What will pediatrics look like in ten years and beyond?  The American Academy of Pediatrics recently put together a task force to study important trends, envision "likely scenarios of the future", and recommend "strategies to best prepare pediatric clinicians and pediatric organizations for a range of potential futures" (p.971)1. Using a combination of literature review, electronic surveys, and qualitative interviews, the panel identified eight "megatrends" that are likely to significantly influence what pediatric care looks like a decade from now.  One hoped to read a fearless, insightful, and visionary look at things to come. Alas, one gets something else.

The report is vague, general, and cautious in its predictions. It not only describes a large forest, rather than any particular trees; it also seems to be viewing the forest from a fly-by at 35,000 feet. This is not terribly helpful to those navigating the terrain on the ground.

Still, key features can be discerned: for example, the panel's discussion of the megatrend "Dynamics of the Pediatric Workforce" details a number of pressing concerns related to recruiting and retaining a diverse and qualified medical workforce that can adequately meet the changing health needs of our population. Factors like high medical student debt and desires for more "innovation, flexibility, work-life balance, and diversity in academic and practice options" lead many bright young people (especially from minority backgrounds) to pursue alternative careers (p.978). Meanwhile, those who do dare to take the plunge are offered old-fashioned medical education that hasn't kept pace with the rapid scientific and medical developments of our day and doesn't prepare students for diverse clinical settings. We are training yesterday's doctors for tomorrow's problems. Combine all this with "poor geographic distribution" of care providers and you've got a formula for ever-widening disparities in health outcomes.

We know that we need bold and innovative solutions for addressing the shortage and maldistribution of qualified care providers. But it's precisely at this point that the report goes comatose. What should they be? How will they be imposed? Who will force medical schools to change their curriculum, or help doctors in rural areas find the technology and support they need? The report gives at its "most plausible scenario" for the future (as opposed to its "worst-case" and "best-case" scenarios) that "innovative solutions [will] align resources to improve distribution of physicians in some areas" (p.975). However, it offers no details about these solutions and no evidence to support claims about their likelihood. As with the other seven megatrends, the report diagnoses but doesn't prescribe treatment.

Overall, then, while there certainly is some value in the report, it is limited by its hesitancy to get more specific and detailed, or to prioritize the challenges in some way, or to offer fresh thinking about solutions. Readers are encouraged to comment on the panel's findings and recommendations, or to simply weigh in on what they consider to be the most important challenges and trends influencing the direction of pediatric care in the coming decade.

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1The findings and recommendations of the panel were published in the November 2010 issue of Pediatrics. Cf Starmer et al. Pediatrics in the Year 2020 and Beyond: Preparing for Plausible Futures. Pediatrics. 2010;126:971-981. All references in this post are to that article.