Pediatric rheumatology fellowships have increased from 25 total positions in 1997–1998 to 58 in 2004–2005, although some are unfilled. The number of first-year positions available in 2004–2005 was 24; 12 (53%) were filled, and nine (39%) had completed their program at the time of the survey. The percentage of international medical graduates in these fellowships went from 33% in 1997–1998 to 20% in 2004–2005.
These numbers are on the rise despite the fact that salaries for pediatric rheumatologists are in the low range for specialists. Most physicians who chose pediatric rheumatology instead of adult rheumatology end up working in academic medical centers where they can do clinic research and see patients but make less in salary than those in private practice. The median total compensation for academic faculty in pediatric rheumatology in 1998 was $106,844. That rose 9.2% during a four-year period to $116,723 in 2002. As a comparison, physicians who go into internal medicine, endocrinology, allergy/immunology, and geriatrics tend to have higher salaries than pediatric rheumatologists.
Many Avenues to Meet Pediatric Need
“Choosing to go into pediatric rheumatology is daunting,” says Patience White, MD, chief public health officer for the Arthritis Foundation, professor of medicine/rheumatology at George Washington University in Washington, D.C., and a member of the Workforce Study Advisory Group. “The reasons for the shortage are complex and there are many factors that make the earning potential less attractive than in other subspecialties,” she says. “In the academic setting, there are limited numbers of good mentors and great teachers who motivate the students with exposure to exciting cases in pediatric rheumatology.”
The Arthritis Foundation is working with the ACR on getting a bill passed by the U.S. Congress to help students who are interested in this field pay for their medical education. The Arthritis Prevention, Control, and Cure Act has been introduced in both the U.S. Senate (S626) and the House (HR 1283). A hopeful sign for this authorizing bill (with no exact funding caps) is the lead taken by Senator Edward Kennedy (D-Mass.) who is a sponsor and chair of the Health Education Labor and Pensions (HELP) Committee.
Dr. Klein-Gitelman says that the ACR and the AAP have both had positive feedback for a visiting professor program that will fund a pediatric rheumatologist to work with residents and fellows and spend two days each week teaching pediatric rheumatology. The first of these visiting professorships was completed at the University of Alabama, Birmingham. Alabama has historically had a severe shortage of pediatric rheumatologists.
