{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:51:37Z","timestamp":1791827497561,"version":"4.3.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"DOI":"10.1186\/s12969-026-01267-8","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:29:48Z","timestamp":1791826188000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A big problem for little people: the impact of proposed Medicaid reimbursement cuts and the fragility of pediatric rheumatology care"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7424-6062","authenticated-orcid":false,"given":"Michelle V.","family":"Benjamin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Amara","family":"Ogbonnaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwenesta B.","family":"Melton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Dowell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace C.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia T.","family":"Chandler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"1267_CR1","unstructured":"American Board of Pediatrics. General pediatricians: U.S. state and county maps. American Board of Pediatrics; 2024."},{"key":"1267_CR2","unstructured":"Arthritis Foundation. Addressing the pediatric rheumatology shortage. Arthritis Foundation; 2023. Accessed August 17, 2026."},{"issue":"8","key":"1267_CR3","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1002\/art.23087","volume":"57","author":"JJ Sacks","year":"2007","unstructured":"Sacks JJ, Helmick CG, Luo YH, Ilowite NT, Bowyer S. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001\u20132004. Arthritis Rheum. 2007;57(8):1439\u201345. https:\/\/doi.org\/10.1002\/art.23087 . PMID:18050185.","journal-title":"Arthritis Rheum"},{"key":"1267_CR4","doi-asserted-by":"publisher","unstructured":"Correll CK, Ditmyer MM, Mehta J, Imundo LF, Klein-Gitelman MS, Monrad SU, et al. 2015 American College of Rheumatology workforce study and demand projections of pediatric rheumatology workforce, 2015\u20132030. Arthritis Care Res (Hoboken). 2022;74(3):340-348. https:\/\/doi.org\/10.1002\/acr.24497. PMID:33107674.","DOI":"10.1002\/acr.24497"},{"issue":"Suppl 2","key":"1267_CR5","doi-asserted-by":"publisher","first-page":"e2023063678R","DOI":"10.1542\/peds.2023-063678R","volume":"153","author":"CK Correll","year":"2024","unstructured":"Correll CK, Klein-Gitelman MS, Henrickson M, Battafarano DF, Orr CJ, Leonard MB, Mehta JJ. Child health needs and the pediatric rheumatology workforce: 2020\u20132040. Pediatrics. 2024;153(Suppl 2):e2023063678R. https:\/\/doi.org\/10.1542\/peds.2023-063678R . PMID:38300008.","journal-title":"Pediatrics"},{"issue":"6","key":"1267_CR6","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1542\/peds.2013-3466","volume":"133","author":"KN Ray","year":"2014","unstructured":"Ray KN, Bogen DL, Bertolet M, Forrest CB, Mehrotra A. Supply and utilization of pediatric subspecialists in the United States. Pediatrics. 2014;133(6):1061\u20139. https:\/\/doi.org\/10.1542\/peds.2013-3466 . PMID:24799548.","journal-title":"Pediatrics"},{"issue":"1","key":"1267_CR7","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1002\/1529-0131(200002)13:1<33","volume":"13","author":"LE Schanberg","year":"2000","unstructured":"Schanberg LE, Sandstrom MJ, Starr K, Gil KM, Lefebvre JC, Keefe FJ, Affleck G, Tennen H. The relationship of daily mood and stressful events to symptoms in juvenile rheumatic disease. Arthritis Care Res. 2000;13(1):33\u201341. https:\/\/doi.org\/10.1002\/1529-0131(200002)13:1%3C33. :AID-ART6>3.0.CO;2-S. PMID:11094924.","journal-title":"Arthritis Care Res"},{"issue":"12","key":"1267_CR8","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1093\/rheumatology\/41.12.1428","volume":"41","author":"JC Packham","year":"2002","unstructured":"Packham JC, Hall MA. Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology (Oxford). 2002;41(12):1428\u201335. https:\/\/doi.org\/10.1093\/rheumatology\/41.12.1428.","journal-title":"Rheumatology (Oxford)"},{"issue":"8","key":"1267_CR9","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1002\/acr.25519","volume":"77","author":"NR Cunningham","year":"2025","unstructured":"Cunningham NR, Danguecan AN, Ely SL, Amponsah Y, Davis A, Edison S, et al. American College of Rheumatology guidance statements for addressing mental health concerns in youth with pediatric rheumatologic diseases. Arthritis Care Res (Hoboken). 