Robert J. Vinci’s research while affiliated with University of Massachusetts Medical School and other places

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Publications (80)


Projecting the Future Pediatric Subspecialty Workforce: Summary and Recommendations
  • Article

February 2024

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16 Reads

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18 Citations

PEDIATRICS

Colin J Orr

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Emily McCartha

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Robert J Vinci

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[...]

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This article summarizes the findings of a Pediatrics supplement addressing the United States workforce for 15 pediatric subspecialties. It includes results from a microsimulation model projecting supply through 2040; growth is forecasted to be uneven across the subspecialties with worsening geographic maldistribution. Although each subspecialty has unique characteristics, commonalities include (1) the changing demographics and healthcare needs of children, including mental health; (2) poor outcomes for children experiencing adverse social drivers of health, including racism; and (3) dependence on other subspecialties. Common healthcare delivery challenges include (1) physician shortages for some subspecialties; (2) misalignment between locations of training programs and subspecialists and areas of projected child population growth; (3) tension between increasing subsubspecialization to address rare diseases and general subspecialty care; (4) the need to expand clinical reach through collaboration with other physicians and advanced practice providers; (5) the lack of parity between Medicare, which funds much of adult care, and Medicaid, which funds over half of pediatric subspecialty care; and (6) low compensation of pediatric subspecialists compared with adult subspecialists. Overall, subspecialists identified the lack of a central authority to monitor and inform child healthcare provided by pediatric subspecialists as a challenge. Future research on the pediatric subspecialty workforce and the children it serves will be necessary to ensure these children’s needs are met. Together, these articles provide overarching and subspecialty-specific recommendations to improve training, recruitment, and retention of a diverse workforce, implement innovative models of care, drive policy changes, and advise future research.


Child Health Needs and the Pediatric Infectious Diseases Workforce: 2020-2040

February 2024

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10 Reads

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5 Citations

PEDIATRICS

Pediatric infectious diseases (PID) physicians prevent and treat childhood infections through clinical care, research, public health, education, antimicrobial stewardship, and infection prevention. This article is part of an American Board of Pediatrics Foundation–sponsored supplement investigating the future of the pediatric subspecialty workforce. The article offers context to findings from a modeling analysis estimating the supply of PID subspecialists in the United States between 2020 and 2040. It provides an overview of children cared for by PID subspecialists, reviews the current state of the PID workforce, and discusses the projected headcount and clinical workforce equivalents of PID subspecialists at the national, census region, and census division levels over this 2-decade period. The article concludes by discussing the education and training, clinical practice, policy, and research implications of the data presented. Adjusting for population growth, the PID workforce is projected to grow more slowly than most other pediatric subspecialties and geographic disparities in access to PID care are expected to worsen. In models considering alternative scenarios, decreases in the number of fellows and time spent in clinical care significantly affect the PID workforce. Notably, model assumptions may not adequately account for potential threats to the PID workforce, including a declining number of fellows entering training and the unknown impact of the COVID-19 pandemic and future emerging infections on workforce attrition. Changes to education and training, clinical care, and policy are needed to ensure the PID workforce can meet the future needs of US children.


Child Health and the US Pediatric Subspecialty Workforce: Planning for the Future

February 2024

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24 Reads

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20 Citations

PEDIATRICS

This article opens a multi-article Pediatrics supplement that provides a rigorous analysis of the projected pediatric subspecialty workforce in the United States. Congenital variations, epigenetics, exposures, lifestyle, preventive care, and medical interventions from conception through young adulthood set the stage for health and wellbeing in adulthood. Although care provided by pediatric subspecialists is associated with better outcomes and lower costs compared with adult providers, the authors of recent articles in the lay and medical literature have questioned the capacity of pediatric subspecialists to meet children’s health care needs. This article highlights that, despite numerous advances in prevention, diagnosis, and treatment, the last decade has witnessed increasing numbers of children with acute or chronic physical and mental health disorders, including medical complexity, obesity, type 2 diabetes, anxiety, depression, and suicidality, all of which are exacerbated by poverty, racism, and other social drivers of health. In this article, we then describe the variability in the demographics, practice characteristics, and geographic distribution of the 15 core pediatric subspecialties certified by the American Board of Pediatrics. We then discuss the rationale and approach to the development of a pediatric subspecialty workforce model that forecasts subspecialist supply from 2020 to 2040 for 14 subspecialties at the national and subnational levels (not including the newest subspecialty, pediatric hospital medicine), accounting for US Census Bureau child population projections. The model does not account for the unique physical and mental needs of individual children, nor does it address the increasingly precarious commitment to, and financing of, pediatric subspecialty care in the US health care system impacting market demand.


