The biggest factors that attract medical students to enter pediatric rheumatology are interest in disease pathology, the patient-physician relationship, and clinical exposure in residency, according to preliminary research shared at the annual scientific meeting of the Childhood Arthritis and Rheumatology Research Alliance.
Dr. Katherine Schultz
A shortage in pediatric rheumatology already exists and is expected to worsen to 61% by 2030, noted the authors. About one-third (32%) of current pediatric rheumatologists will retire in the next decade, and less than two-thirds of fellowship slots have filled in the past 5 years.
Katherine Schultz, MD, a clinical fellow in the division of rheumatology at Cincinnati Children’s Medical Center, led the study and said she was surprised that medical school exposure did not play a bigger role in attracting people to the field, but perhaps that’s because too few people received that early exposure.
“If we had earlier exposure, maybe that wouldn’t be definitive for saying, ‘yes, I want to do this subspecialty of pediatric rheumatology,’ but it would open the door, so when you hit residency, you can explore it further,” Dr. Schultz said in an interview.
Dr. Schultz and her colleagues conducted a survey using the CARRA registry during September-December 2020. Respondents included pediatric rheumatology clinical fellows, early-career pediatric rheumatology faculty with less than 7 years practice experience, and mid- to late-career pediatric rheumatology faculty – those with more than 7 years of practice. They are currently in the process of analyzing additional qualitative data.
Of the 428 clinicians recruited to complete the study, 92 did so, for a response rate of 21%. Most respondents were female and non-Hispanic White. A total of 40% were clinical fellows, 41% were early-career faculty, and 18% were mid- to late-career faculty.
Positive factors for choosing the field
More than 80% of respondents across all three experience levels cited disease pathology as a positive attribute of pediatric rheumatology, something that Dr. Schultz mentioned as well.
“The rewarding part of pediatric rheumatology is we take these complex diseases and we help give kids their life back,” she said.
Nearly all the clinical fellows who responded said the patient-physician relationship was important, which early- and mid- and late-career faculty mentioned as well, although to a slightly lesser extent.
Other factors following closely behind disease pathology, patient-physician relationship, and clinical exposure in residency were having a role model in the field – cited by more than three-quarters of clinical fellows and early-career faculty – and having mentorship during residency.
“One of the strengths of our field and one of the things I love about pediatric rheumatology is our community is so close-knit, so kind, and so welcoming,” Dr. Schultz said. “If students can have that exposure and they can see the kind of people who are in this field, that’s our greatest power to draw people to our field.”
Low compensation is a deterrent
The least frequently mentioned positive factors were research opportunities and income. In fact, income was by far the most commonly cited negative attribute of pediatric rheumatology, reported by nearly half of clinical fellows and more than a quarter of early- and mid- and late-career faculty.