Med-Peds Workforce Landscape

Academic Pediatrics · 2025-11-01

The Evolving Landscape of the Medicine-Pediatrics Workforce: Lessons From the Last 10 Years

Cureus · 2025-02-11

Objective As a combined subspecialty, internal medicine-pediatrics (Med-Peds) physicians have played a significant role in both primary care and subspecialty care across the country. Over the last decade, the workforce has continued to grow and evolve. Thus, this study aims to characterize the current landscape of the Med-Peds workforce to address preconceptions and shine a light on current practice characteristics and career paths. Understanding factors influencing this group's career path is vital in addressing the needs of an aging population and physician shortages. Methods The survey study was designed by the Committee on Pediatric Workforce of the American Academy of Pediatrics (AAP) and modified by the Section of Medicine-Pediatrics (SOMP) Executive Committee. The survey was distributed electronically via SurveyMonkey to 3,536 AAP Section members and 3,230 Med-Peds members of the American Medical Association (AMA). There were 1,395 respondents, 956 of whom had completed Med-Peds residency training by 2022 and were eligible to be included in this study. Descriptive statistics and analysis, including frequency distributions and measures of central tendency, were used to summarize all responses. Statistical tests such as t-tests and z-proportions were used for comparative analysis. Results The majority of the Med-Peds physician workforce continued to practice across all ages (89.6%) as primary care physicians (65.4%) and worked an average of 50 hours per week. However, there has been a growing number of hospitalists (27.4%) and a trend toward practices in urban communities at academic medical centers. Growing financial concerns about educational debt and pay gaps between internal medicine and pediatrics as well as differences between early and late-career physicians also revealed changes in career choices, but overall satisfaction in training and specialty decisions was maintained. Conclusions Despite a multitude of external pressures affecting the workforce, Med-Peds physicians were satisfied with their training. They continue to add to the primary care sector and continue to see patients of all ages. While this versatile workforce can aid in the provision of care to populations particularly vulnerable during their transitions of care, such as children with complex medical needs, factors like increasing educational debt, widening pay gaps, and local competition will contribute to changes seen in work type and career paths. Further research to understand the career decisions of this workforce is needed to better address the rising physician shortages plaguing the entire country.

Management of extensively drug-resistant <i>Acinetobacter baumannii</i> bacteremia with cefiderocol and sulbactam-durlobactam: a case report

ASM Case Reports · 2025-05-30 · 2 citations

ABSTRACT Background Extensively drug-resistant (XDR) Acinetobacter baumannii presents an urgent threat to public health due to its significant morbidity and mortality, with limited evidence-based treatment options. Recent drug developments of cefiderocol (FDC) and sulbactam-durlobactam (SUD) provide novel treatment options for XDR A. baumannii . Case Summary We present the case of a patient with XDR A. baumannii bacteremia following a prolonged hospital course for gangrenous cholecystitis and hospital-acquired bacterial pneumonia. He completed a 14-day course of FDC and SUD with clinical resolution and was discharged home. Conclusion This case demonstrates the potential efficacy of FDC combined with SUD in treating XDR A. baumannii bacteremia, highlighting the need for further research into combination therapy regimens for XDR A. baumannii .

Using ChatGPT in the Development of Clinical Reasoning Cases: A Qualitative Study

Cureus · 2024 · 8 citations

• Computer Science
• Artificial Intelligence
• Computer Science

Background There has been an explosion of commentary and discussion about the ethics and utility of using artificial intelligence in medicine, and its practical use in medical education is still being debated. Through qualitative research methods, this study aims to highlight the advantages and pitfalls of using ChatGPT in the development of clinical reasoning cases for medical student education. Methods Five highly experienced faculty in medical education were provided instructions to create unique clinical reasoning cases for three different chief concerns using ChatGPT 3.0. Faculty were then asked to reflect on and review the created cases. Finally, a focus group was conducted to further analyze and describe their experiences with the new technology. Results Overall, faculty found the use of ChatGPT in the development of clinical reasoning cases easy to use but difficult to get to certain objectives and largely incapable of being creative enough to create complexity for student use without heavy editing. The created cases did provide a helpful starting point and were extremely efficient; however, faculty did experience some medical inaccuracies and fact fabrication. Conclusion There is value to using ChatGPT to develop curricular content, especially for clinical reasoning cases, but it needs to be comprehensively reviewed and verified. To efficiently and effectively utilize the tool, educators will need to develop a framework that can be easily translatable into simple prompts that ChatGPT can understand. Future work will need to strongly consider the risks of recirculating biases and misinformation.

