Addressing the Pediatric Rheumatology Shortage
There is a critical shortage of pediatric rheumatologists in the U.S., with only 420 board-certified and practicing physicians to treat young people with arthritis.
Kids get arthritis, too.
Like many other pediatric subspecialists, pediatric rheumatologists are primarily clustered in and around large cities. Startlingly, 9 states have no pediatric rheumatologists and 6 states have only one. As a result, the estimated 300,000 patients with juvenile rheumatic diseases have limited access to needed care:
- Only 25% of children with arthritis are currently able to see a pediatric rheumatologist
- The workforce is aging – the average pediatric rheumatologist in his or her early-to-mid 50s
- A child with rheumatic disease must travel an average of 57 miles to be seen by a pediatric rheumatologist – more than double the average number of miles for other pediatric subspecialties
Access to pediatric rheumatologists is essential for a variety of reasons:
- Early diagnosis/treatment is critical for disease management, and it can be difficult for providers untrained in pediatric rheumatology to diagnose arthritis
- Pediatricians tend not to be adequately trained to care for children with juvenile arthritis, while adult rheumatologists are not trained to deal with pediatric issues – whether it be the stunted bone growth that can result from arthritis and its treatment, or the particular requirements of providing care to an adolescent
- Treatment of juvenile arthritis is complex, and there are many potential co-morbidities and related diseases, such as uveitis and TMJ disorders
- Access to a pediatric rheumatologist increases access to novel therapies, including treatments that are only available in clinical trials
What Congress can do.
Loan repayment and scholarship programs can help incentivize physicians to choose pediatric rheumatology as a sub-specialty and to practice in rural and under-served areas.
The House and Senate are working to renew Title VII Health Professions programs, which are administered by the Health Resources and Services Administration (HRSA). One such program is the Pediatric Subspecialty Loan Repayment Program (PSLRP, Section 775 of the Public Health Service Act). The program would provide $35,000 in loan repayment per year for up to 3 years in exchange for practicing in a rural or underserved area. Section 775 was originally authorized in 2010 but was never fully funded by Congress before the authorization lapsed in 2014.
Incentivizing pediatric subspecialists to practice in underserved areas through loan repayment will help reduce the burden from pursuing subspecialty training in pediatric rheumatology and provide needed access to care and treatment. Over 70 public health and medical organizations have urged Congress to include a reauthorization for this program.
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