Pediatric rheumatology comes up short on Match Day: Just 69% of fellowship slots filled
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Results from the 2021 Medical Specialties Matching Program reveal that pediatric rheumatology fellowship programs filled less than 70% of their available slots, according to the American College of Rheumatology.
The figures, released by the National Resident Matching Program on Dec. 1 for the 2022 appointment year, underscore the need to increase interest in pediatric rheumatology, the ACR said in a press release. The subspecialty has been suffering from a dire workforce shortage, with fewer than 350 pediatric rheumatologists practicing in the United States as of 2018.
“Increasing fellowship training capacity in both pediatric and adult rheumatology is an important way to mitigate the expected workforce shortages in both fields in coming years,” Beth Marston, MD, chair of the ACR Committee on Rheumatology Training and Workforce Issues (COTW), said in the release. “In pediatric rheumatology, like many other pediatric specialties, the limiting factor is the number of interested candidates. The number of available positions has not really changed over the last several years, but multiple positions again remained unfilled this year.”
According to the ACR, the latest Match Day saw nearly 74% of eligible candidates interested in adult rheumatology, and 96% of eligible applicants interested in pediatric rheumatology matched to fellowship programs. However, although adult programs filled 97.8% of their available slots, the pediatric programs were only able to occupy 69%.
“For the 2022 appointment year, there were 27 positions filled, which has remained steady in recent years,” Marston said in the release. “The fact that the number of applicants to pediatric rheumatology has not grown, despite the number of available slots, suggests the need for additional efforts to understand and address barriers to choosing rheumatology fellowship training as a career path for pediatricians.”
More than 300,000 U.S. children were diagnosed with arthritis and other rheumatic conditions as of 2018. A 2017 study published in Pediatric Rheumatology found that 28% of included parents traveled more than 3 hours for a pediatric rheumatology visit, and 43% reported travel as an inconvenience.
The lagging interest in pediatric rheumatology contrasts with the number of adult fellowship matches, which has seen a steady increase over the past 5 years, according to the ACR. Findings from the previous Match Day were similarly cheerful for the specialty, with 246 out of 338 interested applicants matched to rheumatology, for a rate of 72.8%. The ACR COTW likewise increased its residency opportunities that year, adding 15 new programs and 36 slots for first-year trainees.
“Adult rheumatology training is among the most competitive fields now, filling over 95% of positions each year, so increasing the number of graduates depends on increasing available training positions,” Marston said in the release. “This year there were 264 positions filled, which represents a steady increase over the last 5 years. However, as in previous years, a significant number of applicants did not match, suggesting that further support for funding and creating fellowship positions is likely to continue to directly translate to increased numbers of graduates entering the workforce.”
Although recent figures have been encouraging, it remains unclear if the advances are enough to offset the coming rheumatology workforce shortage predicted by the ACR’s own 2015 Workforce Study and multiple studies. According to the ACR Workforce Study, a burgeoning elderly population combined with a lack of growth in new rheumatologists would lead to a severe lack of rheumatologists by 2025. Later, a pair of 2018 studies published in Arthritis Care & Research and Arthritis & Rheumatology suggested that demand for rheumatology services will overtake projected workforce growth by 2030.
Efforts undertaken by the ACR to combat these trends have included increased exposure within medical schools and pediatric residencies. In addition, the ACR has aimed to improve access to patients in underserved areas through collaboration with primary care physicians and advanced practice providers. The organization has also advocated for loan reimbursement and sought opportunities for increasing and filling training slots for adult and pediatric rheumatology fellows.
This year, the ACR COTW additionally announced a new survey of combined medicine-pediatrics graduates in rheumatology aimed at better understanding their career pathways. According to the ACR, this could lead to additional insights about trainee career decisions.
“The ACR also continues to provide education and support for programs and program directors to better understand and manage changing curricular and regulatory needs and guidance for divisions interested in increasing fellowship positions,” the ACR said in the press release. “Additional efforts to understand and address the geographic variations and needs within the rheumatology workforce are also underway.”
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