She also stresses the value of Med-Peds rheumatologists for diagnosing and treating certain medical problems sick pediatric rheumatology patients may face, such as venous thromboembolic events and heart attacks. “Often, these [conditions] aren’t at the top of the differential diagnosis in a pediatric patient who presents with shortness of breath, for example, but are common in adults with all diagnoses,” Dr. Edens says. “I’m very comfortable managing blood pressure medications and diuretics for my patients with renal complications from their lupus, for example, due to my internal medicine training.”
Dr. Edens says her combined training enables her to address such issues as school and work difficulties; mental health diagnoses; social concerns, such as drugs, tobacco use and vaping; and concerns surrounding reproductive health in patients of all ages. In particular, she hopes to broaden knowledge and resources for both pediatric rheumatologists and patients surrounding reproductive health issues. This topic is important to teens, young adults and parents affected by pediatric rheumatic diseases. Resources, such as those recently developed by the ACR, could also be beneficial for this population.4
Advancing the Role
In response to workforce demands and patient needs, current efforts are taking place across several fronts to increase the number of practicing Med-Peds rheumatologists.
1. Research
Dr. Edens is working with the ACR’s Committee on Rheumatology Training and Workforce Issues and Kimberly DeQuattro, MD, to explore various aspects of combined rheumatology fellowship training. Two questions Dr. Edens says need to be explored: Why do physicians in training choose a categorical or a Med-Peds fellowship? And how are Med-Peds trained rheumatologists using their training?
“It would be valuable to understand what happens to physicians who complete their combined rheumatology fellowship,” she says. “For example, are they dual-board certified? Are they taking care of more children [than] adults? And are they at an academic center or [in] private practice?”
These answers may help guide further efforts in addressing the workforce shortage.
2. Training
The course of medical education and training for a Med-Peds rheumatologist is substantially longer than both the categorical training for adult and pediatric rheumatology—which is a barrier to attracting residents to a combined fellowship, Dr. Edens explains. She says the rheumatology community is discussing incentives to attract more people to pediatric rheumatology in conjunction with legislation to help fund pediatric subspecialty training. Program leaders are also discussing ways to share costs for combined medical and pediatric rheumatology fellowship training to attract Med-Peds to their institutions.
