Concerns regarding provision of specialized care of children have received increased attention due to recent and sustained decreased match rate for pediatric residency and fellowship positions. These trends have not kept pace with the overall increase in positions over time, thus widening the gap between available and filled positions.1 Current changes in the Accreditation Council on Graduate Medical Education (ACGME) general pediatric training requirements which reduce time in critical care rotations may deter trainees from pathways leading to pediatric subspecialty training, including Neonatal-Perinatal Medicine.2

Combining perspectives from pediatricians engaged in education at the medical student, resident, and fellowship levels, we review the current landscape of the pediatric subspecialty workforce, contributing factors to the pediatric subspecialty applicant shortage, and the potential impacts of this shortfall. We then present strategies to address this issue. More research is needed to better understand how the dearth of subspecialty applicants will impact outcomes of medically complex children.