Lessons From the Mpox Education and Vaccination Campaign

Infectious Diseases in Clinical Practice · 2023-12-14 · 3 citations

The Mpox virus (previously termed monkeypox) was a relatively obscure zoonotic infection mainly confined to West and Central Africa with the notable exception of a 2003 outbreak in the United States associated with exotic pets. In the summer of 2022, however, the United States experienced an unexpected and unprecedented surge in cases with a markedly different clinical presentation. This epidemic appeared to be driven by close/intimate contact and evidenced a more varied clinical presentation easily confused with common sexually transmitted infections.1 While still navigating the COVID-19 pandemic, public health services launched education campaigns designed to raise awareness and mitigate risks of infection, educate the public and medical community on modes of transmission and the new clinical presentations, and minimize stigma. These education campaigns did influence behavior changes in some members of high-risk communities that led to decreased infections.2 The other major intervention was the release of the JYNNEOS vaccine, which has proven to lower the risk of Mpox infection.3 This vaccination campaign was launched at a time of decreased vaccine confidence4 stemming in part from the continued politicization of the COVID-19 vaccination recommendations. The success of the Mpox vaccine campaign is thus even more impressive and deserving of study to potentially provide a roadmap of combating vaccine hesitancy. “Mpox knowledge and vaccine willingness among a representative analysis of adults in Pennsylvania” in the issue uses a broad-ranging survey to examine Pennsylvania residents' knowledge of Mpox, perception of risk, and willingness to accept vaccine. The survey was conducted in September 2022 reflecting a period after the intensive education campaigns began. Less than 15% of the 1039 survey participants reported no knowledge of Mpox symptoms or transmission modalities reflecting wide penetrance of the education initiatives. The knowledge did appear more basic and the authors point out lacing a “nuanced understanding specific to the current outbreak.”5 Although the majority of survey participants considered themselves to be at low or no risk, those who did perceive increased risk were significantly more likely to plan to accept vaccine. Men who have sex with men comprised 7.2% of the respondents, well represented across age groups, and were more likely to have Mpox awareness/knowledge and acceptance of vaccination. These findings are consistent with the Centers for Disease Control and Prevention's Monkeypox State of Vaccine Confidence Report6 and represent a “dose-response” relationship between perception of Mpox risk and acceptance of vaccine.5 A finding that bears more study involves the health disparities in vaccination rates. Black and Hispanic populations were disproportionally affected in this epidemic yet received relatively fewer vaccines, even in high-risk groups such as those with a recent sexually transmitted infection.7–9 Pinto et al showed Black, non-Hispanic respondents were more likely to report wiliness to vaccinate. This argues against vaccine hesitancy as a reason for undervaccination and should be understood as a call to investigate hidden sources of bias decreasing vaccine rates. To date, the United States has experienced 31,010 cases and 55 deaths due to Mpox.10 Although cases have dropped, there remains a risk of resurgence of this infection. The willingness and ability to receive Mpox vaccine will be a significant modifier of future outbreaks. These data may also be generalizable to other instances of vaccine hesitancy and can further the investigations in health disparities.

Evaluating Methicillin-Resistant Staphylococcus aureus Polymerase Chain Reaction Nasal Screening as a Tool for Antimicrobial Stewardship

