“We are one of the lowest paid specialties in pediatrics. We often make [income] comparable to or less than a general pediatrician,” Dr. Schultz said. One reason for that is the difficulty of doing pediatric rheumatology in private practice. Most positions are at academic institutions, which will nearly always involve lower pay scales, she said. The field is also not a procedure-based one, which makes billing more difficult to quantify.
“If I spend an hour thinking about a patient’s diagnosis and interpreting their labs, how do we quantify that?” she asked. “Our field is so cognitive that it makes it hard to bill in the same manner” as fields who bill more procedures, she said.
Dr. Colleen Correll
Colleen Correll, MD, MPH, an assistant professor of pediatric rheumatology at the University of Minnesota in Minneapolis, was also not surprised to see salary listed as the biggest deterrent to the field.
“Unfortunately, compared to other specialties, our compensation is lower, and this can be a real barrier for people who have large medical student loans to repay and for those providing for their families,” Dr. Correll said in an interview. She and Dr. Schultz both said that workforce advocacy groups are working on ways to compensate for that difference, including loan repayment programs.
The other specialties that respondents considered before choosing pediatric rheumatology varied by generation, but allergy and immunology and endocrinology were among the most cited by early-, mid-, and late-career faculty. Clinical fellows’ responses were more evenly distributed across a range of different subspecialties.
Early exposure is key
A large proportion of all three groups, including almost 90% of early-career faculty and clinical fellows, said they received exposure to pediatric rheumatology during residency. However, only a little more than two-thirds of clinical fellows had exposure to the field in medical school, and fewer than that reported medical school exposure among both faculty groups.
Both Dr. Correll and Dr. Schultz said that early exposure to pediatric rheumatology was key to bringing more people into the workforce.
“I believe that once a medical student or resident has an opportunity to work with a pediatric rheumatologist, they are able to see the many reasons for which this is a great career choice,” Dr. Correll said. “Pediatric rheumatologists are seen as positive role models. We love what we do, we have great patient-physician relationships, and we see interesting disease pathophysiology on a regular basis.”
Although earlier exposure to the field is primarily an institutional issue, clinicians can play a role as well.
“For the individual practitioners, the biggest way they can make an impact is to make themselves visible,” Dr. Schultz said. Although the subspecialty is stretched thin, she encouraged pediatric rheumatologists to do med school and resident lectures, volunteer to do feedback sessions, offer residents opportunities to rotate with them, and generally make themselves more visible. “It’s going to take the community to really make the change we need,” she said.
She and Dr. Correll both cited the American College of Rheumatology and CARRA pediatric residency programs as helpful, but there’s more to do. Other ways to increase exposure to the field include creating medical student rotations in pediatric rheumatology, working on case reports or small research projects with new learners, and requesting that pediatric rheumatology be a mandatory rotation in pediatrics training, Dr. Correll said.
“We absolutely have a responsibility to promote our field because if we don’t, the workforce supply issue will continue to worsen,” Dr. Correll said. “We already have a workforce shortage, and models show this shortage will only worsen if we don’t improve recruitment into the field, especially with many pediatric rheumatologists coming up on retirement. Once we are able to expose medical students and residents to the field, I think they easily see our passion and our love for the field, and it’s easy to recruit them.”
The research was funded by CARRA, which receives funding from the Arthritis Foundation. Dr. Schultz and Dr. Correll had no disclosures.