The Lewin Group, which prepared the report for the ACR, says that, according to data from the American Medical Association (AMA) in 2005, the number of board-certified and/or fellowship-trained pediatric rheumatologists is 171. Supplementing the AMA list with ACR membership files, the total estimate rises to 256. This includes some physicians trained in both adult and pediatric rheumatology (46). The majority of pediatric rheumatologists are board certified (138) and 45 have both adult and pediatric board certification.
Because of the differential between supply of and demand for pediatric rheumatologists, many children are seen by adult rheumatologists. But this doesn’t mean that there is always an available provider willing to take on a new pediatric patient. The survey asked adult rheumatologists the youngest age of patients they are willing to treat. The highest percentage (27.7%) said they would treat a patient between 16 and 17 years old; another 22.4% said they would treat patients between 12 and 15 years old. But the percentage that would treat younger patients drops dramatically: 9% would treat 7–11-year-olds; 7.1%, 4–6-year-olds; and 10.9%, children 4 and under. Respondents also were less likely to take on 18-year-olds (only 17.3%).
Pediatric rheumatologists are a little younger than their adult counterparts. While the median age for the adult rheumatologist is 51, the median age for pediatric rheumatologists is 47. Just under half (49%) are female. The median age for rheumatologists on the whole is older than some other medical specialties due in part to the fact that the normal path to this profession is a residency in internal medicine or pediatrics followed by a two- or three-year fellowship.
Even more striking is the age spread within pediatric rheumatology. The percentage of women varies considerably by age, with a majority of pediatric rheumatologists over age 55 being male and, in contrast, 67% of pediatric rheumatologists under 40 being female. Females account for 69% of new pediatric rheumatology fellows. The survey analysis speculates that retirement will pose less of a factor in the future because females tend to stay in practice longer than their male counterparts. However, averaged over their careers, women tend to work fewer hours than men, which will affect the number of pediatric rheumatologists needed to meet annual demand.
Pediatric rheumatologists practice mostly in academia and in large urban settings. The highest concentration (28) is found in the New York–Northern New Jersey–Long Island, N.Y.–N.J.–Pa. metropolitan statistical area (MSA). The highest percentage per one million population is 2.7 in the Boston–Cam-bridge–Quincy, Mass.–N.H. metropolitan area. There are nine states that had no pediatric rheumatologist (Alaska, Idaho, Maine, North Dakota, Nevada, South Dakota, West Virginia, Wyoming, and Vermont). Only recently has Arizona come off this list, with a specialist for these children in the Phoenix–Mesa– Scotsdale, Ariz., area of 3.6 million.