Journal of Surgical Research · 2022-12-12 · 7 citations

376. COVID-19 Severity in HIV+ Patients Receiving Tenofovir

Open Forum Infectious Diseases · 2020-10-01

Abstract Background Early in the COVID-19 pandemic, tenofovir (TAF/TDF) was identified as a potential agent for SARS-CoV-2 due to binding to RNA-dependent RNA polymerase similarly to remdesivir. This led to the hypothesis that TAF/TDF may be lessening the severity and improving outcomes of COVID-19 infection. COVID-19 Severity COVID-19 Infection Outcomes Methods Patients were identified by searching for HIV infection and SARS-CoV2 PCR testing. Type of antiretroviral therapy (ART), CD4+ cell count, HIV viral load (VL), comorbidities, presenting symptoms, severity of COVID infection, and outcomes were analyzed. COVID disease was classified as mild, moderate, severe, or critical based on World Health Organization criteria. We primarily sought to determine the effect of TAF/TDF on the severity of COVID infection. The secondary endpoint was to determine the effect of low CD4 count and HIV VL on the severity of infection. Results 39 HIV+ patients were tested at least once for SARS-CoV2 by PCR at VA NJ Health Care System. 18 of 39 patients were PCR positive. In those, common presenting symptoms included: fever (15/18), cough (7/18), and lethargy/fatigue (6/18). 16 of the 39 HIV+ patients’ ART included TAF/TDF; 8 of 18 COVID+ and 8 of 21 COVID-. In the COVID- group, 2 patients had CD4 count &amp;lt; 200 cells/mm3, 3 patients had HIV VL &amp;gt;200, and 19 of 21 had at least 1 comorbidity. In the COVID+ group, 3 had CD4 count &amp;lt; 200 cells/mm3, none had detectible HIV viremia, and all but one had comorbidities. Of COVID+ infections, 7 were mild, 3 moderate, 8 severe, and 5 patients died. 4 of the 5 patients that did not survive were in non-TAF/TDF group. All 3 patients with CD4 count &amp;lt; 200 cells/mm3 had severe disease. 6 out of 8 patients developed mild disease in TAF/TDF group vs. 1 out of 10 patients in non-TAF/TDF group. 1 out of 8 and 7 out of 10 patients had severe or critical disease in TAF/TDF vs non-TAF/TDF groups respectively. Conclusion In this sample of 18 HIV+ patients with COVID-19 infection, patients receiving TAF/TDF were more likely to develop mild disease and have full recovery than those who were on TAF/TDF-free regimens (75% vs. 10% and 87.5% vs. 50%, respectively). Patients not on TAF/TDF-based regimens had a higher rate of developing severe and critical COVID-19 disease (40% vs. 0% and 30% vs. 12.5%, respectively). Disclosures All Authors: No reported disclosures

Global Contributors to Antibiotic Resistance

Journal of Global Infectious Diseases · 2019-01-01 · 636 citations

INTRODUCTION: Antibiotic-resistant infections have become increasingly prevalent nowadays. As a result, it is essential to examine the key socioeconomic and political factors which contribute to the rise in the prevalence of antibiotic resistance in developing and developed nations. This study aims to identify the various contributors to the development of antibiotic resistance in each type of nation. METHODS: PUBMED was used to identify primary research, systematic reviews, and narrative reviews published before Jan 2017. Search terms included antibiotic resistance, antimicrobial resistance, superbugs, multidrug-resistant organisms, developing countries, developed countries. Publications from different countries were included to ensure generalizability. Publications were excluded if they didn't mention factors causing resistance, focused on the molecular basis of resistance, or if they were case reports. Publicly available reports from national and international health agencies were used. RESULTS: In developing countries, key contributors identified included: (1) Lack of surveillance of resistance development, (2) poor quality of available antibiotics, (3) clinical misuse, and (4) ease of availability of antibiotics. In developed countries, poor hospital-level regulation and excessive antibiotic use in food-producing animals play a major role in leading to antibiotic resistance. Finally, research on novel antibiotics is slow ing down due to the lack of economic incentives for antibiotic research. CONCLUSION: Overall, multiple factors, which are distinct for developing and developed countries, contribute to the increase in the prevalence of antibiotic resistance globally. The results highlight the need to improve the regulatory framework for antibiotic use and research globally.

