Shortage of pediatric Rheumo

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Yes, we only have ONE Pediatric Rheumy on our side of the state.
The other side I think has a couple more but not enough.

At Grace's hospital you meet with the Rheumy every fourth or fifth visit.
Other then that you meet with his PA's.
 
Wow makes me very glad we live on the east coast! My daughters are planning to go to Washington DC next year with the Arthritis Foundation to advocate.

We've seen several ped rheumys and it never fails to surprise me that a big children's hospital with 20+ ped GIs can have just one or two pediatric rheumatologists.
 
Gi docs do endoscopies =$$$ but rheumatologists don't have any procedures that I can think of... maybe they tap a joint once in a while so not much $
 
Wow I am naive!!! :lol: I've often wondered what initially piqued the interest of doctors in certain fields?? Now I know! :facepalm: I wonder if it works the same way in Canada? :shifty-t:
 
Interesting. There are 8 pediatric rheumatologists at our hospital and 7 pediatric GI docs. Funding model is completely different here.
 
xmdmom said:
Gi docs do endoscopies =$$$ but rheumatologists don't have any procedures that I can think of... maybe they tap a joint once in a while so not much $
Click to expand...

It's a little degrading and cynical to claim all doctors are simply motivated by billable hours. Some fields simply aren't as popular, rheumatology is already a specialty that demands five more years of study and fellowship after med school and tying the label of pediatric to it is adding yet another specialty that requires four years, at minimum (varies with country). We're talking nearly two decades of training at this point, including the acquisition of the MD.

There's also the angle of certain conditions being more fulfilling to treat, because you can see the patients health improve in very concrete ways. The consistently happiest, most satisfied doctors work in dermatology, radiology, and onocology. (Source) All related to high profile illnesses with drastic quality of life components or powerful visual signs of improvement. Arthritis is a bit...esoteric by comparsion, especially to the poor social skills of many doctors that may miss subtle but important signs of improvement.
 
Who claimed that all doctors are simply motivated by billable hours? Certainly not me. I am only saying that reimbursement is a factor in medical student's choice-- this is especially true when doctors have a lot of student loans to pay back. There are lots of factors which pique medical students interest in different fields. Sometimes students do a rotation and it just clicks. Other people just find certain specialties more intrinsically interesting. Then there's lifestyle -- ER and hospitalists have more flexible schedules and "no call" when they're out of the hospital. These specialties also don't have long term relationships with patients. Radiology requires good spatial relationships! Surgery requires manual dexterity. Dermatology and Radiology have the good hours and reimbursement and I am positive that's what attracts many medical students to those fields. Oncology is different- doctors have close relationships with their patients and can feel like they are really making a difference though it's a really difficult field to be in, emotionally.

Pediatric specialties generally make less $ than adult specialists. I am not aware that ped rheumatologists study any more than other specialists. Peds endo do medical school, 3 years residency, and 3 years of fellowship. From what I can tell here, it's the same for ped rheum. Surgeons and surgical specialists have more years. http://www.chp.edu/CHP/rheumatology+fellowship+program
 
I want C to stay pediatric as long as possible but we didn't have great options for ped. rheumatologist, tried one we weren't happy with and the travel played a role for C. So his rheumatologist is adult, so far so good but it is early days in the new dx.

Also C is older. I can absolutely see where this would be concerning if he wasnt closer to the aging out stage to begin with!
 
My experience with a ped specialist is limited and probably not the norm but, S was diagnosed at a children's hospital and stayed with one of their GIs post-dx. However, their rules were extremely rigid re the transfer from ped to GI (we even had to move a follow-up apptmt up by a week because it fell 3 or 4 days after his 18th birthday!). It was a bit disappointing to have just started to build a relationship with his GI and then be transferred to a new GI again. So, given C's age, even if he were with a ped rheumo, it might not be too long before before he'd be starting over with a new doctor again.

And, sorry if my offhand remark started the idea that doctors were only in a field for the money! I just assumed they were paid some sort of overall 'salary' and it never occurred to me that specific types of procedures, etc. would have an impact on their income. But, I certainly do agree that many factors would play into decisions re specialty, location, etc.
 
The rules are a bit different here most peds affiliated with the children's hosp C goes to will see the patient at least until 21 much past that in some vases. C's GI will keep patients through college if things are stable and moving along well. If there case is severe and has required many hospitalizations or surgeries then due to the cutoff age of 21 he ages those out to adult GIs he is comfortable with. The same applied to the ped rheumatologist but I was just not impressed with his demeanor or care.
 
I have no idea about paediatric rheumatologists here so…Yikes!…

Current Situation in NSW (this was published in 2103

• Access to expert paediatric rheumatology services in urban, regional and rural NSW falls well behind national benchmarks and international guidelines.
• In NSW there are only 16 hours per week of publicly funded consultant paediatric rheumatologist time (which equates to less than 15 minutes per patient per year).
• There is no specific funding allocated for allied health and nursing essential in the care of children and young people with rheumatic disease.
• The lack of easily available expert rheumatology services results in many children being managed by clinicians without specific expertise – they are managed by either physicians trained in adult rheumatology care or physicians without specific rheumatology training.

Don’t know how things fare in the private sector.

What is it they say about dermatology?…it is the best field of medicine because you never cure your patients but you don’t kill them either. :lol:

Dusty. xxx
 
Interesting, just looked to see what we had available because y'all made me curious. We have one doctor who works as a ped reheumo. His services state internist, pediatrician and rheumotology and it looks like he does adult and ped.
 
Well I guess our ratios are the same CIC, we have 4 Ped GI's (all in the same practice) and 1 Ped Rhuemo but it's for the entire area.
 
We've seen 2 Ped Rheumos and 6 Ped GIs throughout our journey. I find that the GIs are more black and white. They want concrete indisputable proof before making a diagnosis. Rheumos are more comfortable in the gray. They tend to rule things out first, then make a diagnosis based on what is left. It is a whole different way of thinking that not everyone is comfortable with.
 
We've seen 3 ped rheumos and 2 GIs along the way. Here's some food for thought though......

GI diagnoses as a group (all GI not just Crohn's) have to more prevalent per capita in kids than rheumatological disease. Docs-to-be aren't likely to choose a specialty for which they know hospitals aren't recruiting. Or at least, that makes sense to me.

It would be interesting to know the number of GI vs. Rheumatology vacancies......wonder if they correlate?? :ybatty:

J.
 
We have two local peds rheumatologists One is awful he told me there is no link between joint pain and Crohn's disease. The other is supposed to be great but doesn't take our insurance.
 
I just want to say that quite a few of my specialists have made comments about how difficult the field of rheumatology is- difficult to make an accurate diagnosis. I was really surprised when my oncologist said that his job was easy, to detect and treat cancer, and that my rheumatologist has the hardest job!
 
kimmidwife - UGH!!!!!!!

And fozheart - I agree. If I heard once when Claire was 3, I heard a thousand times "this is a diagnosis of exclusion". It seems like they have to rule out damn near every crazy thing before anyone will even think arthritis! They DO have a tough job. Especially ours.....he has to put up with me. :rof:

J.
 

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