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PEDIATRICS Vol. 113 No. 3 March 2004, pp. e173-e181

ELECTRONIC ARTICLE

Role of Pediatric and Internist Rheumatologists in Treating Children With Rheumatic Diseases

Michelle L. Mayer, PhD, MPH, RN*, Christy I. Sandborg, MD{ddagger} and Elizabeth D. Mellins, MD§

* Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
{ddagger} Department of Pediatrics, Stanford University School of Medicine, Stanford, California
§ Division of Immunology and Transplantation Biology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

Objective. To quantify and describe the role of internist and pediatric rheumatologists in the care of children with rheumatic diseases and identify factors associated with internist rheumatologists’ willingness to treat children.

Methods. We surveyed physician members of the American College of Rheumatology who currently practice in California (n = 589). Bivariate and logit analyses were used to examine the effects of training, provider, practice, and distance to the nearest pediatric rheumatologist on the likelihood that an internist rheumatologist treated children.

Results. Our effective response rate was 51%. More than one third of internist rheumatologists who practice in California reported treating pediatric patients. On average, internist rheumatologists who treated children saw 3.1 patients younger than 18 years weekly; half of these patients were 16 and 17 years of age. In logistic regression analysis, internist rheumatologists who treat pediatric patients were significantly more likely to practice in a multispecialty clinic (adjusted odds ratio: 3.5; 95% confidence interval: 1.9–9.7) and to live >50 miles from a pediatric rheumatologists (adjusted odds ratio: 6.8; 95% confidence interval: 2.1–22.7). In aggregate, we estimate that pediatric rheumatologists and internist rheumatologists provide care to 550 and 419 patients younger than 18 years per week, respectively.

Conclusions. A substantial number of California internist rheumatologists are involved in the care of children, especially adolescents. The heavy involvement of internist rheumatologists in the care of children suggests that additional pediatric rheumatologists may be needed in select areas. Our findings have important implications for the size and distribution of the pediatric rheumatology workforce, the content of fellowship training for internist rheumatologists, and future studies of the relative quality of pediatric rheumatology care offered by internist rheumatologists. Furthermore, the role of internist subspecialists in caring for children with other chronic illness should be assessed.

Key Words: health manpower • rheumatic diseases • physician practice patterns • rheumatology • chronic conditions

Abbreviations: AAP, American Academy of Pediatrics • JRA, Juvenile Rheumatoid Arthritis • ACR, American College of Rheumatology

Received for publication Aug 20, 2003; Accepted Oct 21, 2003.




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