeking part-time work and to examine associated characteristics. STUDY DESIGN: The American Academy of Pediatrics (AAP) Periodic Survey of Fellows and the AAP Annual Survey of Graduating Residents were used to examine part-time employment. Fourteen periodic surveys were combined with an overall response rate of 57%. Part-time percentages were compared for surveys conducted from 2006-2009 and 2010-2013. The AAP Annual Surveys of Graduating Residents (combined response rate = 60%) from 2006-2009 were compared with 2010-2013 surveys for residents seeking and obtaining part-time positions following training. Multivariable logistic regression models identified characteristics associated with part-time work. RESULTS: Comparable percentages of pediatricians worked part-time in 2006-2009 (23%) and 2010-2013 (23%). There was similarly no statistically significant difference in residents seeking part-time work (30%-28%), and there was a slight decline in residents accepting part-time work (16%-13%, aOR .75, 95% CI .56-.96). Increases in working part-time were not found for any subgroups examined. Women consistently were more likely than men to work part-time (35% vs 9%), but they showed different patterns of part-time work across age. Women in their 40s (40%) were more likely than other women (33%) and men in their 60s (20%) were more likely than other men (5%) to work part-time. CONCLUSIONS: There has been a levelling off in the number of pediatricians working part-time and residents seeking part-time work. Overall, women remain more likely to work part-time, although 1 in 5 men over 60 work part-time.

Changes in Work Characteristics and Pediatrician Satisfaction: 2012-2020.

OBJECTIVES: To examine the association of changes in pediatricians' work characteristics with their satisfaction using longitudinal data. METHODS: Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study (PLACES), were used to examine self-reported work satisfaction from 2012 to 2020 among 2002-2004 and 2009-2011 residency graduates (N = 1794). Drawing from the Physician Worklife Study, work satisfaction was measured as a 4-item scale score and averaged [range, 1 (low)-5 (high)]. Mixed effects linear regression for longitudinal analysis examined work satisfaction with year as the lone explanatory variable and then with 11 variables that might change over time (time variant) to assess how changes in work might be linked to increased or decreased satisfaction. RESULTS: In total, 85.9% of pediatricians in 2020 (September-December) thought their work was personally rewarding. Overall mean work satisfaction scale score displayed a small but significant (P < .001) decrease over time (3.80 in 2012 to 3.69 in 2020). Mixed effects modeling identified several changes associated with increasing work satisfaction over time: increased flexibility in work hours (B = 0.23; 95% confidence interval, 0.20 to 0.25) and personal support from physician colleagues (B = 0.18; 95% confidence interval, 0.15 to 0.21) had the largest associations. Pediatricians reporting increased stress balancing work and personal responsibilities and increased work hours had decreased satisfaction scores. CONCLUSIONS: Early- to midcareer pediatricians expressed high levels of work satisfaction, though, satisfaction scale scores decreased slightly over time for the sample overall, including during 2020 (year 1 of the coronavirus disease 2019 pandemic). Pediatricians reporting increases in flexibility with work hours and colleague support showed the strongest increase in work satisfaction.

High-Deductible Health Plans for US Children: Trends, Health Service Use, and Financial Barriers to Care.

OBJECTIVE: Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. METHODS: Trend data on HDHP enrollment were available for 58,910 children ages 0 to 17 with private insurance from the 2007 to 2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. RESULTS: The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007 to 2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs 5.7%), had problems paying medical bills (15.7% vs 10.3%), and had family medical debt (34.1% vs 25.8%). CONCLUSIONS: Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care.

Primary care pediatricians' satisfaction with subspecialty care, perceived supply, and barriers to care.

