The medical subspecialty of pediatric rheumatology has grown steadily in recent years amid efforts to shine a light on the field, but a shortage remains critical as more veterans get closer to retirement age.
A scarcity in some parts of the United States means children with rheumatic diseases often travel long distances to be treated for their illnesses.
Access to a pediatric rheumatologist in most states is a challenge and limits the medical options for the more than 300,000 children that the Centers for Disease Control and Prevention (CDC) estimates nationwide are afflicted with arthritis and other rheumatic conditions. Several states have fewer than two board-certified pediatric rheumatologists who treat patients, according to the Arthritis Foundation (AF). Eight states—Alaska, Idaho, Montana, Nevada, North Dakota, South Dakota, West Virginia, and Wyoming—have none, says Michael Henrickson, MD, clinical director in the division of rheumatology at Cincinnati Children’s Hospital Medical Center.
Board certification for pediatric rheumatology began in 1992 and, some two decades later, there are between 280 to 300 board-certified pediatric rheumatologists in the United States, based on data from the American Board of Pediatrics (ABP), the American Medical Association, and the AF. The majority are based in academic centers and clustered in larger, more populated cities, says Emily von Scheven, MD, professor of pediatrics and division chief of pediatric rheumatology at the University of California, San Francisco. Some split their time between research and clinical practice.
A closer look at the numbers reveals an even starker picture. Do the math when you count board-certified certified pediatric rheumatologists and it becomes clear that not all are practicing clinicians, says Dr. Henrickson, who researches and writes about pediatric rheumatology workforce issues.
“Many of the board-certified pediatric rheumatologists live overseas (and may not be American citizens), are full-time bench research scientists, are employed full time in industry positions with pharma companies, or are retired,” Dr. Henrickson noted in an e-mail.
Populations and Geography
Of the many medical centers in Chicago, three have pediatric rheumatologists, but it is still difficult to get coverage for the whole state of Illinois, says Marisa Klein-Gitelman, MD, head of the rheumatology division at Children’s Memorial Hospital and assistant professor at Northwestern University Feinberg School of Medicine in Chicago. Her medical center recruited more faculty members to improve care and reduce wait time for appointments.
The situation is similar—or in some cases worse—in other states. Texas has a large population and not enough pediatric rheumatologists for children who need treatment, says Dr. Klein-Gitelman, who chairs the ACR Special Committee on Pediatric Rheumatology.