Child Health and the Pediatric Pulmonology Workforce: 2020-2040

February 2024

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24 Reads

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2 Citations

PEDIATRICS

There is concern as to whether the supply of pediatric pulmonology (PULM) subspecialists will be adequate to meet future demand. As part of an American Board of Pediatrics (ABP) Foundation-sponsored supplement investigating the future of the pediatric subspecialty workforce, this article assesses the current PULM clinical workforce and estimates the clinical workforce supply in the United States through 2040. The current workforce was assessed using ABP certification and Maintenance of Certification data, and a workforce supply model evaluating population growth, clinical effort, and geographic trends was developed after incorporating ABP data. Findings demonstrate that the number of pediatric pulmonologists has gradually increased over the past decade, and the ratio of subspecialists to children is likely to increase another 20% to 40% over the next 2 decades, although absolute numbers remain small. Geographic variation in access will persist in some regions. The proportion of women in the discipline has increased, but the proportion of pediatric pulmonologists from underrepresented in medicine backgrounds still lags behind the general population. Based on current trends, the PULM clinical workforce appears equipped to meet both population growth and the modest increase in demand for clinical services speculated to occur because of changes in the subspecialty’s clinical portfolio. However, several factors could inhibit growth, and geographic maldistribution may continue to impact care access. Efforts to address variation in access and demographic diversity in the field are warranted. This article concludes by discussing the training, clinical practice, policy, and future workforce research implications of the data presented.


Child Health Needs and the Pediatric Gastroenterology Workforce: 2020-2040

February 2024

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24 Reads

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2 Citations

PEDIATRICS

This article is part of an American Board of Pediatrics Foundation-sponsored effort to analyze and forecast the pediatric subspecialty workforce between 2020 and 2040. Herein, an overview of the current pediatric gastroenterology workforce is provided, including demographics, work characteristics, and geographic distribution of practitioners. Brief context is provided on the changing nature of current practice models and the increasing prevalence of some commonly seen disorders. On the basis of a rigorous microsimulation workforce projection model, projected changes from 2020 to 2040 in the number of pediatric gastroenterologists and clinical workforce equivalents in the United States are presented. The article closes with a brief discussion of training, clinical practice, policy, and future workforce research implications of the data presented. This data-driven analysis suggests that the field of pediatric gastroenterology will continue to grow in scope and complexity, propelled by scientific advances and the increasing prevalence of many disorders relevant to the discipline. The workforce is projected to double by 2040, a growth rate faster than most other pediatric subspecialties. Disparities in care related to geography, race, and ethnicity are among the most significant challenges for the years ahead. Changes to training and education, incentives to meet the needs of underserved populations, and new multidisciplinary models for health care delivery will be necessary to optimally meet the volume, diversity, and complexity of children with gastroenterological diseases in the years ahead.


Child Health and the Neonatal-Perinatal Medicine Workforce: 2020-2040

February 2024

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17 Reads

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6 Citations

PEDIATRICS

In 2022, 3.7 million children were born in the United States, of whom ∼600 000 received care from a neonatologist. The dramatic growth of the neonatal–perinatal medicine (NPM) workforce from 375 in 1975 to 5250 in 2022 has paralleled exploding clinical demand. As newborn medicine continues to push the limits of gestational viability and medical complexity, the NPM workforce must advance in numbers, clinical capability, scientific discovery, and leadership. This article, as part of an American Board of Pediatrics Foundation-sponsored supplement that is designed to project the future of the pediatric subspecialty workforce, features a discussion of the NPM workforce’s history and current status, factors that have shaped its current profile, and some plausible scenarios of the workforce’s needs and configuration in the future. In the article, we use an analytical model that forecasts the growth trajectory of the neonatologist workforce from 2020 through 2040. The model uses recent data on the number of neonatologists and clinical work equivalents per 100 000 children and projects future workforce supply under several theoretical scenarios created by modifying key baseline parameters. The predictions of this model confirm the need for a greater sustainable clinical capacity of the NPM workforce. Several future trends indicate that there may be geographic shortages of neonatologists, similar to expected shortages in other pediatric subspecialties. We do not address what an appropriate target for workforce size should be with the model or this article because the current and projected geographic variability in the NPM workforce and risk-appropriate care suggest that a uniform answer is unlikely.




