Background/Purpose: Future projections deem the rheumatology workforce insufficient to meet patient demand, with certain with catchment areas (micropolitan, rural) already lacking clinicians.  Currently there is an inadequate number of pediatric rheumatologists to care for patients, only expected to worsen as the current workforce reaches retirement. Interest in combined adult and pediatric rheumatology training has increased in recent years in concert with medpeds residency applicants and rheumatology fellowship training. One prospect to minimize the workforce gap is to capitalize on physicians trained in both medicine and pediatrics (medpeds) rheumatology who can treat patients of all ages.  While combined medpeds rheumatologists exist in clinical practice, the path to this career title has historically not been standardized and there is no governing body to determine this designation. No study has established the number of medpeds rheumatologists in practice, their demographics, practice characteristics, and board certifications of this unique rheumatology workforce.

Methods: Mixed-methods approach of primary and secondary data was used to identify baseline medpeds workforce data. Secondary data derived from query of matriculation, board certification, and practice records of multiple organizations including Accreditation Council for Graduate Medical Education, American Board of Pediatrics, American Board of Internal Medicine (ABIM), American Board of Medical Specialties, MedPeds section of American Academy of Pediatrics, and Childhood Arthritis and Rheumatology Research Alliance. Formally medpeds trained rheumatologists were defined as having achieved board certifications in both pediatric and adult medicine and rheumatology.  Surveys were used to characterize medpeds physician fellowship training and career experiences. Pediatric rheumatology program directors were queried about past medpeds fellowship trainees. Identified combined medpeds rheumatology fellowship graduates were queried to determine their practice location and type, employment percent (full or part-time), patient population, salary, and board certifications.  A similar survey was sent to those who completed a medpeds residency followed by a categorical rheumatology fellowship. 

Results: In the United States, there are approximately 5000 rheumatologists, 300 of which are pediatric rheumatologists. Thrirty-four formally trained medpeds rheumatologists were identified in the past 20 years, although the number of dual board-certified rheumatologists is incongruent to this.  Additionally, 80 pediatricians were board certified through ABIM in rheumatology in addition to those with combined training.  Further survey data collection and analysis is currently ongoing.

Conclusion: Inconsistent data exists on the number of practicing medpeds rheumatologists who care for adult and pediatric patients with rheumatologic conditions. This information is vital to the workforce shortage facing rheumatology, particularly pediatric rheumatology, as medpeds rheumatologists may fill a unique clinical niche and help meet the future provider demand.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/workforce-survey-career-trends-of-combined-adult-and-pediatric-rheumatology-fellowship-graduates/