Child/Adolescent Health

The shortage of pediatric rheumatologists limits residency training in pediatric rheumatology among general pediatricians

Less than one-fifth of pediatricians feel adequately trained to diagnose and treat juvenile rheumatoid arthritis, with 42 percent of them referring these children to pediatric rheumatologists. However, there is a shortage of pediatric rheumatologists. This not only limits available specialized care for children with arthritis and other rheumatology problems, but also limits medical education.

For example, more than 40 percent of medical directors of 127 pediatric residency programs surveyed in the United States reported that they did not have a pediatric rheumatologist on site. Programs with on-site pediatric rheumatologists were significantly more likely than those without one to have an on-site pediatric rheumatology rotation available (94 vs. 9 percent) to train pediatric residents.

The involvement of pediatric rheumatologists in four curriculum areas relevant to pediatric rheumatology was nearly universal in the programs with on-site pediatric rheumatologists. Yet, nearly two-thirds of programs without on-site pediatric rheumatologists had to rely on internist rheumatologists, general pediatricians, or other physicians to cover these areas.

This lack of exposure to pediatric rheumatology during residency may impede general pediatricians' ability to identify and treat children with rheumatic diseases, undermine resident interest in this field, and perpetuate the low supply of pediatric rheumatologists, concludes Michelle I. Mayer, Ph.D., M.P.H., R.N., of the University of North Carolina at Chapel Hill. The study was supported in part by the Agency for Healthcare Research and Quality (HS13309).

See "Availability of pediatric rheumatology training in United States pediatric residencies," by Dr. Mayer, Laura Brogan, M.S.P.H., and Christy I. Sandborg, M.D., in the December 15, 2006, Arthritis & Rheumatism 55(6), pp. 836-842.

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