Complexity and challenge in paediatrics: a roadmap for supporting clinical staff and families
Open accessAbstract
There is much that paediatricians love about their job. The attraction of working with children and families, colleagues who are supportive and non-hierarchical, and the diversity of the specialty are all integral to a stimulating and fulfilling career. Yet, despite these positive features, paediatricians are seeing an insidious decline in morale and well-being within the profession. Most of the current cohort of consultant paediatricians started their careers at a time when competition ratios for entry to the specialty were high. The perception was of a specialty that was tough due to the long hours and high-intensity work, but amply compensated by the rewarding nature of the job. However, between 2015 and 2018, although the calibre of applicants remained high, recruitment to Specialist Trainee 1 in paediatrics fell from 97.5% to close to 80%, with this once-popular specialty having the lowest competition ratio of all the medical specialties.1 Recruitment shortfalls are one manifestation of broader problems in the specialty, with paediatricians now representing around 5% of referrals to the NHS Practitioner Health Programme (PHP), a confidential mental health and addiction service for doctors.2 This is an over-representation compared with other specialties. In addition, the service sees a higher percentage of trainees (70% compared with an average of 54% across all specialties). Neonatologists and intensive care specialists form a significant subset of the paediatric group. Almost all paediatricians presenting to PHP have mental illness as opposed to addiction problems, with the vast majority displaying anxiety, depression and symptoms of burn-out. Most tragically, a small number have committed suicide. In 2018 two meetings ( ‘Spotlight on Paediatrics’ ) were convened to discuss the issues which may have contributed to this worrying trend, and to try and find solutions. This paper describes the format and outputs of the two meetings and provides key insights …
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Most integrated care models are based on specific medical conditions or types of medical complexity.
“most integrated care models are based on specific medical conditions or types of medical complexity.”
From Integrated care for children and young people with special health and care needs: a systematic review (2024) · cites this paper as [12]
The ‘Sharing of good practice and quality improvement initiatives’ section gives examples of integrated care for children with long-term conditions and a dedicated team for children with medical complexity. These examples support the condition- or complexity-specific aspect, but the paper does not establish that *most* integrated care models have that basis. No page number is available in our copy. (LLM, conf=0.79)
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Ghotane, S., Hirve, R., Forman, J., Tan, D., Achercouk, Z., & Wolfe, I. (2024) · Archives of Disease in Childhood · doi:10.1136/archdischild-2024-326905 · Cited by 12 · see citing works
- Authors
- Cass, H., Barclay, S., Gerada, C., Lumsden, D. E., & Sritharan, K.
- Affiliations
- St Thomas' Hospital (GB)
- King's College London (GB)
- Royal Society of Medicine (GB)
- Corresponding author
- Cass, Hilary
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2019-06-11
- Volume
- 105
- Issue
- 2
- Pages
- 109-114
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W2951179795
- Cited by
- 34
- References
- 0
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 3 · 2019: 1
- FWCI
- 5.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Royal Society
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Keywords
- physician morale, burnout, mental health of doctors, family support
- MeSH terms
- Occupational Stress, Family, Health Workforce, Humans, Pediatrics, Guidelines as Topic
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