Deborah Rothman, MD, PhD, has been advocating for the need for more pediatric rheumatologists since 2004, when she testified in front of a U.S. Senate subcommittee. She spoke about some of her patients with juvenile idiopathic arthritis who went untreated for months before they were referred to her. “Why did it take so long for these children to get help?” she asked, and then provided the answer: “There is a critical shortage of pediatric rheumatologists.”
More recently, Dr. Rothman received two separate ACR REF/Amgen Pediatric Rheumatology Visiting Professorship Awards, which allowed her to visit programs that do not have either a pediatric rheumatologist or a pediatric rheumatology fellowship program. Since the award’s inception in 2003, pediatric rheumatologists have visited 61 institutions.
“There remains a shortage of pediatric rheumatologists in the U.S., and many programs do not have a full-time pediatric rheumatologist,” says Dr. Rothman, who is director of pediatrics and rheumatology at Shriners Hospital for Children in Springfield, Mass.
Dr. Rothman cites some compelling evidence: There have been just 312 pediatric rheumatology diplomates certified by the American Board of Pediatrics, and about 10% of states do not have a practicing pediatric rheumatologist.1,2 Only 30 accredited pediatric rheumatology programs exist to train residents in the specialty.3
The visiting professorship award provides programs with the opportunity to learn from a pediatric rheumatologist for two days. For Dr. Rothman, the process starts when she speaks to the director of the pediatric residency program to discuss specific needs, and together they plan the schedule. It may include lectures on juvenile idiopathic arthritis, lupus, or dermatomyositis, a demonstration of the musculoskeletal exam, and a discussion of autoantibody testing for rheumatic diseases. Dr. Rothman usually rounds with house staff to discuss cases with possible rheumatologic diagnosis and sometimes participates in a “Stump the Chumps” session to discuss challenging cases and difficult diagnoses.
Dr. Rothman’s goal is to raise awareness of pediatric rheumatologic diseases. They are relatively rare, and residents may not encounter them very often. She credits the ACR REF award for providing pediatric medical students, residents, and fellows with access to specialized information regarding rheumatologic diseases.
“It’s a phenomenal program,” Dr. Rothman says. “Delay in diagnosis and treatment of rheumatic diseases is associated with poorer outcome. Studies have shown that many children come to diagnosis only after months of untreated disease.”
In part due to the visiting professorship award, the situation is improving: The number of ACGME-accredited pediatric rheumatology programs has grown from 20 in 2000 to 30 in 2010. In addition, the number of fellows completing training has gone from four in 2000 to 24 in 2010. At the same time, the award provides training that can help ensure that children with rheumatic diseases receive the treatment they need. “With education of the next generation of physicians, there will be earlier recognition and referral of children to pediatric rheumatologists,” says Dr. Rothman.