September

Pediatric fellowships provide home-grown solution to physician shortages

Published on Monday, September 28, 2015

Media Contact: Alana Bowman at 601-984-1970 or abowman@umc.edu.

Published in News Stories on September 28, 2015

No parent wants to hear the words "your child needs to see a specialist," then hear that the next available appointment is two months away. 

This is a problem facing parents and kids nationally - a shortage in pediatric subspecialists. According to the Children's Hospital Association (CHA), the most severe pediatric shortages are in neurology, developmental/behavioral medicine, gastroenterology, surgery and neurosurgery.

Barr
Barr

"Certain pediatric specialists are always hard to recruit. This isn't just Mississippi. It's everywhere," said Dr. Rick Barr, Suzan B. Thames Professor and chair of pediatrics.  "We aren't producing enough pediatric specialists nationally to meet the need - probably aren't producing enough to keep up with the retirement of physicians."

Subspecialist shortages mean a longer than average wait for an appointment - up to 14.5 weeks, when a two-week wait is considered normal. Patients often must travel long distances to keep these long-awaited appointments. The American Academy of Pediatrics reports that one in three children in the U.S. travel 40 or more miles to see a pediatric specialist.

Recruiting pediatric specialists can be a difficult task for several reasons. Becoming a subspecialist requires additional training beyond specializing in pediatrics. And according to the CHA, the subspecialists' income can also be lower because they provide more consulting services than daily patient care in a clinical setting, and Medicaid pays 30 percent less than Medicare for services. Half of Mississippi's children are covered by Medicaid.

Hematology/Oncology fellows, Dr. Laura Newman, left, Dr. Hafsat Mashegu and Dr. Amanda Strobel, visit the bedside of oncology patient Andrew McCall of Philadelphia, Miss.
Hematology/Oncology fellows, Dr. Laura Newman, left, Dr. Hafsat Mashegu and Dr. Amanda Strobel, visit the bedside of oncology patient Andrew McCall of Philadelphia, Miss.

Being able to train specialists from candidates who are already settled in Mississippi and call it home can lessen the uncertainty of recruitment. "Fellowship programs tie directly into our mission: improving child health in Mississippi. It is incredibly important to be able to grow your own," said Barr.

Although some pediatric residents show an interest in seeking further specialized training, Barr said they are hesitant to move away for a fellowship in another state. "They want to stay in Mississippi. They have family ties here and don't want to move away for the three-year training process. If they do, sometimes we have trouble recruiting them back because they get established in the new area."

Although Children's of Mississippi operates satellite locations in Tupelo, Grenada, Hattiesburg and on the Gulf Coast, most of Mississippi's pediatric specialists are located in the Jackson area. Barr would like to see that change. "That's the rationale for all of our fellowship programs, train specialists for the state and have them branch out throughout the state to provide care. If we can grow our own, I can make sure we are serving the entire state."

Dr. Radhika Narang, right, neonatal-perinatal fellow, rounds in the NICU with residents Dr. Edward Landry and Dr. Diana Tate.
Dr. Radhika Narang, right, neonatal-perinatal fellow, rounds in the NICU with residents Dr. Edward Landry and Dr. Diana Tate.

Regulated by the Accreditation Council for Graduate Medical Education, fellowships are approved and monitored in a way similar to residency programs. Barr said that the school must have enough board-certified faculty to provide a well-rounded educational experience for the fellows. The training in any pediatric subspecialty is three years long, with both clinical and research aspects.

"We are training people to ask questions, to really contribute new knowledge to the field," said Barr.

Barr said a division has to have a game plan when deciding to pursue a fellowship accreditation. "We built the capacity over the past four years. We have the infrastructure in place with qualified research mentors and challenging projects that can translate into improved health for our patients."

The ACGME accredited the new gastroenterology fellowship program in May of this year. In July 2016, the school will welcome its first pediatric gastroenterology fellow, adding an additional fellow each year to bring the total to three.

Currently, the School of Medicine has pediatric fellows training in allergy, cardiology, critical care, hematology-oncology, neonatology, neurology, pediatric surgery and palliative care.

Tipnis
Tipnis

Dr. Neel Tipnis, division chief of pediatric gastroenterology, said that qualifying to host a fellowship is a source of pride for a medical school.

"I think that it says a lot about the quality of academics here with regards to both clinical exposure and the depth and diversity of the faculty," said Tipnis.

Tipnis said that having a basic science researcher in the group, access to the vast network of researchers, academic programs, lectures and faculty who have published well all contribute to being able to host a fellowship.

In the past five years, the department has grown from two pediatric gastroenterologists to six, one of whom is primarily a researcher. The department also has added a nurse practitioner, and a seventh physician will join the group at the end of October. Specialty areas of the team include motility, short bowel syndrome, liver transplant patients, childhood obesity and biofeedback.

Blecker
Blecker

Dr. Uwe Blecker, professor of pediatric gastroenterology, is the fellowship director for the new program. He arrived at Batson in July 2014 with the goal of starting a gastroenterology fellowship.

"Having a medical school-wide accredited education program, an established pediatric residency program and six other fellowships, there was a support system already in place," said Blecker.

Blecker is pleased by the initial interest in the program, despite having missed this year's matching process to obtain fellows. "I received a significant number of inquiries about the fellowship program," said Blecker.

The department will begin interviewing candidates in the fall.

Dr. Jenna Dear, hospice and palliative medicine fellow, speaks with Dr. Rick Boyte, professor of pediatrics and division chief of pediatric palliative medicine at Batson Children's Hospital.
Dr. Jenna Dear, hospice and palliative medicine fellow, speaks with Dr. Rick Boyte, professor of pediatrics and division chief of pediatric palliative medicine at Batson Children's Hospital.