Chapter 3.  Estimating Pediatric Rheumatology Workforce Requirements

In 2002, the chair of the American Academy of Pediatrics Section on Pediatric Rheumatology called for a doubling of the number of United States pediatric rheumatologists to 400. ²³ The appropriateness of this goal has yet to be evaluated and depends, in part, on the geographic distribution of pediatric rheumatologists and patient demand for pediatric rheumatology care.  Moreover, academic medical centers continue to be the primary employers of pediatric rheumatologists; as such, the educational and research needs of these institutions heavily influence the demand for these providers.

Patient Demand for Pediatric Rheumatology Care by State

Estimating demand for pediatric rheumatology care is challenging.  Because of low incidence rates, national sample surveys of the general population generally fail to identify sufficient patients with juvenile rheumatic diseases to generate reliable estimates.  Using an exhaustive list of 48 possible International Classification of Disease (ICD-9) codes, the National Ambulatory Medical Care Survey (NAMCS) contains only 16 records for rheumatic diseases visits among children under 18.  National Hospital Ambulatory Care Survey (NHAMCS) similarly contains 57 visit records for rheumatic conditions among children under 18.  As a result, reliable estimates of patient demand for care are not possible using such data.

In the absence of a measure of need for pediatric rheumatology services or even utilization of these services, prevalence rates ^[iii] allow estimates of patient to provider ratios as a proxy for patient demand.  Using state-level population data from the Bureau of the Census ²⁴ and physician data from the American College of Rheumatology (ACR) Membership File and American Board of Pediatrics (ABP) Diplomate File, ratios of pediatric population to pediatric rheumatologists were generated for each State.  State level ratios were used because many States have either no pediatric rheumatologist or only one pediatric rheumatologist.  As such, a state-level analysis helps identify relatively underserved States and provides an estimate of the number of pediatric rheumatologists that are needed nationwide.  As in analyses of the MSA-level ratios, these estimates rely on “head counts” and do not adjust for the percentage of time that a pediatric rheumatologist is involved in patient care as these data are not available for each pediatric rheumatologist in the United States.   

Table 9:  Ratio of Pediatric Population to Board-Certified Pediatric Rheumatologists, 2003 American Board of Pediatrics Diplomate File

Table 9:  Ratio of Pediatric Population to Board-Certified Pediatric Rheumatologists, 2003 American Board of Pediatrics Diplomate File, cont.

Ratios were calculated separately using the ACR and ABP files; States without pediatric rheumatology providers are highlighted in yellow in Tables 9 and 10.  Using the ABP file, Washington D.C. ^[iv] has the lowest ratio of children to pediatric rheumatologists at 47,645:1; Texas has the highest with a ratio of 953,206:1 (Table 9).  Assuming a prevalence of pediatric rheumatic conditions of 390 per 100,000 children, ratios range from 186 children with rheumatic disease per provider in Washington D.C. to 3,718:1 in Texas.  Among States that lack Board-certified pediatric rheumatologists, the population size ranges from 126,000 in Wyoming to over 1.3 million in Arizona.        

Table 10:  Ratio of Pediatric Population to Self-identified Pediatric Rheumatologists, 2003 American College of Rheumatology