Ensuring culturally effective pediatric care: implications for education and health policy.

This policy statement defines culturally effective health care and describes its importance for pediatrics and the health of children. The statement also defines cultural effectiveness, cultural sensitivity, and cultural competence and describes the importance of these concepts for training in medical school, residency, and continuing medical education. The statement is based on the conviction that culturally effective health care is vital and a critical social value and that the knowledge and skills necessary for providing culturally effective health care can be taught and acquired through focused curricula throughout the spectrum of lifelong learning, from premedical education and medical school through residency and continuing medical education. The American Academy of Pediatrics also believes that these educational efforts must be supported through health policy and advocacy activities that promote the delivery of culturally effective pediatric care.

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.

Pediatricians working part-time: past, present, and future.

BACKGROUND: Pediatrics has consistently attracted a large number of women. Although the majority of practicing pediatricians are male, female pediatricians will soon constitute the majority. The challenge to balance personal and professional life is of particular concern to women, and part-time positions may provide a potential solution. OBJECTIVE: To examine how many pediatricians currently work part-time, to examine trends in part-time employment from 1993 to present, to determine pediatric residents' interest in part-time employment, and to identify perceived barriers to part-time work. DESIGN/METHODS: Two data sources were used for these analyses. The first was an American Academy of Pediatrics Periodic Survey from 1993 and 2000 asking a combined national sample of 3218 American Academy of Pediatrics members about their employment status. Multiple mailings were conducted for each survey producing an overall response rate of 62%. The second data source was a survey asking a national random sample of 500 pediatric residents completing training in 2000 about their job search experiences and attitudes toward part-time employment. Four mailings of this survey were completed, and responses were obtained from 71% of residents. RESULTS: The percentage of pediatricians working part-time increased from 11% in 1993 to 15% in 2000. This increase did not exceed what would be expected based on the rise in the percentage of pediatricians who are female from 36% in 1993 to 45% in 2000. On average, pediatricians working part-time provided 36% fewer direct patient care hours than full-time pediatricians (42 hours vs 27 hours). No statistically significant difference in direct patient care hours was apparent between male and female pediatricians working full-time. Female residents were more likely than male residents to consider part-time or reduced-hours positions (42% vs 14%) and to accept part-time or reduced-hours positions (14% vs 3%). Also, considerably more female residents (58%) than male residents (15%) indicated that they would be interested in arranging a part-time position within the next 5 years. The most commonly perceived barriers to working part-time by both male and female residents included loss of income (70%), reduction in job benefits such as health insurance (47%), and loan repayment (46%). When those who reported some interest in part-time employment were asked how they would spend their extra time, most reported that they would address family needs related to children (females: 92%; males: 63%). Finally, residents interested in working part-time were more likely to be without a position when surveyed than residents not interested in part-time work (15% vs 2%). CONCLUSIONS: The relative percentages of female pediatricians and pediatricians working part-time will likely continue to grow. As a result, the total direct patient care hours available for children may be reduced. Pediatric practices will benefit by better accommodating the needs of pediatricians to balance work and family goals, and future workforce projections and training decisions must begin taking part-time employment rates into account.