Background/Purpose: The pediatric rheumatology workforce shortage has significant downstream effects on pediatric trainees and patients. Currently, 9 out of 50 states do not have a board-certified pediatric rheumatologist. Earlier identification and treatment of rheumatic disease leads to improved outcomes. Without recognition of these signs by general providers, patients are not referred in a timely manner, but without proper education, we cannot expect them to understand the protean presentation of rheumatic disease. A 2004 study showed that 40% of US pediatric residency programs lacked on-site pediatric rheumatologist, while one-third of medical schools had the same deficiency. The purpose of this project was to identify whether increased attention to workforce shortage issues impacted the number of US and Puerto Rico pediatric residency training programs with associated pediatric rheumatology faculty from 2004 to present.

Methods: One research team member (MV) identified all pediatric residency programs accredited for the 2022-2023 academic year through the Accreditation Council for Graduate Medical Education (ACGME) website. MV then reviewed all websites to identify those that had affiliated pediatric rheumatology faculty. In cases that were unclear, MV emailed programs with the address provided on the ACGME report. Another team member (JS) discussed programs that were unable to be categorized based on their website or via email at a meeting of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Medical Education Workgroup. Members of the working group, all practicing pediatric rheumatologists or rheumatology fellows, were queried and able to categorize most remaining programs.

Results: 212 pediatric residency programs are accredited for the 2022-2023 academic year by the ACGME in the US and Puerto Rico. 181 programs indicated presence/absence of pediatric rheumatology faculty on their website. Of the remaining 31 programs, 18 did not respond to email inquiries. Of the 212 total accredited pediatric residency programs, 132 (62.3%) have pediatric rheumatology faculty, 77 (36.3%) do not have pediatric rheumatology faculty and 1.4% remain unknown.

Conclusion: Over one-third of all pediatric residency programs do not have a pediatric rheumatologist on faculty, unchanged since 2004. This creates a significant barrier to providing appropriate education in rheumatology for trainees and limits exposure to patients with rheumatologic conditions. Lack of robust rheumatology knowledge impacts patient care and limited exposure to the field likely contributes to declining fellow match rates—most recently 62.8% positions filled for 2022, down from 69.2% in 2021. Next steps include establishing areas of essential knowledge in pediatric rheumatology for pediatric residents with the goal of creating precise learning objectives so programs can focus their educational efforts and better prepare pediatric residents for identifying and managing pediatric rheumatologic issues after graduation. Additionally, efforts should continue to understand resident motivation to pursue fellowship in pediatric rheumatology with the goal of improving recruitment given the known workforce shortage.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/running-out-of-rheum-where-are-the-pediatric-rheumatology-faculty/