Pediatric Rheumatologists Increasing in Number but Still Rare

When the question of the difference between pediatric and adult rheumatologist comes up in conversation, Dr. Ferguson says she likes to make the point that just as doctors wouldn’t send an elderly patient to a pediatrician, it makes no sense to send a child to a doctor accustomed to treating adults. Aside from the disease itself, there are other treatment issues unique to growth phases of a child.

Further, not all adult rheumatologists feel comfortable treating children, says Helen Emery, MD, professor of pediatrics at the University of Washington and director of medical student education at Seattle Children’s Hospital. Pediatric rheumatologists are trained to watch out for adolescent behaviors that could sabotage treatment. Teenagers are famous for going through phases of denial and “they just don’t take their medicines,” says Dr. Emery.

Growing Older Pains

An ABP 2006 workforce report found that pediatric rheumatology was the 12th most selected pediatric subspecialty among first-time candidates applying for general pediatrics certification. That’s 2.7% of the 866 applicants that showed a career interest in the subspecialty.

This low level of interest foreshadows fewer medical students in line to boost the ranks of certified pediatric rheumatologists and fill vacancies left by retiring baby boomers bidding farewell to the office workplace. Meanwhile, the average age of the present workforce is just over 50 years old, according to ABP data from 2011. That, however, is a decrease from 2010 data when the average age was 52 years old.

The number of people with rheumatic disorders is expected to climb as the aging population swells, leaving experts to predict a significant shortage of adult rheumatologists over the next 20 years as demand outpaces supply. The projected shortage could be even worse for pediatric rheumatologists because they number far fewer than adult rheumatologists. That translates into higher numbers of children whose rheumatic diseases potentially go undiagnosed.

Recruitment and Education

How will the field replace the expertise and experience of those retiring pediatric rheumatologists? Experts agree that recruitment and education are crucial. Better-paying specialties and pediatric rheumatology’s low profile pose serious challenges to recruiting new doctors. At medical schools where there are no pediatric rheumatology programs, future doctors are not likely to have the specialty on their radar, notes Dr. von Scheven.