title: Subspecialization within pediatric surgical groups in North America.
abstract: OBJECTIVE
  The purpose of this study was to assess the current status of subspecialization in North American pediatric surgical practices and to evaluate factors associated with subspecialization.
  
  
  METHODS
  A survey was sent to each pediatric surgical practice in the United States and Canada. For each of 44 operation types, ranging in complexity and volume, the respondents chose one of the following responses: 1. everyone does the operation; 2. group policy--only some surgeons do the operation; 3. group policy--anyone can do it but mentorship required; 4. only some do it due to referral patterns; 5. no one in the group does it. Association of various factors with degree of subspecialization was analyzed using nonparametric statistics with p<0.05 considered significant.
  
  
  RESULTS
  Response rate was 70%. There was significant variability in subspecialization among groups. Factors found to be significantly associated with increased subspecialization included free-standing children's hospitals, pediatric surgery training programs, higher number of surgeons, higher case volume, and greater volume of tertiary/quaternary cases.
  
  
  CONCLUSIONS
  There is wide variation in the degree of subspecialization among North American pediatric surgery practices. These data will help to inform ongoing debate around strategies that may be useful in optimizing pediatric surgical care and patient outcomes in the future.
authors.affiliation: Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: jacob.langer@sickkids.ca.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.affiliation: Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Gordon
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Li Ern
authors.initials: LE
authors.lastname: Chen
mesh_terms: D002170:Canada; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D010372:Pediatrics / Q000706:statistics & numerical data*; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014481:United States
keywords: Optimization of care; Regionalization; Survey; Volume outcome relationship