Immunodeficiency and Ataxia

Infectious Diseases in Clinical Practice · 2019-08-19

To the Editor: A 46-year-old man with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (CD4 unknown at presentation); hepatitis C; cocaine, tobacco, and alcohol use; genital herpes; and recent pulmonary embolism presented to the hospital with 3 months of progressively worsening ataxia and visual changes, with frequent associated falls but no syncopal episodes. He also noted several recent episodes where friends told him that he was speaking oddly, articulating proper words but not making grammatical sense. Lastly, he complained of 3 weeks of dysuria but denied neck stiffness, photophobia, nausea, vomiting, parasthesias, fever, chills, chest pain, or palpitations. A headache was intermittently endorsed and denied by the patient to different members of the primary and consulting teams, but it was not a reason that led to his presentation at the hospital. Human immunodeficiency virus was diagnosed approximately 7 years before presentation, and he was being managed on fixed dose combination of efavirenz/emtricitabine/tenofovir. However, he had not taken the medication for several months. He was alert and oriented to person, place, and time. He was afebrile at 37.1°C with stable vital signs. Mini-Mental Status Examination score was 19/30. He had a slow, wide-based, ataxic gait, difficulty with tandem walk, a positive Romberg sign, impairment in rapid alternating movements, mild dysmetria with heel-to-shin testing, and spasticity of the right leg. Nuchal rigidity was absent. Ophthalmologic examination revealed an old, inactive, left chorioretinal scar but no evidence of HIV retinopathy (eye examination was done by a consult team at a later point during the admission). Laboratory studies were obtained (Table 1).TABLE 1: Relevant Laboratory DataComputed tomography scan found extensive foci of low attenuation in the periventricular and subcortical white matter, as well as in the lentiform nucleus. Magnetic resonance imaging was obtained to further evaluate these findings, revealing extensive nonspecific white matter changes, 3 areas of acute punctate infarction, multiple nodular deposits of contrast along the cortical surface of the cerebrum, and contrast enhancement of the right thalamus that was consistent with a subacute or chronic infarction. Given these nonspecific findings, lumbar puncture was pursued. Opening pressure was 17 cm H2O, and cerebrospinal fluid analysis was consistent with fungal meningitis (Table 1). Cryptococcal antigen titer was 1:512, and cultures grew Cryptococcus neoformans. Induction therapy with liposomal amphotericin B and flucytosine was started, although flucytosine was discontinued owing to worsening thrombocytopenia. He was later transitioned to maintenance therapy with fluconazole. He was doing well postdischarge with improvement of his gait, and he transitioned his care to an outpatient physician. Cryptococcal meningitis is a significant cause of meningitis in populations with a high burden of HIV and is a leading fungal cause of illness and death worldwide.1 It has a significant neurotropism1,2 and classically presents with the neurological findings of altered mental status and headache with associated fever, nausea, and vomiting in a subacute fashion.1,3 However, it can present in various ways given that not all clinical signs are reliably present in those with HIV and diminished inflammatory responses.4 Immune defense against Cryptococcus requires cell-mediated immunity, and the absence of this response allows for dissemination.4 Our patient represents an atypical case in that he was afebrile with a normal opening pressure on lumbar puncture, and his chief complaint centered around chronic worsening ataxia rather than headache and fever. A study of 230 HIV-positive individuals with cryptococcal meningitis showed headache and fever to be presenting signs and symptoms in 91% of patients, whereas ataxia was not noted in any of those patients.5 Elevated opening pressure is commonly seen in patients with cryptococcal meningitis, contributing to the presenting headache and other symptoms of elevated intracranial pressure such as altered mental status, cranial nerve palsies with resulting diplopia, and seizures.1,3 As a result of this elevated intracranial pressure, repeated lumbar punctures are often required.1 Although our patient did note intermittent visual changes, it is notable that lumbar puncture revealed a normal opening pressure. Our initial differential diagnosis was broad, including HIV encephalitis, progressive multifocal leukoencephalopathy, and lymphoma, as well as infectious etiologies such as tuberculosis meningitis and cryptococcal meningitis. A major teaching point to take away from this case is that, in the presence of HIV/acquired immune deficiency syndrome, cryptococcal meningitis should always be considered in a patient presenting with neurological complaints. The threshold for lumbar puncture should be low in these patients, considering the valuable information that it can provide and because classical presentations are not always reliable in patients with significant immunocompromise.4 Thomas A. Di Vitantonio, BARobert Fede, MD Department of Medicine Rutgers New Jersey Medical School Newark, NJ [email protected]David J. Cennimo, MD Department of Medicine Division of Infectious Diseases Rutgers New Jersey Medical School Newark, NJ

Case Report: Imported Case of Lassa Fever — New Jersey, May 2015

American Journal of Tropical Medicine and Hygiene · 2018-07-31 · 12 citations

We report a fatal case of Lassa fever diagnosed in the United States in a Liberian traveler. We describe infection control protocols and public health response. One contact at high risk became symptomatic, but her samples tested negative for Lassa virus; no secondary cases occurred among health care, family, and community contacts.