The lack of a loan repayment program did not dissuade me from entering pediatric rheumatology. Neither did the relatively low salaries in comparison to other specialties and subspecialties. On one side of my family, I was one generation removed from poverty, and I appreciated that any medical salary would keep me comfortable. Further, the relative financial disincentive to go into pediatric rheumatology felt like a badge of honor at times.
“You are not going into pediatrics to make money,” people often warned us as medical students.
A pediatric hematologist once confided to me that he preferred it this way, because it meant the people who went into the field had to really, really love it.
Supply & Demand
There is some appeal to a field of self-selected, highly dedicated practitioners, who have already passed a test of devotion by signing up for a career that ensures a loss of close to $1 million in total lifetime earnings compared with general pediatrics.1
But serious risks exist with this model: There’s the obvious risk of dissuading highly capable candidates and limiting the number of trainees. For the 2019 match in pediatric rheumatology, there were 14 U.S. graduate applicants and 22 total applicants for 39 positions. Only 19 positions were filled.2 The 2018 match was similar, with only 22 of 41 positions filled.3 In the current climate, a program filling its available fellowship positions in pediatric rheumatology is no less than a small miracle.
This is extremely worrying considering the staggering gap between supply and demand of pediatric rheumatologists that is projected over the next 10 years. The 2015 ACR Workforce Study Report indicated that, given current trends, a significant decrease will occur in the supply of pediatric rheumatologists despite an increase in demand.4 By 2030, the projected need for pediatric rheumatologists will be twice the supply.
Although the gap between supply and demand is magnified in pediatric rheumatology, one of the lowest paying fields in medicine, it is not unique. Many other pediatric subspecialties struggle to attract applicants for the annual National Resident Matching Program subspecialty match. Pediatric endocrinology, infectious disease, nephrology and pulmonology each filled only about half of their spots last year.2
A cost analysis of salary potential for pediatric subspecialists published in 2011 showed that among 11 pediatric subspecialties, only three have lifetime earnings higher than that of general pediatrics.1 In fact, even with a possible loan repayment plan, most pediatric subspecialists, from emergency medicine to infectious disease, would still not recoup the relative financial losses of three years of fellowship and lower earnings. With loan repayment, pediatric rheumatologists will still make $500,000 less, on average, than general pediatricians over the course of their careers.
