Projecting the Future United States Pediatric Subspecialty Workforce: A Workforce Microsimulation Model, 2020-2040.

Projecting the Supply of Pediatric Subspecialists in the United States through 2040.


This website presents a workforce projection model that estimates the future clinical supply of pediatric subspecialists in the United States (US) and regions of the US from 2020-2040.

The model contains numerous “what if” scenarios that allow users to simulate changes in pathway into fellowship, retirement, and other factors that may influence the future supply and distribution of the workforce.

The model will serve as a critical step in ongoing national efforts to estimate the degree to which the number and distribution of pediatric subspecialists meets the clinical needs of the US pediatric population nationally and regionally.

Key Findings

Headcount (HC) is Not a Sufficient Measure of the Clinical Pediatric Subspecialty Workforce. When the absolute number, termed “headcount” (HC), of board-certified pediatric subspecialists is corrected for self-reported proportion of time spent in clinical care, termed “clinical workforce equivalent” (CWE), supply is reduced.

  • For example: The HC for pediatric hematology-oncology is projected to increase from 3.02 per 100,000 children in 2020 to 5.03 per 100,000 children in 2040 (+67%); however, the CWE of pediatric hematology-oncologist is 1.64 per 100,000 children in 2020 and increases to 2.71 per 100,000 children in 2040 (+66%). For the pediatric hematology-oncology workforce, each physician spends on average half their time in clinical activities.

Implications: CWE is a more robust marker of available clinical supply of pediatric subspecialists in the US. Data from the American Board of Pediatrics indicates that most pediatric subspecialists are affiliated with academic medical centers and spend time in medical education, administration, quality improvement, or research.

Current Supply and Projected Growth Vary by Subspecialty. Subspecialties are vastly different in terms of current workforce HC and CWE and projected HC and CWE growth.

  • For example, neonatal-perinatal medicine has a HC of 6.38 per 100,000 children, with a corresponding CWE of 4.36 per 100,000 in 2020. In 2040, the projected HC is 8.01 per 100,000 children (+26%), corresponding to a CWE of 5.43 per 100,00 children (+25%).
  • Contrastingly, adolescent medicine has a HC of 0.8 per 100,000 children, corresponding to a CWE of 0.43 per 100,000 children in 2020. In 2040, the projected HC is 0.9 per 100,000 children (+13%), corresponding to a CWE of 0.49 per 100,000 children (+13%).

Implications: The subspecialties are different. Subspecialties with a smaller HC and CWE in 2020 and that are projected to grow more slowly (e.g., developmental-behavioral pediatrics, pediatric endocrinology) will likely struggle to meet future clinical care needs nationally. Subspecialties that currently have larger overall HC and CWE and are forecast to increase in supply (e.g., pediatric cardiology) may have a sufficient supply at the national level, if historical trends continue.

Some U.S. Census Region and Division Levels May Face Gaps in Supply. Examining supply at the national level obscures the fact that the child population is forecast to grow at different rates across the country.

The South and West census regions are projected to increase their child populations more than the Northeast and the Midwest regions by 2040. The growth in both HC and CWE for pediatric subspecialists is not aligned with where child population growth is projected to occur.

  • For example, the supply of pediatric subspecialists is projected to be highest in the Northeast area of the country (Figure 1), a region where a number of fellowship positions are located. However, the Northeast region is only projected to see a 4% growth in the child population (0-18 years) by 2040 as compared to the South (19%) and the West (23%).
A choropleth map of the United States projecting the workforce supply for all pediatric subspecialties combined in the year 2040. The map is color-coded to represent the number of subspecialists per 100,000 children, with a gradient scale ranging from dark purple (0 subspecialists) to yellow (60 subspecialists). The northeastern states are highlighted in yellow, indicating a higher concentration of subspecialists, while the majority of the states are in various shades of green, suggesting a lower concentration. The map is labeled 'Projection of Workforce Supply for All Pediatric Subspecialties (Combined), 2040' and includes a legend for interpretation of the color scale. Below the map are the model parameters: Census Division, Headcount, Subspecialists per 100,000 Children, Baseline.
Figure 1: Projection of Workforce Supply for All Pediatric Subspecialties (Combined) by Census Division, Baseline Scenario, 2040

Implications: The projected growth of the pediatric subspecialty workforce does not align with projected growth of the child population. Increasing the size of the workforce alone, under current model assumptions, will not address subspecialty workforce distribution concerns, even when different scenarios are applied.

Ready to Start Exploring?

This website has an Interactive Model that lets you compare different projections and an Interactive Map.

Who Are We

This project is brought to you by the Program on Health Workforce Research & Policy at The Cecil G. Sheps Center For Health Services Research at the University of North Carolina in partnership with The American Board of Pediatrics Foundation, which funded the development of the workforce model and this website, and Strategic Modelling Analysis & Planning Ltd.