Objective Transitioning into the early career physician workforce is a uniquely challenging period in a neonatologist's career. There are limited educational opportunities in fellowship regarding career progression, practice models, and benefits. Understanding these factors are key when searching for employment. This study evaluates the early career neonatologist (ECN) workforce and employment characteristics to improve identification of professional needs. Study Design An anonymous 59-question cross-sectional survey was distributed in July 2020 to members of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine Trainees and Early Career Neonatologists (TECaN). The survey instrument was designed using SurveyMonkey and assessed search methods for identifying employers, employment contract details, and professional duties. Questions addressed clinical service time, level of acuity, protected research time, financial compensation, benefits, job search methods, and promotion requirements. Comparisons were drawn between respondents exclusively working in a university-based setting and respondents employed in nonuniversity locations. Responses were collected using SurveyMonkey and then extracted to a Microsoft Excel Workbook for analysis. Statistical analysis was performed using SAS version 9.4. Results Of 1,302 eligible members, 348 people responded (26.7%). Forty-six percent of respondents worked in a university setting and 54% worked in a nonuniversity setting. Using employment site as a discriminator, significant differences were noted in scheduling models. University-located respondents were more likely to work 2-week block schedules, fewer weekend/weeknight call, less clinical weeks per year, and more research/administrative weeks per year. Between university and nonuniversity located positions, benefits were largely comparable, while factors perceived as influential toward promotion varied depending on practice site. Conclusion This study provides ECNs with a contemporary workforce description vital to graduating TECaN seeking employment or renegotiating professional obligations. While benefits were largely similar based on practice site, promotion factors and scheduling models may vary depending on location. Key Points

In 2022, 3.7 million children were born in the United States, of whom ∼600 000 received care from a neonatologist. The dramatic growth of the neonatal–perinatal medicine (NPM) workforce from 375 in 1975 to 5250 in 2022 has paralleled exploding clinical demand. As newborn medicine continues to push the limits of gestational viability and medical complexity, the NPM workforce must advance in numbers, clinical capability, scientific discovery, and leadership. This article, as part of an American Board of Pediatrics Foundation-sponsored supplement that is designed to project the future of the pediatric subspecialty workforce, features a discussion of the NPM workforce’s history and current status, factors that have shaped its current profile, and some plausible scenarios of the workforce’s needs and configuration in the future. In the article, we use an analytical model that forecasts the growth trajectory of the neonatologist workforce from 2020 through 2040. The model uses recent data on the number of neonatologists and clinical work equivalents per 100 000 children and projects future workforce supply under several theoretical scenarios created by modifying key baseline parameters. The predictions of this model confirm the need for a greater sustainable clinical capacity of the NPM workforce. Several future trends indicate that there may be geographic shortages of neonatologists, similar to expected shortages in other pediatric subspecialties. We do not address what an appropriate target for workforce size should be with the model or this article because the current and projected geographic variability in the NPM workforce and risk-appropriate care suggest that a uniform answer is unlikely.

Objective Workforce characteristics and compensation specific to early career neonatologists remain poorly defined. Lack of transparency surrounding compensation limits benchmarking for neonatologists entering the workforce and may negatively influence individual lifetime earnings. Our objective was to provide granular data for this unique subpopulation by defining employment characteristics and factors influential to compensation of early career neonatologists. Study Design An anonymous 59-question cross-sectional electronic survey was distributed to eligible members of American Academy of Pediatrics Trainees and Early Career Neonatologists. A focused analysis was conducted on salary and bonus compensation data collected from the survey instrument. Respondents were classified based on primary site of employment: nonuniversity located (e.g., private practice, hospital employed, government/military, and hybrid employment groups) versus university located practice settings (e.g., work is primarily conducted in a neonatal intensive care unit (NICU) setting located within a university organization). Median quantile regression was used to conduct univariate and multivariate analyses using SAS Software version 9.4. Results We received 348 responses (26.7% response rate). Median salary was $220,000 (interquartile range: $200,000–250,000). Factors associated with salary include academic rank (instructor: $196,000; assistant professor: $220,000 [12% increase; p < 0.001]; associate professor: $260,000 [18% increase]; p = 0.027) and years of experience (p = 0.017), after adjusting for relevant factors. Employment location, practice type, group size, clinical schedule, location of medical school training, and gender identity did not significantly influence salary in multivariate quantile regression. Median annual bonus was $7,000 higher for nonuniversity located positions ($20,000 vs. 13,000; p = 0.021), with assumption of additional administrative roles and practice group seniority as most commonly cited bonus criteria (p = 0.002 and <0.001, respectively). Conclusion Academic rank and years of experience may influence salary. Bonus earnings are higher for nonuniversity located positions. Employment models are evolving to incorporate academic teaching appointments while practicing in nonuniversity located NICUs. This is the first detailed compensation analysis of early career neonatologists. Key Points

