2026 FSA Podium and Poster Abstracts

Background: Equitable access to pediatric anesthesiology services is essential for safe perioperative care. Improved pediatric surgical outcomes are associated with specialized care as supported by the American College of Surgeons. Pediatric anesthesiology is a subspecialty requiring completion of a four-year ACGME-accredited anesthesiology residency followed by a one-year pediatric anesthesiology fellowship, with subspecialty certification through the American Board of Anesthesiology (ABA). Despite expansion of fellowship positions, a national shortage of pediatric anesthesiologists persists. This study evaluated statewide workforce distribution and pediatric population-adjusted access metrics in Florida.

Methods: A cross-sectional geospatial workforce analysis was conducted using Florida Department of Health licensure data cross-referenced with ABA certification records. Providers were included if they held active anesthesia certification and documented pediatric fellowship training. Physicians were excluded for expired certification, absence of pediatric fellowship training, active ABA examination status, or lack of an active Florida medical license. National Provider Identifier (NPI) registry data were used to verify provider identity and primary practice addresses.

County-level pediatric population data (<18 years) and rural classification (Florida Statute 288.0656) were merged using Federal Information Processing Standard (FIPS) codes. Spatial mapping and provider density calculations were performed using ArcGIS (Esri, Redlands, CA), a geographic information system platform that enables geocoding, spatial visualization, and integration of demographic datasets. Provider density was calculated as pediatric anesthesiologists per 100,000 children and stratified by rural versus non-rural counties.

Results: Of 275 physicians initially identified, 108 (39.3%) were excluded based on predefined criteria. A total of 167 pediatric anesthesiologists met inclusion criteria; 159 (95.2%) were successfully geocoded for spatial analysis. Eight additional physicians were excluded due to incomplete or uncertain Florida practice addresses.

All 159 mapped providers practiced in non-rural counties. Non-rural counties demonstrated substantially higher pediatric anesthesiologist-to-population ratios, with several exceeding 20 providers per 100,000 children. In contrast, rural counties demonstrated near-zero provider density, with most rural counties having no practicing fellowship-trained pediatric anesthesiologist despite measurable pediatric populations. Among active providers, 32 (19.2%) reported secondary practice locations in another state and 7 (4.2%) reported additional practice sites within Florida.

Conclusions: Pediatric anesthesiology services in Florida are overwhelmingly concentrated in non-rural counties, with significant population-adjusted access disparities across rural regions. The presence of cross-state secondary practices, coupled with minimal rural representation, reinforces evidence of subspecialty workforce maldistribution. While general anesthesiologists may provide pediatric care in rural areas, these regions may lack fellowship-trained expertise for complex pediatric perioperative management. These findings highlight the need for targeted workforce planning and strategic allocation of pediatric specialty resources to address rural access gaps.