The Child Abuse Pediatrics Workforce in the US: A Review of Emerging Trends

Background: Child Abuse Pediatrics (CAP), formally recognized as a pediatric subspecialty in 2006, faces substantial workforce challenges that parallel and, in some respects, exceed those affecting other pediatric subspecialties. Concerns regarding workforce adequacy are amplified by increasing clinical demand, an aging workforce, declining fellowship recruitment, and financial and professional barriers to subspecialty practice. Objective: To review current trends affecting the CAP workforce in the United States and examine factors influencing its future capacity to meet the needs of children and families. Methods: A narrative review of recent workforce literature, including data from the National Academies of Sciences, Engineering, and Medicine (NASEM), the American Board of Pediatrics (ABP), the National Resident Matching Program (NRMP), and publications from the 2024 Pediatrics special issue on pediatric subspecialty workforce projections. Workforce demographics, fellowship training patterns, financial considerations, and projected workforce models were evaluated. Results: CAP is among the smallest pediatric subspecialties, with only 363 board-certified physicians reported in 2023 and the lowest provider-to-child ratio among ABP-certified pediatric subspecialties (0.45 per 100,000 children). More than one-fifth of CAP physicians are aged 61 to 70 years, raising concerns regarding impending retirements. Fellowship recruitment remains inadequate, with only 55.7% of available CAP fellowship positions filled on average during the past decade. Workforce simulation models project growth ranging from a 4% decline to a 20% increase through 2040, with even the most optimistic scenarios unlikely to meet future demand. Contributing factors include high educational debt burdens, comparatively limited financial return on subspecialty training, extensive non-billable clinical and medicolegal responsibilities, and risks of burnout and moral injury. Conclusions: The CAP workforce is at a critical inflection point. Current workforce trends suggest that future supply will be insufficient to meet projected clinical needs without targeted intervention. Emerging strategies, including competency-based fellowship pathways, greater integration of advanced practice providers, collaborative care models, and focused workforce development initiatives, may help mitigate shortages. Sustained investments in training, compensation, recruitment, retention, and policy support are essential to ensure continued access to specialized child abuse evaluation and treatment services and to safeguard the health and well-being of vulnerable children.