Just 69% of fellowship slots filled

December 23, 2021

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Results from the 2021 Medical Specialties Matching Program show that pediatric rheumatology fellowship programs filled less than 70% of their available slots, according to the American College of Rheumatology.

The numbers, released by the National Resident Matching Program on Dec. 1 for the 2022 nomination year, underscore the need to increase interest in pediatric rheumatology, the ACR said in a press release. The subspecialty faces a dire staff shortage, with fewer than 350 pediatric rheumatologists working in the United States in 2018.

Results from the 2021 Medical Specialties Matching Program show that pediatric rheumatology fellowship programs filled only 69% of their available slots, according to the ACR. Source: Adobe Stock.

“Increasing the training capacity of fellowships in both pediatric and adult rheumatology is an important way to reduce projected staff shortages in both fields in the 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 vacancies has not really changed in recent years, but several vacancies have again remained unfilled this year.”

According to the ACR, last Match Day saw nearly 74% of eligible candidates interested in adult rheumatology, and 96% of eligible candidates interested in pediatric rheumatology, matched fellowship programs. While adult programs filled 97.8% of their available slots, the pediatric programs were only able to fill 69%.

“For the 2022 nomination year, 27 vacancies had been filled, which has remained stable in recent years,” Marston said in the press release. “The fact that the number of pediatric rheumatology candidates has not grown despite the number of slots available suggests the need for additional efforts to understand and address barriers to choosing rheumatology fellowship training as a career path for pediatricians.”

In 2018, more than 300,000 children in the US were diagnosed with arthritis and other rheumatic diseases. A 2017 study published in Pediatric Rheumatology found that 28% of concerned 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 competitions, which has steadily increased over the past 5 years, according to the ACR. The findings from the previous Match Day were similarly excited for the specialty, with 246 of the 338 interested candidates matching rheumatology, at a rate of 72.8%. The ACR COTW also increased its residency options that year, with 15 new programs and 36 positions for first-year interns.

“Adult rheumatology training is now one of the most competitive fields, filling more than 95% of vacancies every year, so increasing the number of graduates depends on increasing the training positions available,” Marston said in the release. “This year, 264 vacancies were filled, which is a steady increase over the past 5 years. However, as in previous years, a significant number of candidates did not match, suggesting that further support for funding and the creation of fellowship positions is likely to continue to translate directly into an increased number of graduates entering the job market.”

While recent numbers are encouraging, it remains unclear whether the progress is sufficient 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 rapidly growing elderly population coupled with a lack of growth in new rheumatologists could lead to a severe shortage of rheumatologists by 2025. Later, a pair of 2018 studies in Arthritis Care & Research and Arthritis & Rheumatology suggested that demand for rheumatology services will exceed projected workforce growth by 2030.

The ACR’s efforts to combat these trends include increased exposure within medical schools and pediatric residencies. In addition, the ACR has aimed to improve access to patients in deprived areas through collaboration with primary care physicians and advanced practice providers. The organization has also advocated for loan repayments and sought opportunities to increase and fill training positions for adult and pediatric rheumatology fellows.

In addition, this year, the ACR COTW announced a new survey of combined medicine-pediatrics graduates of rheumatology aimed at better understanding their career paths. According to the ACR, this could lead to additional insights about trainee career decisions.

“The ACR also continues to provide training and support to programs and program directors to better understand and manage evolving curriculum and regulatory needs, and guidance for divisions interested in increasing fellowship positions,” the ACR said in the press release. . “Additional efforts are also underway to understand and address geographic variations and needs within the rheumatology workforce.”

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