Objective Racial and ethnic inequities in leadership achievement, compensation, scholarly productivity, and grant funding exists among physicians. This study explores whether similar inequities exist among neonatologists within the United States. Study design A voluntary anonymous survey was distributed to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents. Logistic regression and ordinary least squares were used to assess whether racial and ethnic identity is associated with clinical time, leadership, compensation, publication, grant funding, or academic rank. Results As compared to non-Hispanic White neonatologists, statistical differences were found for underrepresented minorities in medicine in: regions of the country where they worked, total cash compensation received, being awarded an NIH grant, and location of graduate medical education. Fewer differences were found for Asian neonatologists and included location of graduate medicine education. Conclusion Racial and ethnic identity remains a significant independent factor influencing professional achievement and compensation.

Objective Inequity between genders with regards to leadership achievement, compensation, scholarly productivity, and grant funding exist among physicians. This study explores whether similar inequities exist among board certified neonatologists within the USA. Study design A voluntary anonymous survey was distributed to 3575 members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents (15.7% response rate). The survey contained questions assessing clinician characteristics, work environment, compensation, professional productivity, and social factors. Statistical analysis was done using JMP Pro 15.0.0 by SAS. Results Female neonatologists, compared to male peers, were less likely to hold leadership positions (OR 0.36, p = 0.005), received lower compensation by an average of $34,916 or 12.47% (p < 0.001), and had 6.71 fewer primary authored publications (p = 0.025) after adjusting for several confounding factors. Conclusion Gender remains a significant independent factor influencing leadership attainment, compensation, and academic productivity in this cohort of neonatologists.

Background: Each year, in the United States, approximately 3500 infants die from sudden unexpected infant deaths. The leading causes of SUIDs include: SIDS; unknown cause and accidental suffocation and strangulation in bed due to unsafe sleep practices. The American Academy of Pediatrics stresses that all levels of nurseries and health providers should endorse and model the safe sleep practices (SSP). Medical personnel are critical role models for parents, and the way they position infants in the hospital strongly influences parental practices at home. Objective: Improve in hospital SSP of …

OBJECTIVE:Physician compensation has been found to be influenced by gender, academic affiliation, specialty, productivity, and time in practice. This study explores their impact in the field of neonatology to inform institutional strategic planning and decisions by current and future practitioners.STUDY DESIGN:A voluntary anonymous survey was distributed to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with a 15% response rate. The survey contained questions assessing clinician characteristics, work environment, and professional productivity. Statistical analysis was done using JMP Pro 14.0.0 by SAS.RESULTS:Median salary was $256,000 (interquartile range, $213,608-315,000). Generalized linear model found that years post fellowship, academic affiliation, gender, practice location, professional duties, and clinical team member types independently influenced expected salary.CONCLUSION:Several factors influence the expected compensation of this cohort of neonatologists, even after adjustments for differences in clinician characteristics, work environment, and productivity.

Preterm births (deliveries before 37 weeks' gestation) comprise 12% of all U.S. births and are responsible for onethird of all infant deaths. Neonatal medical advances have increased survival, and primary care physicians often care for infants who were in the neonatal intensive care unit after birth. Functions of the primary care physician include coordination of medical and social services, nutritional surveillance, and managing conditions associated with prematurity. Parental guidance and encouragement are often necessary to ensure appropriate feeding and infant weight gain. Enriched formula and nutrient fortifiers are used for infants with extrauterine growth restriction. Iron supplementation is recommended for breastfed infants, and iron-fortified formula for formula-fed infants. Screening for iron deficiency anemia in preterm infants should occur at four months of age and at nine to 12 months of age. Gastroesophageal reflux is best treated with nonpharmacologic options because medications provide no long-term benefits. Neurodevelopmental delay occurs in up to 50% of preterm infants. Developmental screening should be performed at every well-child visit. If developmental delay is suspected, more formalized testing may be required with appropriate referral. To prevent complications from respiratory syncytial virus infection, palivizumab is recommended in the first year of life during the respiratory syncytial virus season for all infants born before 29 weeks' gestation and for infants born between 29 and 32 weeks' gestation who have chronic lung disease. Most preterm infants have minimal longterm sequelae.

