Pediatric rheumatology is a highly specialized field focused on diagnosing and treating children and adolescents with autoimmune and inflammatory conditions. These specialists manage diseases like juvenile idiopathic arthritis, systemic lupus erythematosus, and various forms of vasculitis, which can be complex and chronic. The expertise of a pediatric rheumatologist is important because these conditions present differently in growing bodies than they do in adults.
The Current Workforce Landscape
The number of pediatric rheumatologists actively practicing in the United States is relatively small, with estimates placing the total around 420 board-certified physicians. This small workforce is highly concentrated in specific regions, primarily clustered in urban academic medical centers.
This uneven distribution creates significant geographical disparities in patient access, often described as “deserts” of care. Several states have no practicing pediatric rheumatologist at all, and others have only one or two to serve the entire child population. The highest concentration of these specialists is found in the Northeast, while the Southwest region reports some of the lowest ratios of providers to children.
The Scale of Patient Need Versus Physician Supply
The current supply of specialists is far outpaced by the number of children who require this specialized care. While juvenile idiopathic arthritis alone affects approximately 300,000 children, the total number of children and adolescents living with some form of pediatric rheumatic disease exceeds one million, including those with juvenile dermatomyositis, scleroderma, and chronic noninfectious osteomyelitis.
To accurately measure the clinical capacity of the workforce, experts use the concept of a clinical “full-time equivalent” (FTE), which accounts for time spent on administrative duties or research rather than direct patient care. In 2020, the clinical workforce equivalent of pediatric rheumatologists was estimated at only 0.27 providers for every 100,000 children. The demand for pediatric rheumatologists was estimated to exceed the supply by 33% in 2015, a gap that is projected to widen in the coming years.
Implications for Pediatric Care Access
The imbalance between the number of children needing care and the available specialists has direct consequences for patient access. Families often face extremely long wait times for an initial appointment, sometimes extending for months. Children with rheumatic diseases frequently travel an average of over 50 miles to see a specialist, which is more than double the average travel distance for other pediatric subspecialties.
When access is limited, many children receive care from general pediatricians or adult rheumatologists, who may lack specific training in childhood-onset conditions. A delayed diagnosis or treatment can lead to irreversible outcomes, such as permanent joint damage from untreated arthritis or organ damage from conditions like systemic lupus erythematosus. The inability to receive timely, specialized care places children at a higher risk for long-term disability and reduced quality of life.
Initiatives to Expand the Specialty
Recognizing the workforce shortfall, various efforts are underway to increase the number of pediatric rheumatologists. One strategy focuses on increasing the capacity of training programs by creating new fellowship slots, which are three-year positions following general pediatrics residency. However, recruiting remains a challenge, as historically only about half of the available fellowship positions have been filled annually.
To address the financial disincentives of lengthy training and lower compensation compared to other specialties, programs like the Pediatric Specialty Loan Repayment Program are being utilized. This program offers up to $100,000 in loan repayment in exchange for service in an approved facility located in a medically underserved area. Increasing exposure to the specialty early in medical school and residency through rotations and mentorship is also a focus, as this experience is an important factor in encouraging students to choose the field.
Telemedicine and virtual care models are being used to bridge the vast geographic distances between patients and specialists. This approach allows existing providers to offer outreach clinics and consults to patients in states that have few or no local pediatric rheumatologists. Organizations like the American College of Rheumatology are actively pursuing workforce solutions, including advocacy and partnerships with pediatric associations, to sustain the specialty and improve patient access.