Potential barriers to an interest in pediatric rheumatology include inadequate exposure and mentorship within these specialties, as well as long periods of required training and lower compensation for pediatric specialists.
Results of the National Residents Matching Program (NRMP) indicated that 75% of eligible candidates interested in adult rheumatology and 96% of eligible applicants interested in pediatric rheumatology were able to be successfully matched to fellowship programs in 2023. However, although the percentage of available adult programs filled 97.8% of available fellowship slots, pediatric programs only filled 62.8% (26 fellowship positions out of a total of 43 available positions), thus suggesting a direct need to increase interest in pediatric rheumatology.
“Other pediatric specialties such as pediatric pulmonology, nephrology, infectious disease, and endocrinology also had a significant number of unfilled positions; in contrast, the relatively new field of pediatric hospital medicine filled nearly all open positions, which may hint at the goals and training interests of current pediatric applicants,” Beth Marston, MD, chair of the American College of Rheumatology’s Committee on Training and Workforce Issues (COTW), stated. “Many potential barriers have been suggested, including inadequate exposure and mentorship within these specialties, long periods of required training, and lower ultimate compensation for pediatric specialists, which might be targets for future work to improve our pediatric specialty workforce.”
Workforce shortage projections, highlighted in the American College of Rheumatology’s (ACR) 2015 workforce study, have plagued rheumatology in recent years. In a Rheumatology Network feature discussing challenges in rheumatology, published earlier this year, Andrew Concoff, MD, Executive Vice President and Chief Value Medical Officer at United Rheumatology, has described this trend as the “great resignation,” in which maintaining a healthy, comfortable staff at the independent private practice level is becoming increasingly more difficult. The workforce shortage, which is exacerbated by the large number of rheumatologists planning to retire in the upcoming years, is “severe enough that the expectation is that for every rheumatologist we have, there will be an equal number that we lack,” Concoff explained.
However, the number of adult fellowship matches during the Specialty Match Days has grown over the past 5 years and interested candidates have surpassed the number of positions. The ACR believes this may indicate a need to increase fellowship training opportunities. The ACR’s Workforce Solutions Committee continues to focus on increasing fellowships and positions, with a specific concentration on geographically underserved areas.
“This year was the first time that the adult and pediatric fellowship Match dates aligned, allowing participants the opportunity to apply to and rank both adult and pediatric training programs in a single rank list by a dual-trained applicant or by a couple. This change has been welcome, as it facilitates the application process for a number of candidates,” Marston explained.
The ACR continues strive to increase exposure to rheumatology earlier in training, better understand the barriers surrounding training in pediatric rheumatology and pediatric and combined internal medicine.
The NRMP, established in 1952, utilizes an algorithm to fill available training positions at teaching hospitals in the United States by aligning the preferences of both applicants and program directors.