The Evolving Landscape of the Medicine-Pediatrics Workforce: Lessons From the Last 10 Years.

Objective As a combined subspecialty, internal medicine-pediatrics (Med-Peds) physicians have played a significant role in both primary care and subspecialty care across the country. Over the last decade, the workforce has continued to grow and evolve. Thus, this study aims to characterize the current landscape of the Med-Peds workforce to address preconceptions and shine a light on current practice characteristics and career paths. Understanding factors influencing this group's career path is vital in addressing the needs of an aging population and physician shortages. Methods The survey study was designed by the Committee on Pediatric Workforce of the American Academy of Pediatrics (AAP) and modified by the Section of Medicine-Pediatrics (SOMP) Executive Committee. The survey was distributed electronically via SurveyMonkey to 3,536 AAP Section members and 3,230 Med-Peds members of the American Medical Association (AMA). There were 1,395 respondents, 956 of whom had completed Med-Peds residency training by 2022 and were eligible to be included in this study. Descriptive statistics and analysis, including frequency distributions and measures of central tendency, were used to summarize all responses. Statistical tests such as t-tests and z-proportions were used for comparative analysis. Results The majority of the Med-Peds physician workforce continued to practice across all ages (89.6%) as primary care physicians (65.4%) and worked an average of 50 hours per week. However, there has been a growing number of hospitalists (27.4%) and a trend toward practices in urban communities at academic medical centers. Growing financial concerns about educational debt and pay gaps between internal medicine and pediatrics as well as differences between early and late-career physicians also revealed changes in career choices, but overall satisfaction in training and specialty decisions was maintained. Conclusions Despite a multitude of external pressures affecting the workforce, Med-Peds physicians were satisfied with their training. They continue to add to the primary care sector and continue to see patients of all ages. While this versatile workforce can aid in the provision of care to populations particularly vulnerable during their transitions of care, such as children with complex medical needs, factors like increasing educational debt, widening pay gaps, and local competition will contribute to changes seen in work type and career paths. Further research to understand the career decisions of this workforce is needed to better address the rising physician shortages plaguing the entire country.