Background/Purpose: The 2015 American College of Rheumatology Workforce study estimated the pediatric rheumatology full-time equivalent workforce to be 300 providers while the estimated excess demand was 95 providers (33%), with an estimated demand increase to almost 100% by 2030 (1). Nine states do not have a pediatric rheumatologist and the shortage is especially severe in Black, Hispanic, and Native American communities. This further emphasizes the need for physicians from demographics underrepresented in medicine (URiM), who are more likely to work in underserved communities, to care for children with rheumatic disease, while contributing to diverse perspectives in medical practice. This study explores trends of racial and ethnic diversity among US pediatric rheumatology fellows and consider consequences of these results on healthcare access, quality, and outcomes.

Methods: This is a quantitative analysis of the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book from 2011 to 2022. Demographics, including race and ethnicity of pediatric rheumatology fellows, were extracted, and analyzed in Microsoft Excel. A Chi-square analysis was utilized, and expected values were calculated using the 2020 census data (2011 to 2019) and the 2020 US census data for 2020 onwards. The primary outcome was trend in URiM representation (as defined by Licensing Committee on Medical Education) in pediatric rheumatology fellowship programs. The data was publicly available therefore IRB approval was not required.

Results: There were 910 pediatric rheumatology fellows between 2011-2022. Chi-square analysis demonstrated significant underrepresentation of Black, Hispanic, and Native Americans (p < 0.0001) in US pediatric rheumatology fellowship training programs. As seen in Figure 1, there were 3.4% Black (31/910), 8.4% Hispanic (76/910), and 0% Native Americans (0/910) fellows. The number of the fellows with these respective race and ethnicities was consistent throughout the 11 years analyzed. This data indicates that the percentage of URiM fellows in pediatric rheumatology fellowship programs is falling behind compared to the demographic shift in the US.

Conclusion: This data underscores the need to attract URiM physicians to pediatric rheumatology to practice in underserved communities and help address health equity gaps. The ACGME has prioritized the expansion and support of a diverse physician workforce, representative of the population it serves. Medical institutions throughout the US should be intentional in recruiting, cultivating, and retaining URiM fellows to create a culturally informed and inclusive clinical environment that will better serve our growingly diverse population. This call to action will improve health outcomes in underserved groups by training more physicians who are aware of these disparities and fostering patients’ trust in the healthcare system.

References: 1. Correll CK, Ditmyer MM, et al. 2015 American College of Rheumatology Workforce Study and Demand Projections of Pediatric Rheumatology Workforce, 2015-2030. Arthritis Care Res (Hoboken). 2022 Mar;74(3):340-348.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-and-ethnic-diversity-in-pediatric-fellowships-fortifying-the-pipeline/