It’s Not Always Anesthesia’s Fault -- Supply and Demand: Pediatric Surgical Subspecialty Fellowship Match Trends
Aditee P. Ambardekar MD MSEd, Justin L. Lockman MD MSEd, Alan Jay Schwartz MD MSEd
Original article
Kosciuszek ND, Froehlich M, Moore RP, Yammine M, Cardamone SC, Chesler DA, Barsi JM, Doody JP, Wong A, Ernst ML, Scriven RJ, Calabro KA, Gow KW. Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends. J Surg Res. 2025 Aug 21:S0022-4804(25)00497-4. doi: 10.1016/j.jss.2025.06.094. Epub ahead of print. PMID: 40846559.
Our community has been discussing the pediatric anesthesiology workforce and pipeline for years, in the PAAD (here, here, and here), in our subspecialty journals,1-3 and at Society for Pediatric Anesthesia (SPA) meetings and various other circles of our pediatric anesthesiology community. The concerns over the growing supply and demand mismatch motivated the SPA to commission the Pediatric Anesthesia Graduate Medical Education (GME) Task Force to better understand how to position our fellowships and fellow graduates for success in the changing workforce landscape.4,5 Recommendations from the task force have informed recent initiatives that we hope will enhance and sustain the pediatric anesthesia workforce in the future.
Previous PAADs have also discussed the issues facing pediatricians and their subspecialty workforces. But what about pediatric surgical subspecialties? We are partners in the subspecialized care for children, and our work as anesthesiologists is tied to the case milieu, volume, and specialization trends of our pediatric surgical colleagues. In today’s PAAD, Kosciuszek et al share the fellowship trends for pediatric subspecialization after surgical training (in general surgery, cardiac surgery, obstetrics and gynecology, urology, orthopedics, neurosurgery, plastic surgery, otolaryngology), as well as anesthesiology.6 “The number of applicants to pediatric surgical fellowships directly impacts the future availability of specialists and consequently children’s access to care.”
The authors used several publicly available databases to collect retrospective data on applicant numbers, fellowship positions, and fill rates. They used fellowship match data between 2004 and 2024 from the National Resident Match Program, San Francisco Match, Pediatric Orthopedic Society of North America, and the American Urological Association. They compared data from before 2021 with that after 2021 to identify appreciable trends.
Important limitations include most notably that only ACGME-accredited programs were included in the datasets and analysis. Also, applicants who received positions outside of formal match processes and applicants who applied more than once for some of the highly competitive positions may not have been accounted for in this analysis. National data also make it challenging to distinguish regional trends, which may be important contributors of access to pediatric care. Nonetheless, the tracking of these trends will help inform ways to maintain a robust workforce.
Not surprisingly, the authors corroborated the pediatric anesthesiology workforce trends we have already highlighted: low pipeline supply, many unfilled positions, and high match rates, all of which may result in lower selectivity to fill programs. As we have previously discussed, it is our impression that our community should consider the difference between the number of available positions and those necessary to train and develop our best skilled pediatric anesthesiologists. We agree that “a shrinking [anesthesiology] fellowship pipeline may strain staffing models, forcing consultant anesthesiologists to work additional hours, which in turn impacts financial sustainability, clinical care, and academic engagement.” The increased clinical demand in our academic departments challenges the education and research missions. Unfortunately, trends to further regionalize pediatric surgical care will impede the training of general anesthesiologists in low-volume settings.
Some surgical subspecialties show similar patterns. Pediatric general surgery, gynecology, neurosurgery, and cardiac surgery seem to have strong and constant interest with stable application numbers, matched candidates, and low numbers of unfilled positions. However, subspecialization in orthopedics, otolaryngology, urology, and plastic surgery demonstrate declining numbers of applicants with respect to currently available positions. Importantly, the authors note an overall decline in interest among all pediatric surgical fields, a very concerning trend for the future of expert and specialized pediatric care.
Why is this happening? The authors speculate it may be due to 1) changing demands in the workforce in part due to conditions and procedures that may overlap among different disciplines, 2) the current prerequisite for many subspecialties of additional training years spent conducting research to remain competitive in the field, and 3) declining reimbursement rates at a time when trainees are managing rising education debt and other obligations. These factors all contribute to questions about value and return on investment for additional training for subspecialization.
The truth is in the data, and the data are incomplete. The authors call for “a comprehensive, regionally informed assessment of which surgeons perform which operations” to provide “a more accurate picture of national workforce needs.” They also acknowledge that “despite the challenges in gathering and analyzing workforce data, it remains essential for leaders in pediatric surgery to ensure a balanced, sustainable, and highly skilled workforce capable of meeting the evolving surgical needs of pediatric patients.”
It is reassuring to know that we are not alone in the workforce challenges we face – this is one time they can’t blame anesthesia! Yet, it is disheartening to realize that the downstream impact of these trends will likely worsen access to care for some of our most vulnerable pediatric patients. These data are the first step in bridging physician communities to understand that it is a widespread and shared challenge – and that perhaps working together, as we do inside the operating room, may be required to solve this huge problem looming outside of the operating room.
Send your thoughts and comments to Myron (myasterster@gmail.com ) and he will post them in a Friday Reader Response.
References
1. Giustini AJ, Sivak EL, Nasr VG, et al. Where have all the pediatric anesthesiology fellows gone in the USA? Anesthesiology fellowship trends. Paediatr Anaesth. Aug 2024;34(8):734-741. doi:10.1111/pan.14844
2. Muffly MK, Singleton M, Agarwal R, et al. The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015-2035. Anesth Analg. Feb 2018;126(2):568-578. doi:10.1213/ane.0000000000002535
3. Lim D, Corridore M, Lupa C. The impact of current pediatric anesthesiology fellows shortfall on freestanding children’s hospitals and practices. Semin Pediatr Surg. Oct 2024;33(5):151452. doi:10.1016/j.sempedsurg.2024.151452
4. Ambardekar AP, Eriksen W, Ferschl MB, et al. A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study. Anesth Analg. Jun 30 2022;doi:10.1213/ane.0000000000006128
5. Ambardekar AP, Furukawa L, Eriksen W, McNaull PP, Greeley WJ, Lockman JL. A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education. Anesth Analg. Mar 1 2023;136(3):446-454. doi:10.1213/ANE.0000000000006129
6. Kosciuszek ND, Froehlich M, Moore RP, et al. Supply and Demand: Pediatric Surgical Specialties Fellowship Match Trends. J Surg Res. Aug 21 2025;doi:10.1016/j.jss.2025.06.094