Objective Gaining timely access to pediatric subspecialists is becoming increasingly difficult in the United States. Hospitals, primary care providers, families, and health plans are struggling with alternative ways to address this critical workforce shortage in pediatrics. One approach is to expand the reach of existing state and regional networks of pediatric subspecialty services and the other approach is to strengthen the capacity of primary care providers (PCPs) with more consultation support and coordination from pediatric subspecialists. Unfortunately, there are several barriers that impede expanded pediatric subspecialty access and increased coordination between primary and specialty care. These barriers primarily pertain to the supply of pediatric subspecialists, communication and coordination between primary and specialty pediatric providers, and funding.

Methods A Federal Expert Work Group on Pediatric Subspecialty Capacity, comprised of experts in pediatric health care, was established in 2005 to: 1) assess the scope and impact of pediatric subspecialty workforce problems; 2) identify promising practices; and 3) develop a tactical plan to improve access to pediatric subspecialty care within the context of comprehensive, community-based medical homes.

Result/Conclusions Through several meetings of the Expert Work Group, 10 innovative approaches were identified related to referral, consultation, and shared management. An analysis of these approaches will be presented.