O3239: Representation of Indigenous Peoples in Pediatric Subspecialization and Regional Distribution of the Indigenous Pediatric Workforce in the U.S.

Background: More Indigenous [American Indian and Alaska Native (AI/AN), Native Hawaiian, and Other Pacific Islander (NH/PI)] pediatricians are needed to best serve Indigenous children and adolescents. Across the nation, just 0.3% of active physicians identify as AI/AN and 0.1% identify as NH/PI, far below the national representation of 2.9% and 0.5%, respectively. Recent American Board of Pediatrics (ABP) data found that only 0.2% of all pediatricians identify as AI/AN alone (no other race/ethnicity endorsed) and 0.1% identify as NH/PI alone. Among pediatric subspecialists, 13% identify as underrepresented in medicine, compared to 16% of general pediatricians.

Methods: The primary objectives are to 1) report current numbers and demographics of Indigenous identifying pediatricians and pediatric subspecialists, and 2) evaluate regional distribution of the U.S. Indigenous pediatric subspecialty workforce. Using ABP workforce data (2024), we isolated demographic information (age, self-identified gender, stage of training, degree type, certification type, geographic census division, and subspecialty) from self-identified Indigenous (AI/AN, NH/PI) pediatric physicians to create a profile of the Indigenous pediatric workforce. We employed American Community Survey results from the 2020 U.S. Census to provide 5-year estimates of regional pediatric populations. Comparative analysis was conducted using Chi-square testing in R Studio (2024.12.0+467).

Results: Over 70% of Indigenous pediatric physicians were certified in general pediatrics only. Pediatric subspecialization rates varied across racial and ethnic groups, with AI/AN only having significantly lower subspecialization (p = 0.01) and Indigenous in combination with another race having significantly higher subspecialization (p = 0.03) when compared to the overall study population. Neonatal-Perinatal Medicine, Pediatric Critical Care, Cardiology, and Hematology-Oncology had the highest representation of certified Indigenous physicians (Table 1). Three ABP subspecialty programs had no Indigenous providers (Pulmonology, Hospice/Palliative Care, Medical Toxicology). Mapping the last known address for providers in the ABP database to US Census divisions, we observed that the Mountain and West North Central Divisions had high representation of Indigenous peoples, but a low number of Indigenous pediatric subspecialists (Figure 1). The Pacific and West South Central Divisions had both a larger number of Indigenous pediatric subspecialists and a high overall representation of Indigenous peoples.

Conclusion: Disparities in pediatric subspecialization among Indigenous providers suggest a need for focused recruitment and mentorship. The lack of Indigenous providers in certain subspecialties and geographic regions, such as Mountain and West North Central, suggests an opportunity for targeted workforce development efforts. Future qualitative research with Indigenous pediatric trainees and pediatricians could explore cultural strengths and systemic barriers to inform the design of initiatives to enhance representation and accessibility in pediatric subspecialties.