Implementing Social Risk Screening and Referral to Resources in the NICU

March 2023

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16 Reads

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13 Citations

PEDIATRICS

Objective: Social risk screening is recommended by the American Academy of Pediatrics, but this practice is underutilized in NICUs. To address this gap in social care, we aimed to increase rates of: (1) systematic social risk screening and (2) connection with community resources, each to ≥50% over a 14-month period. Methods: We conducted a quality improvement initiative from November 2020 to January 2022. We adapted a screening tool and used Plan-Do-Study-Act cycles to integrate screening and referral to resources into clinical workflow. Primary outcome measures included the percentage of (1) families screened and (2) connection with resources. We examined screening by maternal race/ethnicity and primary language. Process measures were (1) time from admission to screening and (2) percentage of referrals provided to families reporting unmet needs and requesting assistance. We used statistical process control to assess change over time and χ2 tests to compare screening by race/ethnicity and language. Results: The rates of systematic screening increased from 0% to 49%. Among 103 families screened, 84% had ≥1, and 64% had ≥2 unmet needs, with a total of 221 needs reported. Education, employment, transportation, and food were the most common needs. Screening rates did not vary by race/ethnicity or language. Among families requesting assistance, 98% received referrals. The iterative improvement of a written resource guide and community partnerships led to increased rates of connection with resources from 21% to 52%. Conclusion: Leveraging existing staff, our social risk screening and referral intervention built the capacity to address the high burden of unmet needs among NICU families.


The Importance of Subspecialty Pediatricians to the Health and Well-Being of the Nation’s Children

March 2023

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56 Reads

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6 Citations

The Journal of Pediatrics

Through this review of published literature, it is clear that children benefit in measurable ways when they receive care from trained pediatric subspecialists. The improved outcomes provided by pediatric subspecialists supports the care provided in the patient's pediatric medical home and emphasizes the importance of care coordination between all components of the pediatric workforce. The AAP highlights this in a recent policy statement by stating the care provided by pediatric clinicians "encompasses diagnosis and treatment of acute and chronic health disorders; management of serious and life-threatening illnesses; and when appropriate, referral of patients with more complex conditions for medical subspecialty or surgical specialty care" Explicit in this statement is the emphasis on the role of complex care coordination between pediatric specialist and primary care pediatricians and that collaboration and guidance by the pediatrician is central to providing optimal care of patients. 65 Improving health outcomes early in life is an important public health strategy for modifying the complications from childhood chronic disease and highlights the role of pediatricians in mitigating the long-term consequences of antecedents of adult disease. 66 The recent announcement of the National Academies of Science, Engineering, and Medicine (NASEM)'s plan for a Consensus Study on The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-being is a related and exciting development, on a national scale. 67 In response to shortages and geographic maldistributions of pediatric subspecialists, the NASEM committee intends to assess the impact of current pediatric clinical workforce trends on child health and well-being, in order to develop informed strategies to ensure an adequate, high-quality pediatric workforce, with a robust research portfolio that informs those recommendations. While this large, national initiative will surely lead to a better understanding of and strategies to implement across the pediatric subspecialty workforce, more well-designed studies that specifically measure child outcomes related to access to pediatric subspecialty care, would add meaningfully to the body of pediatric literature and to our national pediatric advocacy initiatives.


Citations (66)


... A recently published study projects that the pediatric infectious disease workforce will grow more slowly than most other pediatric subspecialties from 2020 to 2040, exacerbating existing geographic disparities in access to care. Additionally, the number of fellows entering pediatric infectious disease training programs is low, with only about half of fellowship positions being filled, with salaries for pediatric infectious disease specialists among the lowest across medical subspecialties [34,35]. These factors collectively indicate a significant and ongoing shortage of pediatric infectious disease providers, which is expected to worsen unless addressed through targeted policy and training interventions. ...

Reference:

Evaluation and Treatment of Congenital Syphilis: A National Survey of US Pediatric Specialists
Child Health Needs and the Pediatric Infectious Diseases Workforce: 2020-2040
  • Citing Article
  • February 2024

PEDIATRICS

... Conclusions for some subspecialties (eg, pediatric cardiology, pediatric pulmonology) are that future numbers will be sufficient, should historical trends continue. 15,16 Others are struggling to care for current patients (eg, developmental-behavioral pediatrics). 17 Examining supply only at the national level also obscures asymmetric geographic growth at the US census region and division level. ...

Child Health and the Pediatric Pulmonology Workforce: 2020-2040
  • Citing Article
  • February 2024

PEDIATRICS

... This approach helps organizations to develop flexible strategies that can adapt to unforeseen changes in market conditions or internal dynamics. For example, by simulating the impact of a sudden market downturn, organizations can formulate contingency plans for workforce downsizing or re-skilling programs to mitigate adverse effects on operational capacity [3]. ...

