AMBULATORY PEDIATRICS
VOLUME 7, NUMBER 2
EMBARGOED UNTIL March 15, 2007
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Race and Gender Variations in Annual Incomes of Pediatricians
Income disparity by race and gender for pediatricians is of concern as the profession becomes
increasingly diverse. To determine whether these factors are associated with pediatricians’ annual
income, researchers analyzed data from the American Medical Association’s annual survey of physicians
from 1992-2001. After adjusting for practice, geographic, and educational factors that are associated with
variations in physicians’ earnings, they found that the difference in incomes between white and black
male pediatricians was not statistically significant: $183,430 for whites compared with $175,741 for
blacks. However, compared with white male pediatricians’ incomes, white female pediatricians’ incomes
were $150,636 (95% confidence interval [CI] $140,975 - $160,298), or 18% lower (p<.001); and black
female pediatricians’ incomes were $133,018 (95% CI $108,736 - $157,300), or 27% lower (p<.001).
These findings suggest that further exploration to determine the cause of these differences is indicated.
(Contact: William Weeks, MD, MBA, 802 291 6285.)
Children with Asthma Continue To Experience Poor Symptom Control
Asthma is one of the most common chronic disorders of childhood, and despite advances in
therapy, rates of morbidity and mortality continue to increase. In spite of guidelines for the treatment of
persistent asthma that recommend preventive anti-inflammatory medications, many children with
persistent asthma are not receiving preventive medications and are experiencing preventable morbidity.
To determine the use of preventive medications among children with persistent asthma and to identify
factors associated with poor asthma control, researchers analyzed data from the Center for Disease
Control’s National Asthma Survey Four-State Sample conducted in 2003. Among a sample of 975
children with persistent asthma, 37% had inadequate therapy (i.e., persistent symptoms and no
preventive medication use), 42.9% had suboptimal control (persistent symptoms or more than 1 attack in
the past 3 months despite preventive medication use), and only 20.1% had optimal control. In analyses
that took several variables into account, Black race (Odds Ratio [OR] 2.0, 95% Confidence Interval [CI]
1.1-3.5), Hispanic ethnicity (OR 1.8, CI 1.1-2.9), discontinuous insurance status (OR 2.4, CI 1.4-4.3), and
lacking a written asthma management plan (OR 1.6, CI 1.1-2.5) were associated with inadequate therapy.
A large number of children with significant asthma, including many whose treatments are not controlling
their asthma symptoms, are not receiving optimal preventive care. Increased screening to assess asthma
severity and control, provider education to enhance preventive medication prescription, and efforts to
improve medication adherence would likely reduce morbidity for children with persistent asthma
symptoms. (Contact Jill Halterman, MD, MPH, 585-275-4329.)
Medical Licensing Exam Performance is Predictor of
Future Board Passage in Pediatrics
In order to become board certified in their specialty, pediatric residents take the American Board
of Pediatrics (ABP) certifying exam, a two day written test with over 700 questions. In medical school and
during residency, they also take many other exams that faculty use to monitor trainees’ academic
progress as well as to assess the likelihood of passing the ABP exam. To determine the power of prior
exams to predict a resident’s performance on the ABP certifying exam, researchers analyzed the
associations between exam results and eventual board scores. The United States Medical Licensing
Exam (USMLE) (Steps 1 and 2), annual in training exams (ITE 1, ITE 2, and ITE 3), and the ABP exam
were highly correlated with each other. The best predictor of ABP passage was the resident’s
performance on the USMLE Step 1. A score of 202 on the USMLE Step 1 was associated with about an
80% chance of passing the ABP certifying exam while a score greater or equal to 220 was associated
with an almost 95% passage rate on the board exam. Rather than use these findings to screen applicants
for pediatric residency programs, program directors should use these test results to guide residents’
education in ways to maximize their chances of passing the ABP certifying exam. (Contact Quimby
McCaskill, MD, MPH, 904-357-5802.)
Practice-Based Education Not Cost-Effective in
Improving Immunization Rates
“Academic detailing,” providing expert health education in pediatric providers’ offices, can overcome
barriers to immunization and help improve rates of children’s immunizations. To assess the cost
effectiveness of this strategy, researchers conducted a randomized controlled pilot trial of academic
detailing to improve immunization coverage for children aged 12-23 months. The intervention improved
self-reported provider behavior. The immunization rates in the group getting academic detailing increased
by 1% while the immunization rates in the control group dropped by 2-3%. The difference of 3-4% was
not statistically significant. From the cost effectiveness analysis, a 1% increase in practice immunization
rates costs $424-$550 depending on the up-to-date criteria used and the targeted age group. The
incremental cost for having one more child up-to-date with immunizations exceeds the reported benefits
accruing to society. (Contact Luisa Franzini, PhD, 713 500 9487.)
The official journal of the Ambulatory Pediatric Association (APA), Ambulatory Pediatrics provides a
much-needed forum for cutting-edge work in general pediatrics. The journal focuses on areas including
child health services research, emergency medicine, research methodology, complementary and
alternative medicine, child health policy, and adolescent medicine. Ambulatory Pediatrics is indexed in
Index Medicus.
ABSTRACTS FOR ALL MANUSCRIPTS WILL BE AVAILABLE AFTER THE EMBARGO FOR
REVIEW ON THE JOURNAL WEBSITE <http://www.ambulatorypediatrics.org>. JOURNALISTS CAN
OBTAIN PREPRINTS FROM THE JOURNAL OFFICE (ambpeds@partners.org
<mailto:ambpeds@partners.org>).