The article “Does Fellowship Pay: What Is the Long-term Financial Impact of Subspecialty Training in Pediatrics?” by Rochlin and Simon, published in the February 2011 issue of Pediatrics, correctly highlights an issue of critical importance with implications for our future pediatrician workforce and the pediatric patient population it will be called to serve. The authors found that of 11 pediatric subspecialties evaluated, only 3 (cardiology, critical care, and neonatology) generate positive financial returns with respect to general pediatrics. This finding is especially disturbing when we consider the well-documented shortages that already exist in many subspecialty areas and the impact that research such as this might have on people who are considering additional fellowship training.

We know that the pediatric patient population already suffers from a paucity of subspecialty providers. A 2009 national survey of children's hospitals revealed that many pediatric patients must wait between 5 weeks and 3...

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