OBJECTIVES: To compare satisfaction with specialty care by primary care pediatricians (PCPs), perceived barriers to care, and adequacy of specialist supply. STUDY DESIGN: A survey of U.S. pediatricians was conducted in 2007. PCPs were asked about satisfaction with specialty care for their patients, as well as supply of specific pediatric subspecialists. Responses of rural and nonrural PCPs were compared regarding 10 potential barriers to care. RESULTS: Most PCPs are satisfied with the quality of subspecialty care. However, they were not satisfied with wait times for appointments, and the availability of many pediatric medical subspecialties and several pediatric surgical specialties. Rural PCPs were significantly more likely to report these shortages compared with nonrural pediatricians; these included 9 of the 18 medical and 5 of the 7 surgical specialties. In addition to wait times for appointments, PCPs reported that subspecialists' nonparticipation in health insurance plans and lack of acceptance of uninsured patients were also barriers to obtaining subspecialty care for their patients. CONCLUSIONS: PCPs provide valuable insight into access to the pediatric subspecialty workforce. This survey of PCPs raises significant concerns about the adequacy of children's access to pediatric subspecialists, especially in rural communities.

Longitudinal Analyses of Pediatrician Burnout.

OBJECTIVE: Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout. METHODS: Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time. RESULTS: In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22-0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22-0.36), or a job change (aOR, 0.48; 95% CI, 0.36-0.65). CONCLUSIONS: Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians' jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.

The effect of dual training in internal medicine and pediatrics on the career path and job search experience of pediatric graduates.

OBJECTIVE: To compare the job search experience and career plans of medicine-pediatrics (med-peds) and pediatric residents. STUDY DESIGN: Annual surveys of graduating med-peds and pediatric residents were compared from 2003 and 2004. RESULTS: The survey response rates were 58% for med-peds residents (n = 427) and 61% for pediatric residents (n = 611). Pediatric residents were more likely to be female or an International Medical Graduate. The groups were equally satisfied with their career choice and had equivalent debt. Med-peds residents were more likely to seek and accept generalist and hospitalist positions. Pediatric residents were more likely to seek subspecialty careers and research opportunities. More than 94% of med-peds residents expected to care for pediatric patients. Among residents seeking generalist positions, med-peds residents sent half as many applications to get the same number of interviews and offers as pediatric residents, were more likely to be offered their most desired position, and were more likely to accept a position in a rural area/small town. Med-peds residents had substantially greater starting salaries as hospitalists or generalists compared with pediatric residents. CONCLUSION: Med-peds and pediatric trainees differ in their career plans, although primary care is their most popular choice. Med-peds- trained physicians have an easier job search experience and greater market valuation.

A Study of Pediatricians' Debt Repayment a Decade After Completing Residency.

PURPOSE: Pediatricians' education debt has been increasing. Less is known about the pace of their debt repayment. The authors examined patterns of debt repayment for pediatricians who completed residency from 2002-2004. METHOD: The authors analyzed weighted 2013 survey data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study. They categorized participants based on education debt level at residency completion ($0; $1-$49,999; $50,000-$99,999; $100,000-$149,999; ≥ $150,000) and explored debt repayment and well-being by starting debt group using multivariable logistic regression. RESULTS: Of 830 pediatricians surveyed, 266 (32%) had no starting debt and 166 (20%) had ≥ $150,000 in starting debt. A decade after residency, the percentage of participants who completely repaid their debt varied from 76% (68/89) of those with $1-$49,999 of starting debt to 15% (25/164) of those with ≥ $150,000 of starting debt. The percentage of participants concerned about their debt increased with starting debt level, with over half of those in the highest group concerned. Starting debt was associated with all examined measures of debt repayment and with recent financial difficulties among those in the two highest debt groups ($100,000-$149,999: adjusted odds ratio = 3.82, confidence interval = 1.17-12.43; ≥ $150,000: adjusted odds ratio = 4.55, confidence interval = 1.47-14.14). CONCLUSIONS: A decade after completing residency, pediatricians had made progress repaying their debt, yet many still expressed concern, especially those with the greatest amount of starting debt. As debt levels continue to increase, these issues could worsen.

Training experiences of U.S. combined internal medicine and pediatrics residents.

