When Care Is Out of Reach: The Pediatric Rheumatology Shortage 

By Vandana Suresh | March 2026 

Vi Davis, an Alaska resident seated in the audience at the 2026 Arthritis Foundation’s Pathways Conference, is a fierce advocate for arthritis awareness. Vi’s experience upon being diagnosed at 18 months old with systemic juvenile idiopathic arthritis (sJIA) was similar to what many other children with arthritis face in a state without a pediatric rheumatologist. They have three options: either travel to the nearest state for care, wait for a pediatric rheumatologist to visit their state or see a rheumatologist for adults, who probably isn’t trained in the nuances of treating children. 

What Vi experienced in Alaska is part of a much larger national pattern. Across the U.S., pediatric rheumatologists are in short supply. In fact, 26 states have 5 or fewer pediatric rheumatologists and as practicing pediatric rheumatologists retire, they leave critical gaps in the workforce. In 2020, there was just one pediatric rheumatology subspecialist for every 370,000 children, and while this deficit is expected to improve, there will still be fewer than 0.5 specialists per 100,000 children in 2040.  

Yet, even with immense demand, not enough pediatric rheumatologists are entering the workforce.   

So, what’s driving this shortage? 

Workforce shortages are an ongoing concern in both adult and pediatric rheumatology. To narrow the adult rheumatology gap, one solution is to increase the number of slots for rheumatology fellowship training. The Arthritis Foundation, for example, through its Clinical Rheumatology Fellowship Program, funds extra rheumatology fellowship slots to connect rheumatology programs with more medical trainees. This approach, however, does not work the same way in addressing the pediatric rheumatology workforce shortage. 

“The good news is that if you apply to pediatric rheumatology, there is a very high chance you are going to end up where you want,” says Randy Cron, MD, PhD, Pediatric Rheumatology Fellowship Program director and professor at the University of Alabama at Birmingham. “But there are just so few applicants — that is the biggest problem.” 

According to the American College of Rheumatology, 24 of 44 available positions in 2026 were filled (54%), down from 27 of 55 positions in 2025 (49%), highlighting both a 20% decrease in total available positions and a 11% decline in the number of positions filled, despite a modest increase in fill rate. In other words, the number of pediatric rheumatologists being trained and entering the workforce is going down. 

Several factors are limiting the pipeline of new specialists from keeping pace with projected workforce needs. Pediatric rheumatology faces structural barriers, such as limited exposure during medical school and pediatric residency, as well as declining interest in pediatrics overall. Pediatric rheumatology fellowships require an additional three years of training that includes both clinical work and research, perpetuating medical education debt.  

“Students graduate with about $250,000 in debt and often choose higher-paying fields. Pediatric rheumatology requires three additional years of training with lower pay,” says Kyla Driest, MD, pediatric rheumatologist and program director of the pediatric rheumatology fellowship program at Nationwide Children’s Hospital.  

More recently, a new recruitment challenge has emerged. 

“Pre-COVID, fellowship interviews were conducted in person, and candidates were more willing to relocate after visiting the hospital system, meeting faculty and fellows and experiencing the surrounding city,” says Rabecca Sadun, MD, PhD, associate professor and program director for Duke University’s Pediatric Rheumatology Fellowship and MedPeds Rheumatology Fellowship. “Without in-person interviews, recruitment has been extra challenging, especially in less-traveled regions like the Southeast.” 

Further, due to low patient volume, high overhead costs, and the need for multidisciplinary teams, the specialty does not lend itself to private practice, which is more lucrative.  

Even within hospital systems, its financial value is often indirect. Pediatric rheumatology generates money for hospitals through referrals, laboratory tests and infusions. However, the main revenue-makers are inpatient care and surgical procedures. Pediatric rheumatology is primarily an outpatient specialty, and while practitioners do perform joint injections, these procedures receive nominal reimbursements from insurance companies. 

“Healthcare financing in this country has been broken for a long time, and pediatric rheumatology being such a small field, it is really hard to move the needle quickly to alleviate the workforce shortage problem. Systemic changes are needed,” says Jay Mehta, MD, MS, professor of clinical pediatrics and director of the pediatric rheumatology fellowship program at Children’s Hospital of Philadelphia. 

Efforts to address the workforce shortage require a long-term, multi-pronged approach, experts agree. Fellowship training programs should consider flexible training models, such as a two-year fellowship for those interested in clinical careers without research duties. Building structured exposure pathways in medical school and during pediatric residency training, addressing mentorship gaps, increasing funding sources for in-person interviews and improving compensation through policy efforts are potential solutions. Another avenue to ameliorate current and projected workforce shortages will be to train more advanced practice providers. 

While the path requires significant investment and presents obstacles, those in the field agree that pediatric rheumatology is a fulfilling career.  

“When I first started practicing, a significant number of kids with arthritis needed assistive mobility devices. Those days are essentially gone, particularly if we catch them early enough in disease progression,” says Dr. Cron. “It’s extremely rewarding work, and most of us would never have done anything else.”  

Now a young adult living with arthritis, Vi says solutions must go beyond workforce numbers to include access, awareness and support for people living with invisible disabilities. Vi is optimistic that through continued advocacy with the Arthritis Foundation, Alaska will have its first pediatric rheumatologist in the near future.  

“As I pursue my master’s in clinical psychology, I want to help build support in Alaska,” says Vi. “I hope that through the work I do and the opportunities I pursue, it could eventually lead to bringing someone to Anchorage, ideally in a semi-permanent or permanent role. That would be the ultimate goal.” 

The Arthritis Foundation is committed to helping close the rheumatology workforce gap through its adult, pediatric and med-peds fellowships. Julie Campbell, MD, a former Arthritis Foundation-funded clinical rheumatology fellow, is now the first full-time pediatric rheumatologist in Montana. And through a fellowship program supported by the Foundation, Amanda Moyer, MD, became the only full-time pediatric rheumatologist in Oklahoma. She is working to build a pediatric rheumatology division at The University of Oklahoma College of Medicine.  

In addition, the Arthritis Foundation invests in medical curriculum development through its Community Health Program to bring attention to rheumatology. The American College of Rheumatology has also put together a multi-year plan to work toward a variety of solutions to the pediatric rheumatology workforce shortage.