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Pediatric Rheumatology?

oldbearprofessor

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    Can someone tell me how you go about doing it? Is it a Peds residency then a Rheum fellowship or does it have to be IM-Peds residency? Or just IM?

    3 yrs pedi residency then 3 years fellowship specific to pediatric rheumatology.

    great specialty and there is a shortage of them. There are whole states with no pediatric rheumatologists or at least there used to be. I doubt that's changed.
     

    CrazyPeds527

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      Talk about a field with job security...

      I interviewed with a pediatric rheumatologist on the trail this year; he told me that this year's fellowships graduated 16 people for 40 available jobs nationally.

      Even the hospitals that do have peds rheum people, they are incredibly busy, and in some cases, completely overworked and looking for a partner.
       
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      bluebirdie

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        Talk about a field with job security...

        I interviewed with a pediatric rheumatologist on the trail this year; he told me that this year's fellowships graduated 16 people for 40 available jobs nationally.

        Even the hospitals that do have peds rheum people, they are incredibly busy, and in some cases, completely overworked and looking for a partner.

        What is the reason for the shortage?
         

        MedStudentWanna

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          Can anyone give me a link to where I'd find out where these fellowships are located so I can do some research? I don't know how to find them. I'm just curious because I met a ped rheum a few weeks ago and it interested me a great deal. I want to learn more about it.

          Also, you said that the ones who are out there are incredibly busy and looking for partners. I'm wondering if there are any hospitalists? Any idea what the work hours are like? And finally (sorry for all the questions), would you say adult rheumatology provides a better lifestyle/better compensation?
           

          oldbearprofessor

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            Google is amazing

            http://www.rheumatology.org/educ/training/pedprograms.asp

            Now then, as to why pedi rheum has such a shortage. I can give you what I know and some opinions, but I would welcome someone who is actually in the field commenting.

            In general, pedi rheum, like pedi endocrine is a field in which patient interactions are long, there are no procedures, and thus reimbursement is low. It is heavily focused in large academic settings. So, doing a fellowship may not lead to a real increase in income relative to no fellowship. Given the issues with carrying debt, etc, taking three extra years of fellowship training with no real chance to make the money back anytime soon isn't too appealing to many. There are limits to where you can practice as well. On the positive side, I don't think night call is too bad during fellowship or in practice, but given the shortage, I'm sure cross-coverage is an issue.

            Additionally, I don't think pedi rheum tends to appeal to many folks going into pedi. It is a very challenging (albeit often rewarding) group of chronically ill and "in pain" group of children who require lots of attention. One of the physicians whom I admire the most does pedi rheum and this person has amazing "bedside" skills. It takes them to do pedi rheum.
             

            Marigold

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              Just wanted to chime in since I did a Pedi Rheum elective awhile back...I thoroughly enjoyed it. There is definitely a shortage, and I thought that the work done by the rheumatologists was very important and very rewarding. There are more kiddos with rheumatologic problems than one might think...tons of JRA, spondyloarthropathies, lupus, etc. It certainly does befit a pedi rheumatologist to be patient, with an excellent bedside manner (the attending I worked with on my rotation was fantastic...she is brilliant, very perceptive, hardworking, with a real ability to genuinely relate to her patients).

              As OBP said, I found it to be quite rewarding....there was one 7 y/o girl who came in as a new lupus diagnosis who had huge swollen hands, big puffy parotid glands, lots of pain, etc. and I was lucky enough to be able to see her a few weeks later after starting treatment....she was a completely different girl!!!

              All in all, I think it's a cool field and, although I might be biased :D, far more fun and interesting than adult rheum.
               

              Revilla

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                As OBP said, I found it to be quite rewarding....there was one 7 y/o girl who came in as a new lupus diagnosis who had huge swollen hands, big puffy parotid glands, lots of pain, etc. and I was lucky enough to be able to see her a few weeks later after starting treatment....she was a completely different girl!!!

