Addressing the Pediatric Rheumatology Workforce Crisis, with Susan Shenoi, MD

Workforce shortages in rheumatology continue to come to a head and impact care for patients and clinician practice. At the 2026 Rheumatology Winter Clinical Symposium, held in Maui, Hawaii, on February 11–14, Susan Shenoi, MD, Clinical Director for the Pediatric Rheumatology Division at Seattle Children's Hospital and Research Center and Associate Professor at the University of Washington, Seattle, addressed this growing challenge in a talk with a clear message: the pipeline is shrinking at a time when demand continues to grow.

RheumatologyLive sat down with Shenoi during the meeting to learn more about the challenges facing the field. Over the past several years, fewer trainees have chosen pediatric rheumatology as a subspecialty. Most strikingly, this year’s fellowship match rate fell below 50% for the first time. For a field already limited in size, that decline is deeply concerning. Children with rheumatic diseases require specialized, longitudinal care, and without sufficient pediatric rheumatologists, access gaps will inevitably widen.

Shenoi emphasized that the causes are likely multifactorial. Lengthy training pathways remain a barrier; pediatric rheumatology requires 3 additional years of fellowship with no abbreviated clinical track. Financial considerations also weigh heavily. After extended training at fellowship-level salaries, graduates may enter practice earning comparable, or in some cases even lower, salaries than general pediatricians. For many trainees balancing debt and lifestyle priorities, that equation is difficult to justify.

Generational shifts may also play a role. Today’s trainees place greater emphasis on work–life balance, and the demands of subspecialty care can appear daunting. While the rapid expansion of advanced practice providers in rheumatology may help mitigate access challenges, Shenoi views this as only part of the solution.

Long-term sustainability, she argued, will require collaboration with major organizations such as the American Board of Pediatrics and the American College of Rheumatology to explore innovative training models, potential pathway flexibility, and broader workforce strategies. Ultimately, ensuring that the next generation enters pediatric rheumatology is essential not only for maintaining access, but for advancing care.

“You have to love what you do to go into this field,” Shenoi said. “And I hope that [we] can really come up with some innovative ways and work with large organizations such as the ABP and the ACR… to come up with some creative solutions, because eventually, at some point, I'd like to retire so the younger generation has to take this on.”

Reference

Shenoi S. Rheumatology workforce issues: fellows, careers, and the future. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.