The Arthritis Foundation recently came out with its list of the top 10 arthritis events for the year 2007. This series will focus on those events.

#9: Quantification of children with arthritis and number of doctors needed

Two national studies were used to estimate the number of annual hospital and doctor visits related to juvenile arthritis. For the purpose of this study, juvenile arthritis includes arthritis and related musculoskeletal disorders that affect children.

This study estimated that there are 294,000 children in the U.S. that suffer from significant pediatric arthritis or other rheumatic conditions (SPARC). There were an estimated 827,000 health-care visits including 83,000 emergency room visits.

The Public Health Care Act of 2000 mandated that the number of pediatric rheumatologists be evaluated to determine if there are sufficient numbers to address the health care needs of children with SPARC. The act also requires that if there are not enough pediatric rheumatologists, that “strategies shell be developed to address the shortfall”. Determining the number of children have SPARC is an important step in determining the number of doctors that are needed. In a report to Congress the following was stated:

• There is a shortage of pediatric rheumatologists in the United States. Thirteen states lack a pediatric rheumatologist, and throughout the country provider-to-population ratios exceed practice capacity.

• There is evidence of substantial reliance on internist rheumatologists (those that specialize in the care of adults with rheumatic diseases) to compensate for the lack of pediatric rheumatologists.

• The majority of pediatric rheumatologists practice in academic medical settings where they function as patient care providers, medical educators, and researchers. Efforts to increase the availability of clinical time for current pediatric rheumatologists and attempts to increase their numbers are warranted.

• In some states, estimates indicate there are more than 3,000 children with rheumatic diseases per pediatric rheumatologist, a number that far exceeds the average practice capacity of 443 children.

• Statistical models estimate that at least 337 pediatric rheumatologists are needed to meet patient care needs. Given the current number of pediatric rheumatologists, a 75-percent increase in the number of pediatric rheumatologists is needed.

The report identified several approaches to increasing the access to pediatric rheumatologists:

• Enhance the availability and financing of fellowship training to increase the number of trainees in the field.

• Increase the number of trainees by including incentives to practice in underserved areas after completion of training.

• Reallocate resources to increase the number of trainees as well as the number of pediatric rheumatologists practicing in underserved areas.

• Improve the financial viability of pediatric rheumatology practice in academic settings.

• Enhance the ability of internist rheumatologists and primary care providers to care for children with rheumatic diseases through education and training.

• Extend the ability of pediatric rheumatologists to treat children by using nurses, advanced-practice nurses, and physician assistants to perform certain tasks.