Episode Transcript
Interviewer: We are recording a podcast live at the AAMC 2025 Learn Serve Lead conference in San Antonio, Texas. We're at the Pathways booth for the Spencer Fox Eccles School of Medicine at the University of Utah, where we're exploring, finding, and forging pathways in row 900. I'm so excited to have a couple more guests up to my mic talking about some of the major issues in academic medicine.
So we are talking today about pediatric adolescent gynecology, and the question is: Where are the providers? Who's at microphone number one? What is your name? Please introduce yourself and tell us what you do.
Claudette Shephard, MD: My name is Claudette Jones Shephard. I'm a pediatric and adolescent gynecologist at the University of Tennessee Health Science Center in Memphis, Tennessee, and I do PAG—pediatric adolescent gynecology.
Interviewer: We're going to learn more about that, including a shocking statistic coming up. Who's on mic number two?
Nicole Findlay, MD, MPH: I'm Nicole Findlay-Richardson. I am a clinical assistant professor of OB/GYN at the University of Utah.
Interviewer: So the question is: where are the providers? Nicole, why don't you go ahead and start that conversation. How bad of a problem is this?
Nicole Findlay, MD, MPH: Well, to be frank, half of adolescents are female, and they represent a really large portion of our society. They have specific needs, and yet we have less than 300 providers in the entire country to serve those needs. They're often concentrated at academic centers in major urban areas, and even there, you'll have no pediatric adolescent gynecologists for many, many hours' drive away. Much less the rural areas that have no providers at all.
Interviewer: Claudette, how does that make you feel when you hear that? What goes through your mind?
Claudette Shephard, MD: I feel that I'm a very, very valued and needed person. But the problem is, how can we provide that care, given the limited number of resources? Most people don't even understand what a pediatric adolescent gynecologist is until you need one. So it's a workforce need that is not really well understood, and I think letting the public know that may help.
Interviewer: Nicole, what do pediatric adolescent gynecology providers do?
Nicole Findlay, MD, MPH: The role of practice is very multifaceted. They will see infants, children, and adolescents for chronic issues or sometimes congenital issues. That can mean things like abnormalities that the child was born with in their gynecological tract that require care. Sometimes care isn't required until they hit puberty. Sometimes, a child can have a slip and fall and have to go to the emergency room with damage to their pubic area. Pediatric adolescent gynecologists take care of those injuries.
So many things that require specialized care are separate from what we do for adults. Most gynecologists are trained to take care of adults. But not all of those things that we are taught are directly transferable to children and preteens or adolescents. There's a lack of training in that area, and not all OB/GYN residency programs offer a formal pediatric adolescent experience. So it leaves a really huge gap in care, especially when there are emergencies and you don't have the luxury of waiting, or trying to drive for however many hours to find a specialist, or wait for however many months to get an appointment with a specialist. If the care isn't there in that moment, children get substandard care.
Interviewer: What's the core root cause or causes that lead to not enough providers for pediatric adolescent gynecology? Is it a lack of interest for med students, or is it something else entirely? What is it that you see?
Claudette Shephard, MD: It's probably a combination. If you don't have that experience or exposure in medical school, you're not aware that it's available.
Interviewer: And did you have that exposure?
Claudette Shephard, MD: No, I didn't. But I finally got it through connections. I developed an interest in that population, and through a national meeting I was connected with somebody who was a fellowship-trained pediatric adolescent gynecologist. I found out that this was a niche that was legit and people were focusing on. That's why I decided to get additional training.
Interviewer: We want it to be simpler than that.
Nicole Findlay, MD, MPH: There isn't awareness that the specialty even exists. But in terms of OB/GYN care, there's a shortage of OB/GYN providers in the country—just at baseline. So we don't have enough OB/GYNs, especially in rural areas, for our adult population. And then we only have about 18 programs that train pediatric adolescent gynecology fellows each year. It's a pretty competitive fellowship application, so I wouldn't say that it's a lack of interest. There's about a 60-65% match rate in terms of people applying and getting into the fellowships. What I have heard from some colleagues is that once people are fellowship-trained, it's hard to find enough people who actually come back to try to practice inpatient pediatric adolescent gynecology.
