1013: All Roads Lead to Rheum? Modeling Scenarios of New Patients-to-pediatric Rheumatologist Ratios in Different US States

Background/Purpose: Rheumatology is among the pediatric subspecialties with the lowest workforce density in the US¹. Initial management of most of the pediatric rheumatologic conditions relies exclusively on rheumatologist assessment. Pediatric rheumatologists might be responsible for a high patient load in some states of US.

Methods: The number of active certified pediatric rheumatologists in 2024 per state was determined by the American Board of Pediatrics (ABP)² and the pediatric state population < 18 years by US Census Bureau Population Estimates³. We estimated the number of new patients-to-pediatric rheumatologist in 1-year interval applying reported incidence rates of the main rheumatic conditions - juvenile idiopathic arthritis⁴, pediatric lupus⁵, juvenile dermatomyositis⁶, and others^7-9 - equally to each pediatric state population under the assumption that children living in different states are at the same risk of developing a rheumatologic condition. Using Monte Carlo simulations^1,10 we then created 1,000 scenarios of varying incident cases/100,000 children at the state level in a 1-year interval ranging from the minimum to the maximum reported incidence. In a sensitivity analysis, states reported to have zero active certified pediatric rheumatologist were considered to have 0.5.

Results: In the scenario of lowest incidences of all rheumatic conditions, the ratios of new patients-to-pediatric rheumatologist were categorized in quartiles, as shown in Figure 1. The states with highest ratios of new patients-to-pediatric rheumatologist were found in Arizona (189, 95%CI 176-301), Idaho (176, 95%CI 145-247), and New Mexico (165, 95%CI 143-245). States the with lowest ratio of new patients-to-pediatric rheumatologist were Delaware (24, 95%CI 14-31) and Massachusetts (26, 95%CI 18-35). In the sensitivity analysis, states with the highest ratios of new patients-to-pediatric rheumatologist were Louisiana and Oklahoma.

Conclusion: There are striking differences in the ratios of new patients-to-pediatric rheumatologist across the US. Children living in states with very high patient- to-pediatric rheumatologist might be at risk for delay in care. Further studies to examine the implications of workforce availability and pediatric access to rheumatology care are warranted.