Background/Purpose: Rheumatology is among the pediatric subspecialties with the lowest workforce density in the US1. Initial management of most of the pediatric rheumatologic conditions relies exclusively on rheumatologist assessment. Pediatric rheumatologists might be responsible for a high patient load in some states of US.

Methods: The number of active certified pediatric rheumatologists in 2024 per state was determined by the American Board of Pediatrics (ABP)2 and the pediatric state population < 18 years by US Census Bureau Population Estimates3. We estimated the number of new patients-to-pediatric rheumatologist in 1-year interval applying reported incidence rates of the main rheumatic conditions - juvenile idiopathic arthritis4, pediatric lupus5, juvenile dermatomyositis6, and others7-9 - equally to each pediatric state population under the assumption that children living in different states are at the same risk of developing a rheumatologic condition. Using Monte Carlo simulations1,10 we then created 1,000 scenarios of varying incident cases/100,000 children at the state level in a 1-year interval ranging from the minimum to the maximum reported incidence. In a sensitivity analysis, states reported to have zero active certified pediatric rheumatologist were considered to have 0.5.

Results: In the scenario of lowest incidences of all rheumatic conditions, the ratios of new patients-to-pediatric rheumatologist were categorized in quartiles, as shown in Figure 1. The states with highest ratios of new patients-to-pediatric rheumatologist were found in Arizona (189, 95%CI 176-301), Idaho (176, 95%CI 145-247), and New Mexico (165, 95%CI 143-245). States the with lowest ratio of new patients-to-pediatric rheumatologist were Delaware (24, 95%CI 14-31) and Massachusetts (26, 95%CI 18-35). In the sensitivity analysis, states with the highest ratios of new patients-to-pediatric rheumatologist were Louisiana and Oklahoma.

Conclusion: There are striking differences in the ratios of new patients-to-pediatric rheumatologist across the US. Children living in states with very high patient- to-pediatric rheumatologist might be at risk for delay in care. Further studies to examine the implications of workforce availability and pediatric access to rheumatology care are warranted.

Figure 1. New patients-to-pediatric rheumatologist in each state in a scenario of lowest incidences of pediatric rheumatic conditions

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/all-roads-lead-to-rheum-modeling-scenarios-of-new-patients-to-pediatric-rheumatologist-ratios-in-different-us-states/