PURPOSE: To investigate the demographics and training experiences of internal medicine and pediatrics (med-peds) physicians. METHOD: A cross-sectional survey addressing demographics, training experiences, and career plans of fourth-year residents graduating from combined internal medicine and pediatrics programs that were identified in the American Academy of Pediatrics database was initiated in May 2003. Questionnaires were mailed up to four times to nonresponders through August 2003. RESULTS: Valid responses were received from 212 of the 340 graduating residents (62% response rate). The majority (186/208 [89%]) reported that they would choose med-peds training again. Career planning (135/210 [64%]), office management (173/212 [82%]), and outpatient procedures (155/211 [73%]) were the only areas where the majority desired more training. Neonatal intensive care training was the only topic area that the majority of residents (142/212 [67%]) reported could have been carried out in less time. Nearly all residents (183/196 [93%]) planned to care for children and adults. Residents' self-assessment of their preparation was good to excellent for evidence-based medicine (192/210 [91%]), caring for patients with special health care needs (179/209 [86%]), and use of information technology (169/208 [81%]). Residents felt equally well prepared for postgraduate activities in internal medicine and pediatrics primary care (170/212 [80%] versus 163/211 [77%], p = .305, NS) and internal medicine and pediatric fellowships (186/207 [90%] versus 181/208 [87%], p = .058, NS). Only 112 of 209 residents (54%) felt their preparation for research was good to excellent. CONCLUSIONS: The study findings suggest that med-peds residents are satisfied with their decision to train in med-peds and with their level of preparation. They feel equally well prepared to care for adults and children, and well prepared to care for patients that may transition to adulthood with complex needs, to assess evidence, and to use information technology.

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

OBJECTIVE: To examine whether resident characteristics and experiences are related to practice in underserved areas. METHODS: Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. RESULTS: Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. CONCLUSIONS: Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children.

Trends in Access to Health Care Services for US Children: 2000-2014.

BACKGROUND AND OBJECTIVE: Recent years have witnessed substantial gains in health insurance coverage for children, but few studies have examined trends across a diverse set of access indicators. We examine US children's access to health services and whether trends vary by race/ethnicity and income. METHODS: Analysis of 178 038 children ages 0 to 17 from the 2000 to 2014 National Health Interview Survey. Trends are examined for health insurance and 5 access indicators: no well-child visit in the year, no doctor office visit, no dental visit, no usual source of care, and unmet health needs. Logistic regression models add controls for sociodemographics and child health status. Statistical interactions test whether trends vary by race/ethnicity and income. RESULTS: Among all children, uninsured rates declined from 12.1% in 2000 to 5.3% in 2014, with improvement across all 5 access indicators. Along with steep declines in the uninsured rate, Hispanic children had sizeable improvement for no doctor office (19.8% to 11.9%), no dental visit (43.2% to 21.8%), and no usual source of care (13.9% to 6.3%). Black children and those in poor and near-poor families also had large gains. Results from adjusted statistical interaction models showed more improvement for black and Hispanic children versus whites for 3 of 5 access indicators and for children in poor and near-poor families for 4 of 5 access indicators. CONCLUSIONS: Children's access to health services has improved since 2000 with greater gains in vulnerable population groups. Findings support a need for continued support of health insurance for all children.

Response rates and response bias for 50 surveys of pediatricians.

RESEARCH OBJECTIVE: To track response rates across time for surveys of pediatricians, to explore whether response bias is present for these surveys, and to examine whether response bias increases with lower response rates. DATA SOURCE/STUDY SETTING: A total of 63,473 cases were gathered from 50 different surveys of pediatricians conducted by the American Academy of Pediatrics (AAP) since 1994. Thirty-one surveys targeted active U.S. members of the AAP, six targeted pediatric residents, and the remaining 13 targeted AAP-member and nonmember pediatric subspecialists. Information for the full target samples, including nonrespondents, was collected using administrative databases of the AAP and the American Board of Pediatrics. STUDY DESIGN: To assess bias for each survey, age, gender, location, and AAP membership type were compared for respondents and the full target sample. Correlational analyses were conducted to examine whether surveys with lower response rates had increasing levels of response bias. PRINCIPAL FINDINGS: Response rates to the 50 surveys examined declined significantly across survey years (1994-2002). Response rates ranged from 52 to 81 percent with an average of 68 percent. Comparisons between respondents and the full target samples showed the respondent group to be younger, to have more females, and to have less specialty-fellow members. Response bias was not apparent for pediatricians' geographical location. The average response bias, however, was fairly small for all factors: age (0.45 years younger), gender (1.4 percentage points more females), and membership type (1.1 percentage points fewer specialty-fellow members). Gender response bias was found to be inversely associated with survey response rates (r=-0.38). Even for the surveys with the lowest response rates, amount of response bias never exceeded 5 percentage points for gender, 3 years for age, or 3 percent for membership type. CONCLUSIONS: While response biases favoring women, young physicians, and nonspecialty-fellow members were found across the 52-81 percent response rates examined in this study, the amount of bias was minimal for these factors that could be tested. At least for surveys of pediatricians, more attention should be devoted by investigators to assessments of response bias rather than relying on response rates as a proxy of response bias.

