10/21/2025
Hot off the press! This paper was a true labor of love. It took many years to get this done with so much help from the fine folks at and the surgeons listed. Special thanks to Dr. Tom Ricketts, our health policy expert, for helping us with the advanced modeling to predict pediatric orthopaedic workforce trends in the future. Extra special thanks to my co-authors, who put a ton of time and thought into this paper. And extra extra thanks to Dr. Woody Sankar for getting this project off the ground and doing the lions share of the ideation and data analysis, as well as getting aligning the Board of Directors of POSNA with this effort.
Key points:
(1) The supply of POS and physician extenders continues to increase. Growth of the number of POS in the United
States is expected to occur with the current rate of 57.5 fellows trained per year.
(2) Based on our model, a rate of 49 fellows trained per year shows neither an increase nor decrease in POS supply
in the United States. Thus, there is projected to be a slight surplus of POS supply over the next decade.
(3) Because of the age–gender distribution of the POS workforce, as well as the increasing proportion of females
entering the specialty, gender parity is expected by 2050.
(4) The population of children under 18 years of age will likely continue to decline because of declining birth and
immigration rates. This decrease in demand may possibly be offset by the increasing amount of subspecialization among nonpediatric orthopaedic surgeons and the subsequent decrease in pediatric cases
performed by them, leading to more surgical cases being available for POS over time.
(5) There continues to be an expansion in the scope of practice of POS, most commonly in sports, hand, and spine
surgery. There is also a trend toward treatment of traditionally pediatric orthopaedic conditions through early
adulthood (transitional care), which can lead to an expansion in the number of patients available for the
pediatric orthopaedist.
