Endangered Species

Imagine that you are just finishing medical school. You’ve already done an undergraduate degree in some type of science, and you maintained good grades. You took and passed the MCAT to get into medical school which you completed in another 4 years, and if you are average, you have approximately $150,000 in education debt. You’ve decided to complete your residency in pediatrics or internal medicine, imagining that you’ll be able to get a decent well-paying job to get rid of that debt when your residency is done in three years.

Now, imagine that you decide to take it a step further and become a pediatric rheumatologist. You’ll have another two to four years to complete your specialty fellowship training, during which time you will treat thousands of sick children with over a hundred different diseases. When you finally complete your training, there will be such demand for your service, but not enough clinics established to support rheumatology. Wherever you go, you will be guaranteed a patient load of over a thousand patients, when the appropriate number would be close to 400. Staying current with education and training will be critical, as medicines are being developed all the time, and treatment strategies are constantly in flux. By the way, your starting salary will be about $115,000, much lower than other medical specialties with your level of training.

Is it any wonder that we have a severe shortage of pediatric rheumatologists? They are literally an endangered species. The number I frequently hear is less than 200. Less than 200 pediatric rheumatologists to treat 300,000 children. To check out this figure, I went to the American College of Rheumatology site and went state by state counting. I know that some of the data is off – either dated or misleading. I did not count adult rheumatologists who also treat children, because that is not quite the same thing as a physician who has been specially trained to deal with multisystem illnesses in children and adolescents. I also recognized some retired physicians by name, still participating in research and education, but no longer in clinical service. I came up with 192. I also came up with 9 states with no pediatric rheumatologist at all. ( many studies say this number is 12)

Over the years, I’ve met tens of families who undergo extreme hardship to see a board certified pediatric rheumatologist for their child. They drive 4 hours, five hours…. They drive to a different state and have to rent a hotel room. They camp in motorhomes Recently, I heard of a family in Alaksa selling their home – because they no longer could afford the flights to the nearest doc in Seattle – and they figured they would have to move. They have to move in order to maintain care. And I know a family in Las Vegas that routinely flew to other states for care – because there is no pediatric rheumatologist anywhere in Nevada!!!!

I live in a wonderland where we have a choice of many, many of these special doctors. But even so, their patient load is so high, it can often take months to get in to see one of them.

In a 2007 report to Congress, the Health Resources and Services Administration outlined this dilemma – how the average distance traveled to a ped rheumy is 57 miles and that this shortage of speciallists often leads to delayed diagnosis and inappropriate treatments.


They concluded that a 75% increase in the number of these docs is required to treat the patient load. They also offered several suggestions, a few of which involve loan repayment and additional funding for fellowship positions.

The Arthritis Prevention Control and Cure Act addresses this issue by requesting “an increase in institutional training grants to support pediatric rheumatology training; and (2) an expansion of public-private partnerships to promote education training and fellowship opportunities for pediatric rheumatologists. Directs the Secretary to establish and carry out a pediatric rheumatology loan repayment program, as needed.”

Yet another reason to support this legislation. We’ll be taking this message to our Representative this Wednesday…. and you can too, by e-mailing your own representatives.


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