284 - Missing in action: Where have the pediatric applicants gone?

Publication Number: 1270.284

Judy Chen, Children's Hospital Los Angeles, LOS ANGELES, CA, United States; Jennifer Savitz, Children's Hospital Los Angeles, Los Angeles, CA, United States; Grant Christman, Children's Hospital Los Angeles, Los Angeles, CA, United States; Dalia Calva, Children's Hospital, Whittier, CA, United States

Background: From 2019-2024, applications to pediatrics residency have steadily declined, with a notable drop of 7% in categorical positions filled in 2024. While several reasons have been proposed, most notably lower earning potential, few robust qualitative studies have explored medical students' perspectives to understand the underlying reasons. With fewer graduates entering pediatrics, the future of the pediatric workforce is at stake.

Objective: To examine factors that influence medical students who initially had interest in pediatrics to either pursue another specialty or commit to pediatrics

Design/Methods: We conducted a single-site qualitative study using semi-structured individual interviews with fourth-year medical students (Classes of 2025 and 2026) at our affiliated medical school. Eligible participants included: 1. Students who reported being "somewhat interested" or "very interested" in pediatrics at any point during medical school or 2. Students who planned to apply/applied to pediatrics in the NRMP Match. Interviews explored factors influencing specialty decision-making, including pre-clinical and clinical experiences, financial considerations, and mentorship. Interviews were audio-recorded, transcribed, and inductively coded by three team members using Dedoose software, with regular meetings to ensure agreement. We used thematic analysis, iteratively refining codes using the constant comparative method before developing themes. Interviews from the 2 classes achieved thematic saturation.

Results: 16 interviews were conducted (15 completed). Participants included 4 categorical pediatric applicants, 1 combined pediatrics applicant, and 10 non-pediatric applicants. We identified 4 primary themes explaining why students shifted away from pediatrics: 1) Drawn to inherent aspects of chosen specialty 2) Clerkship experiences in chosen specialty versus pediatrics 3) Economic disincentives in pediatrics 4) Meaningful role models/mentors. Similar themes explained why students interested in pediatrics committed to pediatrics: 1) Drawn to inherent aspects of pediatrics 2) Pediatricians as role models/mentors (with notable influence of early exposure to pediatrics) 3) Positive team experience on pediatric rotation.

Conclusion(s): While intrinsic specialty attributes influence specialty choice, factors such as clerkship experience and mentorship remain powerful levers for encouraging interest in pediatrics. Enhancing medical student engagement during pediatric rotations and increasing early exposure to passionate pediatric role models may help strengthen interest in pediatrics.

Figure 1. Overview of interview participants and student loan status
A total of 16 interviews were conducted (15 complete and 1 incomplete). Participants were categorized as categorical pediatric applicants (n = 4) or non-categorical pediatric applicants (n = 11). Student loan status was self-reported by students during the interview.
*1 incomplete interview due to technological issues and no follow-up
**1 applicant applied to a combined pediatrics residency program.


Table 1. Themes and subthemes of why students who were initially interested in pediatrics pursued a different specialty with exemplary quotes


Table 2. Themes and subthemes of why students interested in pediatrics choose pediatrics with exemplary quotes.