Where do graduating pediatric residents seek practice positions?

OBJECTIVE: To profile the characteristics of areas that graduating pediatric residents target in their job searches and to explore whether residents applying to primary care markets with higher pediatrician supplies experience job-search difficulty. STUDY DESIGN: A national random sample of 500 graduating categorical pediatric residents was surveyed. The communities that the pediatric residents targeted for jobs were linked to local-area characteristics by using Dartmouth Primary Care Service Areas (PCSAs), which are discrete markets that represent patient travel patterns for primary care services. PCSA population and providers were characterized by using data from the 2000 US Census and American Medical Association/American Osteopathic Association Physician Masterfiles. RESULTS: A total of 308 graduating residents (62%) completed the survey. Of the respondents, 136 (44%) applied for general-practice positions. The characteristics of the PCSAs that residents applied to differed from the PCSAs without an application. Residents' first-choice areas had higher ratios of general pediatricians, had higher median household incomes, and were more likely to be urban areas. Residents applying to higher-supply areas were significantly more likely to report moderate or considerable difficulty in their job searches than were residents applying to lower-supply areas. Residents applying to medium- and higher-supply areas sent out more total applications for positions and received lower starting salaries than did residents applying to lower-supply areas. CONCLUSIONS: Residents continue to prefer high-supply areas in their job searches, despite experiencing greater search difficulty in these areas. Current targeted incentives and market forces are unlikely to redress geographic variation in pediatrician supply.

Early Career Experiences of Pediatricians Pursuing or Not Pursuing Fellowship Training.

BACKGROUND AND OBJECTIVES: Choosing career paths can be difficult decisions for residents contemplating fellowship training. This study compares the experiences of early career pediatricians who did and did not pursue fellowships. METHODS: We analyzed national, weighted data from pediatricians 8 to 10 years after residency (n = 842). Work environment, work-life balance, and satisfaction were compared for pediatricians who had pursued fellowship training (fellowship trained) and those who did not pursue fellowship training (generalist trained). Logistic and linear regression examined the independent effects of fellowship training while controlling for demographic differences. RESULTS: A total of 39% of the pediatricians (328/842) pursued fellowship training. The fellowship-trained group was less likely than the generalist-trained group to spend time in direct patient care and more likely to report learning opportunities in their work environment. This group was also more likely to report an income of ≥$150,000, although no difference was found when only full-time pediatricians were examined. Generalist-trained pediatricians were more likely to work <50 hours per week, have flexibility with their schedules, and be satisfied with time spent with their own children. Pediatricians in both the fellowship-trained and generalist-trained groups generally found their work to be rewarding and were satisfied with their lives. CONCLUSIONS: Although residents need to consider important life and career differences when contemplating fellowship training and general care, pediatricians in both groups can achieve overall life and career satisfaction.

A Longitudinal Study of Pediatricians Early in Their Careers: PLACES.

The American Academy of Pediatrics (AAP) launched the Pediatrician Life and Career Experience Study (PLACES), a longitudinal study that tracks the personal and professional experiences of early career pediatricians, in 2012. We used a multipronged approach to develop the study methodology and survey domains and items, including review of existing literature and qualitative research with the target population. We chose to include 2 cohorts of US pediatricians on the basis of residency graduation dates, including 1 group who were several years out of residency (2002-2004 Residency Graduates Cohort) and a second group who recently graduated from residency at study launch (2009-2011 Residency Graduates Cohort). Recruitment into PLACES was a 2-stage process: (1) random sample recruitment from the target population and completion of an initial intake survey and (2) completion of the first Annual Survey by pediatricians who responded positively to stage 1. Overall, 41.2% of pediatricians randomly selected to participate in PLACES indicated positive interest in the study by completing intake surveys; of this group, 1804 (93.7%) completed the first Annual Survey and were considered enrolled in PLACES. Participants were more likely to be female, AAP members, and graduates of US medical schools compared with the target sample; weights were calculated to adjust for these differences. We will survey PLACES pediatricians 2 times per year. PLACES data will allow the AAP to examine career and life choices and transitions experienced by early-career pediatricians.

