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Section on Developmental and Behavioral Pediatrics |
Fall 1999Printable Version (pdf)Section Home
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Survey of Developmental and Behavioral Pediatric Practiceby Desmond Kelly, M.D. FAAP, Greenville, SCMembers of the Section on Developmental and Behavioral Pediatrics recently participated in a survey for the Future of Pediatric Education II (FOPE II) Project. FOPE II has been a three-year, grant funded initiative of the pediatric community to address the future supply and training of pediatricians. This survey was developed for the "Pediatric Subspecialists of the Future Workgroup". It consisted of two parts, a standard questionnaire (the Workforce Survey for Child Healthcare) and a questionnaire addressing issues specific to Developmental and Behavioral pediatric practice (the Developmental-Behavioral Pediatrics Survey). The questionnaires were mailed to pediatricians who provide developmental and behavioral care. These included all 677 members of the AAP Section on Developmental and Behavioral Pediatrics, the 234 members of the AAP Section on Children with Disabilities, the 459 physicians who are members of the Society for Developmental and Behavioral Pediatrics and the 228 physicians in the Society for Developmental Pediatrics. The response rate of 76.8% was apparently the highest for any of the sub-specialty surveys. The general survey examined a number of practice parameters including professional activities, referral patterns, reimbursement and place of employment. The subspecialty-specific questionnaire explored clinical practice (patient demographics and diagnoses, time spent with patients, waiting lists, etc.) as well as training, and participation in teaching, research and other scholarly activities. Survey ResultsThe majority of the respondents were graduates of US medical schools (90%) who averaged 24 years since graduation. Twenty seven percent (257) of the respondents indicated they had completed a fellowship in Developmental and/or Behavioral Pediatrics, 15% (141) in Developmental Disabilities, and 5% (47) in General Academic Pediatrics. Those with fellowship training were more likely to be practicing at medical schools as compared to general pediatricians (44% vs. 28%). Respondents were seeing an average of 6 new patients and 16 follow-up patients a week where developmental or behavioral issues were the primary focus. The most common developmental-behavioral problems evaluated were attention deficit hyperactivity disorders, developmental delays, learning disorders and behavioral/conduct disorders. Those with fellowship training were more likely to see children with autism (80%, vs. 53% for non-fellowship trained) and mental retardation (82% vs. 57%). Those with fellowship training in Developmental Disabilities saw more children with cerebral palsy, spina bifida and multiple handicaps while those with Developmental-Behavioral Pediatric training saw more children with attention deficits and behavioral/emotional disorders. Physicians with fellowship training spent an average of 92 minutes with new patients and 38 minutes with follow-up patients (70 minutes and 28 minutes respectively for the general pediatricians). Waiting time for new evaluations averaged 29 days. The largest portion of time was spent providing services to children of early school age (6-11 years). The ages of children seen for developmental-behavioral problems were as follows: infants -15%; toddlers and preschoolers (1-5 years) - 29%; early school age - 35%; adolescents (12-17 years) - 17%; and young adults - 4%. Almost 90% of respondents indicated constraints in their ability to see additional patients with the most commonly cited hurdles being inadequate reimbursement and excessive paperwork. Time spent on the telephone was reported as a constraint by 39% of the fellowship trained and 24% of the general pediatricians. Most (75%) of the respondents provided some training or educational programs for medical students and residents and 65% of the fellowship trained physicians were involved in some form of research or scholarly activity such as speaking or writing about developmental and/or behavioral issues. Subspecialty Board InterestRespondents were also surveyed regarding their interest in taking future sub-specialty boards. 86% of those with Developmental and/or Behavioral Pediatrics fellowship training, 69% with training in Developmental Disabilities and 40% without formal fellowship training would be interested in taking Developmental-Behavioral Pediatrics Boards. Seventy eight percent of those with fellowship training in Developmental Disabilities, 48% with Developmental-Behavioral Pediatrics training and 22% without fellowship training would be interested in taking Neurodevelopmental Disabilities Boards. A summary of the survey findings has been published by the AAP as part of the FOPE II Project. Those of us who developed the survey are conducting further analyses of the data. A paper will be presented at the Annual Meeting of the Society of Developmental and Behavioral Pediatrics in Seattle in September with further publications to follow. The Real WorldThis survey has provided a very informative and interesting insight into patterns of
developmental and behavioral pediatric practice "in the real world". There is
considerable uniformity in service provision as well as the challenges being faced by
those of us striving to help children with these problems. We hope that this information
will prove useful as we work to address those challenges. |
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