“We’re getting more and more research that shows us that there’s probably this window of opportunity to treat early and to improve the prognosis of the disease,” Dr. Correll says. “If we don’t have the workforce to see children in a timely manner and the right specialists seeing them, then that really can affect their quality of life and their outcomes.”
Background
About 300,000 U.S. children suffer from chronic arthritis and other rheumatic diseases, according to a 2007 study in Arthritis & Rheumatology.2 As of 2006, according to research in the Journal of Pediatrics, only about 200 pediatric rheumatology providers were available to treat this population, and 14 states had no pediatric rheumatologists at all.3 Similar numbers were shown in a 2007 ACR workforce study, which noted the workforce consisted of 218 pediatric rheumatologists and predicted demand would exceed supply by 33 rheumatologists by 2025.4
Dr. Correll
Dr. Correll and her co-authors estimate the number of providers was around 300 as of 2015—measured in full-time equivalents (FTEs)—and predict a significant worsening of the imbalance between supply and demand by 2030 unless action is taken. Their model shows the projected demand will be 461, twice the projected supply (231) by 2030. Further, they note that geographic maldistribution of pediatric rheumatologists is a significant issue for patients in certain states and rural areas.
Study Overview
Dr. Correll and her co-authors set out to define the 2015 pediatric rheumatology workforce in the United States, evaluate current workforce trends and project future supply and demand through 2030. They did this by analyzing primary data, such as surveys of ACR members, and secondary data, such as population studies, to create a model that would paint a picture of the future workforce.
To increase the specificity of the results, the researchers used an integrative approach and performed sensitivity testing. The integrative approach accounted for the different types of providers (e.g., physicians, nurse practitioners [NPs], physician assistants [PAs], fellows) and patients, perspectives on the effects of the workforce, setting (i.e., academic, private) and geography. The sensitivity testing provided a range of possible outcomes.
“That integrative approach sort of allows us to get a perspective from all of those groups of people,” who are affected differently by the workforce, Dr. Correll explains. “The sensitivity analysis gives us a wider range of what the model might look like—the best-case and worst-case scenario—instead of one finite answer.”
To address the current and future workforce challenges, the researchers suggest strategies to bolster the ranks of pediatric providers, including not only attracting more physicians, PAs and NPs to the field, but also succession planning, financial incentives and policy updates. By augmenting the workforce and integrating innovative practices like telemedicine, pediatric rheumatology patients have a better chance of getting the timely, high-quality care they need.
Implications & Solutions
The effect of not having enough pediatric providers is that children with rheumatic disease may not get the quality of care they need when they need it. The situation also causes a strain on existing providers, who don’t have time to see all of the patients.
“Certainly we know that some children, especially children that are far from pediatric centers, are treated by adult rheumatologists. And that’s great … but I think it’s important to have more pediatric specialists,” Dr. Correll says. “Children are different in many ways than adults, and so things we have to think about with children are their growing skeleton, their development, and particularly some diseases in rheumatology are more pediatric focused. … You really just want the expert for children with these diseases to be providing that specialty care as much as possible—or at least a partnership of pediatric rheumatology providers with adult providers.”
Attracting new providers to the field is key to addressing the current and future workforce issues. One way to do this is to encourage medical students and residents who show interest by sharing additional information with them. For example, the ACR and the Childhood Arthritis and Rheumatology Research Alliance have residency programs that provide helpful information, Dr. Correll says.
To help attract providers, Dr. Correll and her co-authors suggest considering a two-year clinical fellowship for physicians seeking to work in community practice or creating strictly clinical positions within academic institutions, recruiting and training more PAs and NPs, and offering financial incentives like medical student loan debt relief and loan repayment programs. Other methods cited in the study include promoting changes in the geographical distribution of providers, improving quality of care initiatives in primary care and extending the use of telemedicine.
Telemedicine, which has become much more mainstream during the COVID-19 pandemic, can help address the issue of geography post-pandemic as well. Although it won’t increase the number of appointments a physician can fit into a day, virtual appointments can help triage new patients, save time spent driving for both patients and providers and facilitate access to specialists for patients in rural areas.
With these workforce issues identified, rheumatology professionals can work together to implement solutions; doing so creates hope that the current trajectory can be corrected.
“The ACR president has made workforce solutions one of his priorities in 2021, which is really great,” Dr. Correll says. “I am part of a small group that has been [asked] to recommend potential strategies to the ACR for workforce solutions. I am hopeful the ACR can facilitate thoughtful solutions. … It’s a strain on the provider when we don’t have enough of a workforce, it’s a strain on the patients, and I think we all want to make improvements that will help everybody.”
Kimberly Retzlaff is a freelance medical journalist based in Denver.
References
- Correll CK, Ditmyer MM, Mehta J, et al. 2015 American College of Rheumatology Workforce study and demand projections of pediatric rheumatology workforce, 2015–2030. Arthritis Care Res (Hoboken). 2020 Oct 27. [Epub ahead of print.]
- Sacks JJ, Helmick CG, Luo YH, et al. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001–2004. Arthritis Rheum. 2007 Dec 15;57(8):1439–1445.
- Althouse LA, Stockman 3rd JA. Pediatric workforce: A look at pediatric rheumatology data from the American Board of Pediatrics. J Pediatr. 2006 Dec;149(6):869–870.
- Deal CL, Hooker R, Harrington T, et al. The United States rheumatology workforce: Supply and demand, 2005–2025. Arthritis Rheum. 2007 Mar;5(3):722–729.