Practice of pediatric otolaryngology: results of the future of pediatric education II project.

OBJECTIVES: To define the practice of pediatric otolaryngology compared with general otolaryngology and to estimate pediatric otolaryngology workforce utilization and needs. METHODS: Survey of members of the American Academy of Pediatrics Section on Otolaryngology and Bronchoesophagology and the American Society of Pediatric Otolaryngology and of a random sample of the membership of the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS: Pediatric otolaryngologists were more likely to practice in urban and/or academic settings than were general otolaryngologists. Children (age <18 years) comprised over 88% of the patients of pediatric otolaryngologists and 30% to 35% of the patients of general otolaryngologists. Pediatric otolaryngologists were more likely to see children with complicated diseases such as airway disorders or congenital anomalies than were general otolaryngologists. Pediatric otolaryngologists, unlike general otolaryngologists, reported an increasing volume of pediatric referrals, as well as increased complexity in the patients referred. The surveyed physicians estimated the present number of pediatric otolaryngologists in their communities as approximately 0.2 to 0.3 per 100 000 people. CONCLUSIONS: Most children receiving otolaryngologic care in the United States receive such care from general otolaryngologists. The patient profile and practice setting of the subspecialty of pediatric otolaryngology differ from those of general otolaryngology. The demand for pediatric otolaryngologists appears to be increasing, but many general otolaryngologists do not believe there is an increased need.

Practice of pediatric critical care medicine: results of the Future of Pediatric Education II survey of sections project.

OBJECTIVE: To summarize the demographics and practice patterns of the current pediatric critical care workforce and to identify the key workforce issues that may affect the delivery of pediatric critical care services in the future. DESIGN: A questionnaire designed to analyze current pediatric critical care workforce demographics and future workforce trends. SUBJECTS: Pediatric critical care physicians from the United States were identified from the American Academy of Pediatrics Critical Care Section, from a list of physicians certified in pediatric critical care medicine (PCCM) by the American Board of Pediatrics, and from a list of pediatrician members of the Society for Critical Care Medicine. INTERVENTIONS: None. MEASUREMENTS: PCCM physicians were polled regarding board certification, practice characteristics, professional activities, referral patterns, patient profiles, competition, job satisfaction, and projected retirement age. MAIN RESULTS: A total of 805 PCCM physicians completed the survey. When grouped by age, 40% of the responding PCCM physicians were younger than 40 yrs, 49% were 40 to 49 yrs old, and only 11% were 50 yrs of age or older. The younger group had a higher percentage of female pediatricians than the older groups. For all age groups, the largest proportion of time was devoted to direct patient care time in pediatric critical care. This was especially true for the youngest age group that had the largest amount of patient care time devoted to critical care (43%). Time devoted to research was also significantly higher for the younger age group, although very few respondents reported that they have >50% of their time protected for research. For all age groups, those reporting increases in referral volume and referral complexity over the previous 12 months far outnumbered those reporting decreases. The majority of respondents reported being satisfied with their career choice. In general, respondents were more likely to report that too many rather than too few PCCM physicians were currently being trained. Approximately one third of respondents (34%) planned on leaving the field of critical care medicine before retiring from medicine completely. CONCLUSIONS: PCCM physicians were increasingly women and working for >65 hrs/wk, with a good level of job satisfaction. Competition from a variety of sources seems to affect the work of PCCM physicians. The relatively small percentage of time devoted to research, however, is a finding of great concern.

Resident cross-cultural training, satisfaction, and preparedness.

