Wondering how best to care for an adult patient with juvenile idiopathic arthritis-associated uveitis or a pediatric patient with early-onset osteoarthritis? Unsure how to manage a 23-year-old with chronic nonbacterial osteomyelitis or an 8-year-old with tophaceous gout due to Lesch-Nyhan syndrome? Ask a Med-Peds rheumatologist.
What Is a Med-Peds Rheumatologist?
Med-Peds rheumatologists in the U.S. are board-certified adult and pediatric rheumatologists. After medical school, they complete a four-year combined residency program in internal medicine and pediatrics (Med-Peds), followed by a four-year combined fellowship in adult and pediatric rheumatology (see Figure 1). Med-Peds rheumatologists represent a small, but growing, subset of the rheumatology workforce in the U.S. As of 2024, an estimated 56 Med-Peds rheumatologists are currently in practice, with an additional 10 currently completing their combined fellowships.
Figure 1: Med-Peds rheumatologists complete 12 years of graduate and post-graduate education. Any institution with an adult or a pediatric rheumatology fellowship may create a combined fellowship, alone or in partnership with another institution. (Click to enlarge.)
What Do Med-Peds Rheumatologists Offer to the Field of Rheumatology?
With their dual training, Med-Peds rheumatologists hold unique perspectives with the potential to address several challenges facing the field of rheumatology, including the expanding number of patients with pediatric-onset rheumatic diseases transitioning to adult care, the shortage of both pediatric and adult rheumatology providers and the overlapping nature of complex rheumatic diseases across the two patient populations. For patients cared for by Med-Peds rheumatologists, the continuity of care provided is extremely meaningful and may decrease loss of follow-up during young adulthood. In addition, many Med-Peds rheumatologists have made significant research contributions that stem from their dual training.
We asked three Med-Peds rheumatologists, each with a different focus, to discuss their careers.
Dr. Peter Nigrovic
Peter Nigrovic, MD, is a Med-Peds rheumatologist at Boston Children’s Hospital, where he is chief of the Division of Immunology. He also leads a basic and translational science lab that focuses on the mechanisms of inflammation in arthritis and systemic lupus erythematosus at Brigham and Women’s Hospital, Boston.
Why did you decide to pursue both adult and pediatric rheumatology?
Dr. Nigrovic: As a medical student, I spent time in Guatemala, and work in rural communities there convinced me that I wanted to be able to take care of the whole age spectrum. This is why I did Med-Peds. When I decided to specialize in rheumatology, I had already trained for several years in a way that emphasized the similarities, rather than the differences, between children and adults. I suspected there might be value in bringing this perspective into our field.
