A Lack of Pediatric Providers Can Have Long-Term Consequences

As with rheumatology care in general, the current demand for pediatric rheumatologists is greater than the supply of providers available. That imbalance is expected to increase significantly by 2030 unless action is taken, according to a new workforce study published in Arthritis Care & Research.¹

The lack of pediatric providers is a serious problem that can have long-term consequences for patients, says Colleen K. Correll, MD, MPH, lead author of the study and a pediatric rheumatologist at the University of Minnesota, Minneapolis.

“We’re getting more and more research that shows us that there’s probably this window of opportunity to treat early and to improve the prognosis of the disease,” Dr. Correll says. “If we don’t have the workforce to see children in a timely manner and the right specialists seeing them, then that really can affect their quality of life and their outcomes.”

Background

About 300,000 U.S. children suffer from chronic arthritis and other rheumatic diseases, according to a 2007 study in Arthritis & Rheumatology.² As of 2006, according to research in the Journal of Pediatrics, only about 200 pediatric rheuma­tology pro­viders were available to treat this population, and 14 states had no pediatric rheumatologists at all.³ Similar numbers were shown in a 2007 ACR workforce study, which noted the workforce consisted of 218 pediatric rheumatologists and predicted demand would exceed supply by 33 rheuma­tologists by 2025.⁴

Dr. Correll

Dr. Correll and her co-authors estimate the number of providers was around 300 as of 2015—measured in full-time equivalents (FTEs)—and predict a significant worsening of the imbalance between supply and demand by 2030 unless action is taken. Their model shows the projected demand will be 461, twice the projected supply (231) by 2030. Further, they note that geographic maldistribution of pediatric rheuma­tologists is a significant issue for patients in certain states and rural areas.

Study Overview

Dr. Correll and her co-authors set out to define the 2015 pediatric rheumatology workforce in the United States, evaluate current workforce trends and project future supply and demand through 2030. They did this by analyzing primary data, such as surveys of ACR members, and secondary data, such as population studies, to create a model that would paint a picture of the future workforce.

To increase the specificity of the results, the researchers used an integrative approach and performed sensitivity testing. The integrative approach accounted for the different types of providers (e.g., physicians, nurse practitioners [NPs], physician assistants [PAs], fellows) and patients, perspectives on the effects of the workforce, setting (i.e., academic, private) and geography. The sensitivity testing provided a range of possible outcomes.

“That integrative approach sort of allows us to get a perspective from all of those groups of people,” who are affected differently by the workforce, Dr. Correll explains. “The sensitivity analysis gives us a wider range of what the model might look like—the best-case and worst-case scenario—instead of one finite answer.”

To address the current and future workforce challenges, the researchers suggest strategies to bolster the ranks of pediatric providers, including not only attracting more physicians, PAs and NPs to the field, but also succession planning, financial incentives and policy updates. By augmenting the workforce and integrating innovative practices like telemedicine, pediatric rheumatology patients have a better chance of getting the timely, high-quality care they need.