Pediatric rheumatology in adult rheumatology practices in Washington state

To determine both the extent to which adult rheumatologists treat children and their level of comfort in doing so.

A questionnaire was sent to all 77 physicians in the state of Washington who were listed as adult rheumatologists in the American College of Rheumatology (ACR) directory.

Sixty-six questionnaires (86%) were returned; 50 were identified as being from private-practicing adult rheumatologists and were the focus of this study. Sixty-two percent of the respondents reported that they care for children; predictors included increased exposure to pediatric rheumatology during fellowship (P = 0.003), increased distance from Seattle (P = 0.001), and listing oneself in the ACR directory as treating children (P = 0.03). Most respondents reported feeling discomfort in treating children younger than 6 years of age, treating Kawasaki disease, and treating polyarteritis nodosa, but most reported feeling comfortable treating children with chronic arthritides. Impediments to referring to a pediatric rheumatologist included distance (median distance 35 miles), convenience for the family, personal preference, and experience in caring for children. Twenty-nine percent reported difficulties referring to a pediatric rheumatologist outside of one's managed care plan. Adult rheumatologists expressed interest in continuing medical education dealing with pediatric rheumatology, preferably with a lecture format in their home communities.

A significant number of adult rheumatologists care for children. Pediatric rheumatologists should provide both educational and consultative support for these adult rheumatologist colleagues.