3 Ways to Advance the Med-Peds Role in Rheumatology

“Rheumatologic care doesn’t stop or end at a certain age. … The diseases we treat are chronic and continuous, and patients need care across ages,” says Cuoghi Edens, MD, FAAP, assistant professor of internal medicine and pediatrics at the University of Chicago. Dr. Edens is an internal medicine-pediatrics trained (Med-Peds) rheumatologist, a specialty type she hopes will become more desirable. She believes these specialists will better serve pediatric, young adult and adult rheumatology patients in light of the projected workforce shortage and increasing patient demand.

Workforce Demands
Between 2015 and 2030, the estimated demand for pediatric rheumatologists in the U.S. is projected to increase by 61%, and the demand already exceeds supply in many areas.¹ It’s not uncommon for pediatric patients who are referred to a pediatric rheumatologist to wait three months or more to be seen. That statistic is only a small glimpse into the workforce needs, Dr. Edens notes.

Until recently, there wasn’t a pediatric rheumatologist in Dr. Edens’ home state of New Mexico. This shortage meant a pediatric rheumatology patient would either travel out of state for care, be cautiously treated by an adult rheumatologist or not treated at all, unfortunately. This scenario is common across the country due to the shortage of pediatric rheumatologists and is compounded by the shortage of adult rheumatologists. Dr. Edens says a rheumatologist with combined training would be well positioned to fill this void by seeing pediatric and adult patients and serving populations outside major metro areas.

Medical centers can also benefit from employing Med-Peds rheumatologists. Being able to see adults and children provides a unique and important niche for care continuity for pediatric patients transitioning to adult care. Dr. Edens has a transition clinic to help pediatric patients with rheumatic diseases safely adapt to adult rheumatology care. “When patients transition to adult care with those who are not trained in pediatric care, studies show diagnoses often get incorrectly changed from juvenile idiopathic arthritis (JIA) to lupus or Sjögren’s syndrome.”²

Often, pediatric-onset diseases have unique clinical courses, unique medication histories and risk factors that can get lost along the way. Studies also show adult rheumatologists are less aggressive in treating pediatric patients than their pediatric counterparts, and disease control may be compromised.³

Patient Needs
As treatment for all ages of rheumatology patients has dramatically changed over the past 15–20 years, many medications available to treat adult patients still lack approval for use in children. “Med-Peds-trained rheumatologists can encourage expansion of research into pediatrics and explore the clinical use of medications only approved for adults that may benefit pediatric patients based on our experiences with our older patients,” Dr. Edens says.