Prolactin (PRL) induces beta-cell proliferation and glucose-stimulated insulin secretion (GSIS) and counteracts the effects of glucocorticoids on insulin production. The mechanisms by which PRL up-regulates GSIS are unknown. We used rat islets and insulinoma (INS-1) cells to explore the interactions of PRL, glucose, and dexamethasone (DEX) in the regulation of beta-cell pyruvate carboxylase (PC), pyruvate dehydrogenase (PDH), and the pyruvate dehydrogenase kinases (PDKs), which catalyze the phosphorylation and inactivation of PDH. PRL increased GSIS by 37% (P < 0.001) in rat islets. Glucose at supraphysiological concentrations (11 mm) increased PC mRNA in islets; in contrast, PRL suppressed PC mRNA levels in islets and INS-1 cells, whereas DEX was without effect. Neither PRL nor DEX altered PC protein or activity levels. In INS-1 cells, PRL increased PDH activity 1.4- to 2-fold (P < 0.05-0.001) at glucose concentrations ranging from 2.5-11 mm. DEX reduced PDH activity; this effect was reversed by PRL. PDK1, -2, -3, and -4 mRNAs were detected in both islets and insulinoma cells, but the latter expressed trivial amounts of PDK4. PRL reduced PDK2 mRNA and protein levels in rat islets and INS-1 cells and PDK4 mRNA in islets; DEX increased PDK2 mRNA in islets and INS-1 cells; this effect was reversed by PRL. Our findings suggest that PRL induction of GSIS is mediated by increases in beta-cell PDH activity; this is facilitated by suppression of PDKs. PRL counteracts the effects of DEX on PDH and PDK expression, suggesting novel roles for the lactogens in the defense against diabetes.

Carbohydrate metabolism in pregnancy reflects the balance between counterregulatory hormones, which induce insulin resistance, and lactogenic hormones, which stimulate beta-cell proliferation and insulin production. Here we explored the interactions of prolactin (PRL) and glucocorticoids in the regulation of beta-cell gene expression, fatty acid oxidation, and glucose-stimulated insulin secretion (GSIS). In rat insulinoma cells, rat PRL caused 30-50% (P < 0.001) reductions in Forkhead box O (FoxO)-1, peroxisome proliferator activator receptor (PPAR)-gamma coactivator-1alpha (PGC-1alpha), PPARalpha, and carnitine palmitoyltransferase 1 (CPT-1) mRNAs and increased Glut-2 mRNA and GSIS; conversely, dexamethasone (DEX) up-regulated FoxO1, PGC1alpha, PPARalpha, CPT-1, and uncoupling protein 2 (UCP-2) mRNAs in insulinoma cells and inhibited GSIS. Hydrocortisone had similar effects. The effects of DEX were attenuated by coincubation of cells with PRL. In primary rat islets, PRL reduced FoxO1, PPARalpha, and CPT-1 mRNAs, whereas DEX increased FoxO1, PGC1alpha, and UCP-2 mRNAs. The effects of PRL on gene expression were mimicked by constitutive overexpression of signal transducer and activator of transcription-5b. PRL induced signal transducer and activator of transcription-5 binding to a consensus sequence in the rat FoxO1 promoter, reduced nuclear FoxO1 protein levels, and induced its phosphorylation and cytoplasmic redistribution. DEX increased beta-cell fatty acid oxidation and reduced fatty acid esterification; these effects were attenuated by PRL. Thus, lactogens and glucocorticoids have opposing effects on a number of beta-cell genes including FoxO1, PGC1alpha, PPARalpha, CPT-1, and UCP-2 and differentially regulate beta-cell Glut-2 expression, fatty acid oxidation, and GSIS. These observations suggest new mechanisms by which lactogens may preserve beta-cell mass and function and maternal glucose tolerance despite the doubling of maternal cortisol concentrations in late gestation.