So of the providers that do exist, a relatively large proportion practice in outpatient settings. And while you need pediatric adolescent gynecologists in the clinics to see people for chronic ongoing conditions, you also really need that in the inpatient hospital setting, in emergency rooms, to consult on complex patients who are admitted to children's hospitals. Having enough of those providers to go around can sometimes be challenging. We are having a hard time filling those positions.
Interviewer: Nicole, if there are people out there who are as passionate about this as you are, what are some things that are being done to solve this problem? What are some challenges to overcome?
Nicole Findlay, MD, MPH: Dr. Shephard, you've been the only pediatric adolescent gynecologist in the Mid-South for many, many years, and it's been your desire to find a colleague so that there's more than one of you for western Tennessee, eastern Arkansas, northern Mississippi, and beyond. What are some of the challenges that you find in taking care of such a large population?
Claudette Shephard, MD: The problems I've found have been individuals who don't want to focus on pediatric adolescent gynecology. They feel they need to give up the scope of OB/GYN care, which is a significant part of what they do. It's understanding what they can do and the fact that they don't have to give things up. Many individuals cite the whole reimbursement piece, because we're surgeons, and unless you have a high volume of surgery, it may not be favorable for them.
Nicole Findlay, MD, MPH: Do you think it's a messaging issue in terms of, once people graduate from training, seeing what's possible for them in their career post-training?
Claudette Shephard, MD: I think we as a community need to provide more mentorship. NASPAG, which is the North American Society for Pediatric and Adolescent Gynecology, is working on that. The support is there, no matter where you go post-training. There's even now a push within board certification to give that to pediatric and adolescent gynecology. Presently, it has a focus designation in the American Board of Obstetrics and Gynecology, but we're hoping that the next step will be to give it board certification status to standardize the care and give it the status that it needs.
Interviewer: So, why aren't more medical schools offering it? Do they not understand the value of it? Is it financially difficult to provide that program?
Claudette Shephard, MD: You have to have people who are trained in order to train the students. So you can say that you have an interest, but if you have not really been trained or participated in that degree of learning, it's hard to train learners. And those who are trained tend to be more apt to consider that as a career.
Nicole Findlay, MD, MPH: Mentorship might be a helpful thing. And having more fellowship-trained pediatric adolescent gynecologists go into academic medicine. If we had more fellowship programs, that would be wonderful, but to have a fellowship program, you need the specialists at academic centers. So somewhere to start would be trying to increase the amount of pediatric adolescent gynecologists who go into academic medicine. That way you have more of a presence in OB/GYN academic departments across the country. There's more exposure for trainees,wWhich would encourage more people to get trained and also have more providers to treat and take care of the population.
Claudette Shephard, MD: There's also the question of, where is it going to be housed? In certain communities, the pediatric adolescent gynecologist is part of the surgery department and the children's hospital, and in others they're part of the OB/GYN department, and there are differences in how that is managed. So. Staying in academia or being out in the community, sometimes there is a pull. I think as we further define who the pediatric adolescent gynecologist is and what that individual can mean for an academic community, we'll be able to have better standardization of the role. And I believe NASPAG is working towards accomplishing that.
Interviewer: Any final thoughts or reflections?
Claudette Shephard, MD: I think it's important for students and learners to realize the breadth of possibilities for career choices and consider options. If they have an appreciation for a population and a discipline, it's probably out there and available, and they can seek it out and find more fulfillment in what they want to do in their career.
Nicole Findlay, MD, MPH: I think some of my thoughts coming into this apply to the pediatric adolescent gynecology problem but also to academic medicine in general. We as a community need to provide support and mentorship to help funnel our graduates and trainees into academic medicine. If enough of them aren't making careers in academic medicine, we're going to have a shortage over time because we don't have enough people to train more people.
So while we do need community physicians, and that is very important, especially trying to address disparities in rural care, we also have a great need for providers to practice academic medicine. Right now, it's even more important to bolster that and provide support and mentorship to trainees. That can give them confidence that, once they're finished, if they were to practice in an academic medical center, they would have a fulfilling career and not feel like they would burn out or be stifled in their progress.
Interviewer: Nicole and Claudette, thank you for shedding light on this. I didn't even know this was an issue, so it's important to spread the word. We need to get mentors out there to show people the path forward and get people excited about pursuing this as a potential specialty. Maybe then that starts solving the problem. Thank you very much for joining us on the Pathways podcast.