OBJECTIVE: To describe the diversity of pediatric residents and examine relationships of cross-cultural training experiences with training satisfaction, perceived preparedness for providing culturally effective care, and attitudes surrounding care for underserved populations. METHODS: A cross-sectional survey was conducted of a national random sample of graduating pediatric residents and an additional sample of minority residents. Using weighted analysis, we used multivariate regression to test for differences in satisfaction, preparedness, and attitudes between residents with more and less cross-cultural experiences during residency, controlling for residents' characteristics and experiences before training. RESULTS: The survey response rate was 57%. Eleven percent were Hispanic, 61% white, 21% Asian, 9% African American, 9% other racial/ethnic groups; 34% grew up in a bi- or multilingual family. Ninety-three percent of residents were satisfied with their residency training, 81% with the instruction they received on health and health care disparities, and 54% on global health issues. Ninety-six percent of residents felt they were prepared to care for patients from diverse backgrounds, but fewer felt prepared to care for families with beliefs at odds with Western medicine (49%) and families who receive alternative or complementary care (37%). Residents with more cross-cultural experiences during residency reported being better prepared than those with less experience to care for families with limited English proficiency (adjusted odds ratio [aOR] 2.11; 95% confidence interval [CI] 1.40-3.17), new immigrants (aOR 1.91; 95% CI 1.32-2.75), and with religious beliefs that might affect clinical care (aOR 1.62; 95% CI 1.13-2.32). CONCLUSIONS: Pediatric residents begin their training with diverse cross-cultural backgrounds and experiences. Residency experiences in cross-cultural care contribute to feelings of preparedness to care for diverse US children.

Pediatric training and career intentions, 2003-2009.

OBJECTIVES: To examine trends in pediatric residents' training and job search experiences from 2003 through 2009. METHODS: Annual national random samples of 500 graduating pediatric residents from 2003 through 2005 and 1000 from 2006 through 2009 were surveyed. Responses were compared across years to identify trends. We examined resident demographics, training, satisfaction, career intentions, and job search experiences. Overall response rate was 61%. RESULTS: Between 2003 and 2009, there was an increase in the proportion of female graduating pediatric residents (69%-75%), residents from international medical schools (15%-23%), and levels of educational debt among the subgroup of residents with debt ($139 945 in 2003 to $166 972 in 2009). Residents consistently reported (>90% of residents) that they would choose pediatrics again if they had the choice. By 2009, the majority was very satisfied with the quality of their training in most areas, with ratings improving across years in caring for children with special health care needs, evidence-based medicine, and using information technology in practice. Although primary care remained the most common clinical practice goal, there was a modest decline in interest in primary care practice across survey years, whereas interest in subspecialty practice increased. Residents accepting both general pediatric practice and hospitalist positions reported less difficulty in their job search over time. CONCLUSIONS: Despite continually changing demographics of pediatric training programs, residents overall remain very satisfied with their decision to become pediatricians. Pediatricians continue to face difficult financial challenges associated with rising debt, but they also report increasing job search success.

Pediatric resident perceptions of family-friendly benefits.

OBJECTIVE: The aim of this study was to examine the importance of family-friendly features in residency program selection, benefits offered to and used by residents, and importance of benefits in future job selection. METHODS: A survey of a random, national sample of 1000 graduating pediatric residents in 2008 was mailed and e-mailed. RESULTS: Survey response rate for graduating resident respondents was 59%. Among the respondents, 76% were women. Thirty-seven percent of men and 32% of women were parents. Residents with children were more likely than residents without children to rate family-friendly characteristics as very important in their residency selection (P < .05). Many residents reported that their programs offered maternity leave (88%), paternity leave (59%), individual flexibility with schedule (63%), and lactation rooms (55%), but fewer reported on-site child care (24%), care for ill children (19%), and part-time residency positions (12%). Among residents reporting availability, 77% of women with children used maternity leave and lactation rooms. Few held part-time residency positions (2%), but many expressed interest (23% of women with children). The majority of residents with and without children reported that flexibility with schedule was important in their future job selection. Most women with children (71%) and many women without children (52%) considered part-time work to be very important in their job selection. CONCLUSIONS: Family-friendly benefits are important to residents, particularly those with children. The data provides a benchmark for the availability and use of family-friendly features at pediatric training programs. The data also shows that many residents are unaware if benefits are offered, which suggests a need to make available benefits more transparent to residents.