707 - EM2PEM: A Needs Assessment

Publication Number: 3684.707

Michele McDaniel, Rady Children's Hospital San Diego, San Diego, CA, United States; Elizabeth Jacobs, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Sarah C. Cavallaro, Boston Children's Hospital, Boston, MA, United States; Andrea Fang, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Filled pediatric subspecialty fellowship slots decreased 3.2% between 2023 and 2024. While there was less decline in filled Pediatric Emergency Medicine (PEM) slots (84.1% in 2024 compared to 85.9% in 2023), projection models anticipate shortages of PEM physicians in certain regions by 2040. This shortage is attributed to a pipeline issue; fewer medical students applying to Pediatrics leads to a smaller pool of pediatricians applying for fellowships. For PEM, however, there is another potential pool of applicants - emergency medicine (EM) residents. EM-trained fellows have unique skill sets and become PEM leaders outside of children's hospitals, aiding to alleviate care deserts. Despite this, they make up only 10% of all PEM physicians and not all PEM fellowships regularly recruit or train them. While there is data on barriers to EM residents electing to pursue PEM fellowship, not much is known about PEM fellowships' current practices in, and barriers to, the recruitment and training of EM-trained PEM fellows.

Objective: Describe PEM fellowships' current practices in, and barriers to, the recruitment and training of emergency medicine-trained pediatric emergency medicine fellows.

Design/Methods: A needs assessment survey was developed and beta-tested by the authors and published in Qualtrics. This survey was distributed electronically to all 92 PEM fellowship directors. Descriptive statistics were performed.

Results: A response was obtained from 41/92 (45%) of PEM fellowships. Most responding fellowships (37/41, 90%) reported having trained a fellow from an EM residency and about half of those (18/37, 49%) currently have an EM-trained fellow. Of PEM fellowships who have never had an EM-trained fellow, all (4/4, 100%) responded that they would like to. Common barriers included lack of EM-trained faculty, perceived low interest of EM-trained fellows in completing scholarly work, the difference in training length compared to Pediatrics-trained fellows, and the development and maintenance of a separate curriculum. In data collected from the programs about their EM-trained graduates in the last five years, 20/35 (57%) of those fellows went on to practice in community or hybrid positions.

Conclusion(s): As decreased entrance into Pediatrics residencies and pediatric subspecialties continues, EM residents remain an under-recruited asset to the field of PEM. Fellowships desire to train fellows from an EM residency, and graduates go on to practice in community settings. Addressing barriers to the recruitment and training of PEM fellows from EM residencies has the potential to mitigate workforce shortages.

Figure 1
Number of PEM fellowships that have accepted an EM-trained fellow

Figure 2
Number of PEM fellowships that are currently training a fellow from an EM residency