Child Health and the US Pediatric Subspecialty Workforce: Planning for the Future
  • Citing Article
  • February 2024

PEDIATRICS

... A földrajzi és demográfiai jellegzetességeken túlmenően a humánerőforrások és -tényezők is jelentősen befolyásolják a regionális neonatális transzportszolgálatra kirótt feladatok minőségét, ugyanis a megfelelően képzett és tapasztalt egészségügyi személyzet (orvos, nővér) számos országban nem áll rendelkezésre elegendő létszámban [10,11]. Ezen túlmenően, a kistérségi kórházakban dolgozó gyermekgyógyászoknak nem biztos, hogy van lehetőségük magabiztosan elsajátítani és fenntartani az extrém kis súlyú újszülöttek stabilizálásához szükséges gyakorlati készségeket. ...

Child Health and the Neonatal-Perinatal Medicine Workforce: 2020-2040
  • Citing Article
  • February 2024

PEDIATRICS

... The supplement closes with an epilogue, summarizing core themes across the articles and offering recommendations. 82 All articles in the supplement include the term "pathway" as opposed to "pipeline," acknowledging the lack of a single pathway into pediatric subspecialty care and potential insensitivities to US indigenous peoples. 83,84 CONCLUSIONS With the proportion of adults >65 years of age in the United States anticipated to surpass children in 2034, 85 attention to child health will suffer without a more holistic, lifespan-focused approach. ...

Projecting the Future Pediatric Subspecialty Workforce: Summary and Recommendations
  • Citing Article
  • February 2024

PEDIATRICS

... The committee recognizes that other pediatric sub-specialties face similar challenges in workforce recruitment, retention, and reimbursement [2, 6,7]. Children receive optimal care when they have access to providers who have been trained specifically to care for children, yet an estimated 2-53% of children live > 80 mi. ...

A Flattening of the Curve: The Challenge of Disparate Growth Rates in the Pediatric Subspecialties
  • Citing Article
  • June 2023

The Journal of Pediatrics

... In the NICU, where patients often experience a prolonged stay, staff may have more opportunities to establish rapport with families; thus the NICU setting may be ideally poised to conduct such screenings. In one safety-net NICU that implemented SDoH screening, over 80 percent of families screened had at least one unmet need, and 98% of those screens resulted in referrals to meet those needs [19]. Nonetheless, only one in four NICUs currently uses a screening tool to identify SDoHrelated needs [20]. ...

Implementing Social Risk Screening and Referral to Resources in the NICU
  • Citing Article
  • March 2023

PEDIATRICS

... Our finding that unmet need for pediatric mental health care was not lower in states with FPA is inconsistent with the substantial evidence of improved adult mental health in those states (Alexander & Schnell, 2019). Given the ample evidence that NPs can provide quality adult mental health care (Alexander & Schnell, 2019;Chapman et al., 2018), our findings may reflect the small number of NPs who provide pediatric mental health care (Delaney & Vanderhoef, 2019;Gigli et al., 2023). Future studies evaluating the distribution and practice patterns of the pediatric mental health NP workforce may elucidate opportunities to target expansion of this workforce in areas with greatest need. ...

A Cross-Sectional Examination of the Nurse Practitioner Workforce Caring for Children in the United States
  • Citing Article
  • March 2023

The Journal of Pediatrics

... 6 Antimicrobial stewardship programs are required for hospitals to receive accreditation and federal funding; there is increasing evidence that these programs reduce medical expenditures. [7][8][9] Diagnostic stewardship, including new diagnostic tests such as molecular pathogen panels, aims to optimize the use of laboratory testing and can have synergistic benefits when paired with antimicrobial stewardship. 10,11 Finally, the complexity of antimicrobial resistance mechanisms and slow development of new antibiotics require expertise in childhood antibiotic-resistant infections. ...

The Importance of Subspecialty Pediatricians to the Health and Well-Being of the Nation’s Children
  • Citing Article
  • March 2023

The Journal of Pediatrics

... Finally, structural resilience or social cohesion and resources in communities can offset some effects of systemic racism and serve as other targets to improve equity (61). One example of this approach is the training of community health workers as a community resource to overcome systemic racism-related barriers to care and increase cancer awareness and screening (62)(63)(64). ...

A Structural Racism Framework to Guide Health Equity Interventions in Pediatric Oncology
  • Citing Article
  • April 2022

PEDIATRICS