Is pediatric pulmonary research training in dire straits

Pediatric pulmonary medicine is a young subspecialty, initially recognized with a unique sub-board certification in the U.S. in 1984. In each subsequent decade, published reports have described workforce needs, practice patterns, program development, and, last but not least, the role of research in our profession. In the 1980s, pediatric departments were creating pulmonary divisions and 85% of pediatric pulmonologists worked in an academic department. In the 1990s, the proportion of pediatric pulmonologists in the U.S. working in academic settings fell to 65%. This proportion has not changed in the last decade, according to the most recent surveys reported by Ferkol et al. in this month’s issue of this journal. Pediatric pulmonology has always been dominated by clinical practice and demand, even within academic programs. In the 1997 survey conducted by the American Academy of Pediatrics (Future of Pediatric Education Project), 535 pediatric pulmonary respondents spent an average of 60% of their time providing clinical care, and 10–15% of their time, respectively, in teaching, administration, and research. Younger fellowship graduates (<10 years since graduation) spent more time and received more funding for basic research than their older counterparts (12% vs. 6%). The average pediatric pulmonary practice or division at that time included 3.6 2.6 physicians. The report by Ferkol et al. in this issue is the most recent to describe features of current pediatric pulmonary programs. The figures in the article illustrate the spectrum of pediatric pulmonary training programs with regard to faculty and trainee number, research-funded faculty, and research-funded graduates. Unlike previous reports, this one provides an in-depth description of research training for pediatric pulmonologists in the U.S. Its primary focus is funding from the National Institutes of Health for research training and for research among fellowship graduates, with less focus on non-federal funding. The authors report that from 2003 to 2008, 19% of pediatric pulmonary fellowship graduates secured extramural research funding and 11% were principal investigators on NIH awards. While concerning, these figures are no different than the 10–20% research funding reported among practitioners in 1997, albeit with the caveat that the data may not be comparable given that the survey questions were worded differently. It is also unclear if these low numbers are specific to pediatric pulmonology compared to graduates of other pediatric subspecialty fellowships. The authors cite many reasons why a career in pediatric pulmonary research could be viewed as unattractive to current trainees, ranging from financial burdens and changes in training requirements by the Accreditation Council for Graduate Medical Education (ACGME) to the inadequacy of extramural grant availability. Even though pediatric department chairpersons reported that 69/145 of the open pediatric pulmonary faculty positions anticipated through 2014 will include >50% time protected for research, the authors express concern that too few fellowship graduates will be sufficiently trained or interested enough to pursue successful research careers. While the results described by Ferkol et al. are certainly cause for concern, placing them in a historical perspective shows they are not dire. The number of graduates pursing research careers as a proportion of total graduates in our subspecialty has not declined. Pediatric pulmonology programs are larger and more mature than in the past, with the development of many sub-subspecialty programs, such as pediatric sleep medicine. There are job opportunities for our graduates in the future that assure time for research. The issues raised are being seen across most