                All in all, I think it's a cool field and, although I might be biased :D, far more fun and interesting than adult rheum.

                Wow. As an adult with lupus, I can't imagine having to deal with such a diagnosis as a child. I'm not in med school yet (applying this summer), but pediatric rheumatology is a field I'm already interested in. Thanks for shedding some light for those of us lurking on your forum.
                 

                Marigold

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                  Wow. As an adult with lupus, I can't imagine having to deal with such a diagnosis as a child. I'm not in med school yet (applying this summer), but pediatric rheumatology is a field I'm already interested in. Thanks for shedding some light for those of us lurking on your forum.

                  Yes, rheumatologic diagnoses can be difficult for children to accept/deal with, as you can imagine, so that's why we need really great Pediatric Rheumatologists! Best of luck with med school!! :)
                   

                  kristing

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                    Can anyone give me a link to where I'd find out where these fellowships are located so I can do some research? I don't know how to find them. I'm just curious because I met a ped rheum a few weeks ago and it interested me a great deal. I want to learn more about it.

                    Also, you said that the ones who are out there are incredibly busy and looking for partners. I'm wondering if there are any hospitalists? Any idea what the work hours are like? And finally (sorry for all the questions), would you say adult rheumatology provides a better lifestyle/better compensation?

                    go to the Freida website, too, (at ama-assn.org) to find rheum fellowships.

                    I think adult rheum deals with significntly different things - you del with a lot more chronic pain and fibro patients, vs. peds, which is straight rheum diagnoses... The idea of doing adult rheum for people who are pediatricians is a stomach turner (I am generalizing, but I bet it's 90% true). We love kids, and prefer to treat them...
                     

                    pathfme30

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                      I did a peds rheum elective at HSS. It was awesome. I also did adult rheum at HSS. The peds population often is much sicker. I love immunology too and kids so it is a great combo. However, not all the peds rheum folks are as basic sciencey as me. It is a mix. If anyone wants to talk to the peds rheum folks that I know just send me a message. I can find someone for you.
                       

                      WestcoastMedicine

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                        Are there any Peds EM Attendings or Fellows out there? Developing an interest in the field after an elective as a 3rd year resident...would love to revive this forum. Specifically talking about ongoing research areas(i know MSK Ultrasound is one of the hot topics), what its like in practice given the groups are typically small (do practices ever have adult rheum cover as needed)? Thanks
                         
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                        bowlofmushypeas

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                          I'd also love to hear more opinions about salary/lifestyle/etc. Peds rheum definitely seems like a field no one knows much about. It's also difficult to understand the low compensation despite lack of procedures because anecdotally, the demand seems incredibly above supply that you'd simply be able to compensate a little better. I've also been thinking about the med/peds route and doing a combined rheum fellowship, but I have little insight into the feasibility of this in practice.
                           

                          oldbearprofessor

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                            It's also difficult to understand the low compensation despite lack of procedures because anecdotally, the demand seems incredibly above supply that you'd simply be able to compensate a little better.

                            Supply and demand for pedi subspecialists doesn't really control salary in this situation. Pedi rheum has a lot of poorly compensated chronic care and they spend a lot of time on each patient visit. They don't generally do critical care with higher billing codes. Mostly they work out of academic centers or a few private Children's Hospitals. They don't starve, but many of the academic pedi rheum divisions are not big money makers for the hospital (actually, my understanding is that they often lose money) limiting their clout.

                            None of that changes the fact that this is a fascinating field, very rewarding to do and has some of the best, most compassionate and most thoughtful docs I've worked with. Tremendous research opportunities as well.
                             

                            oldbearprofessor

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                              Any reason why the same isn't true for adult rheumatologists?

                              Issue is the same for many adult vs pedi specialties. Much more time per patient in pedi without comparable reimbursement increase, lower academic salary with less private practice. This is extremely unlikely to change, IMHO.
                               
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