2025;77(8):953\u201364. https:\/\/doi.org\/10.1002\/acr.25519 . PMID:40051122.","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"1267_CR10","unstructured":"Medicaid CHIP, Payment, and Access Commission. Access for children covered by MedicaidCHIP [Internet]. Washington (DC): MACPAC; 2023 Jul 16. Available from: https:\/\/www.macpac.gov\/subtopic\/access-for-children-covered-by-medicaid-and-chip\/."},{"key":"1267_CR11","unstructured":"National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; Board on Children, Youth, and Families; Board on Health Care Services; Committee on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being. The Future Pediatric Subspecialty Physician Workforce: Meeting the Needs of Infants, Children, and Adolescents. Chapter 8, Financing Children's Health Care. Washington (DC): National Academies Press (US); 2023 Sep 7. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK599767\/."},{"key":"1267_CR12","unstructured":"AMN Healthcare Editorial Team. How much does a rheumatologist make? Dallas (TX): AMN Healthcare; 2025 Feb 19. Available from: https:\/\/www.amnhealthcare.com\/blog\/physician\/perm\/how-much-does-a-rheumatologist-make\/."},{"key":"1267_CR13","unstructured":"Mann C, Rosenbaum S, Sommers BD. No place to hide: children will be hurt by Medicaid cuts. Washington (DC): Georgetown University Center for Children and Families; 2025."},{"key":"1267_CR14","doi-asserted-by":"publisher","unstructured":"Henrickson M. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics. Pediatr Rheumatol Online J. 2011;9:23. Available from: https:\/\/doi.org\/10.1186\/1546-0096-9-24.","DOI":"10.1186\/1546-0096-9-24"},{"issue":"6","key":"1267_CR15","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1093\/jnci\/djad024","volume":"115","author":"JM Barnes","year":"2023","unstructured":"Barnes JM, Neff C, Han X, Kruchko C, Barnholtz-Sloan JS, Ostrom QT, Johnson KJ. Association of Medicaid expansion with pediatric cancer overall survival. J Natl Cancer Inst. 2023;115(6):749\u201352.","journal-title":"J Natl Cancer Inst"},{"key":"1267_CR16","unstructured":"American Board of Pediatrics. Subspecialty training model [Internet]. Chapel Hill (NC): American Board of Pediatrics; 2026. Available from: https:\/\/www.abp.org\/cbme\/subspecialty-training-model."},{"key":"1267_CR17","unstructured":"Association of American Medical Colleges. Medical student education: debt, costs, and loan repayment. Washington (DC): Association of American Medical Colleges; 2023."},{"issue":"10","key":"1267_CR18","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1097\/ACM.0000000000006083","volume":"100","author":"MG Flores","year":"2025","unstructured":"Flores MG, Chollet AJ, Rolin SA. Investigating the Impact of a National Institutes of Health Loan Repayment Program Preparedness Program. Acad Med. 2025;100(10):1111\u20132.","journal-title":"Acad Med"},{"key":"1267_CR19","unstructured":"American College of Rheumatology. Interdisciplinary Care Team. Advanced Practice Provider [Internet]. Atlanta (GA): American College of Rheumatology. Available from: https:\/\/rheumatology.org\/interdisciplinary-care-team-advanced-practice-provider."},{"issue":"3","key":"1267_CR20","doi-asserted-by":"publisher","first-page":"e022097","DOI":"10.1136\/bmjopen-2018-022097","volume":"9","author":"Y Yang","year":"2019","unstructured":"Yang Y, Li J, Wu X, et al. Factors influencing subspecialty choice among medical students: a systematic review and meta-analysis. BMJ Open. 2019;9(3):e022097.","journal-title":"BMJ Open"},{"key":"1267_CR21","unstructured":"American College of Rheumatology. ACR Committee on Pediatric Rheumatology [Internet]. Atlanta (GA): American College of Rheumatology. 2026. Available from: https:\/\/rheumatology.org\/volunteering\/acr-committee-on-pediatric-rheumatology."},{"key":"1267_CR22","unstructured":"Harvey WF. Pediatric rheumatology: its launch, present & future. The Rheumatologist [Internet]. 2026 Mar 12 [cited 2026 Aug 17]. Available from: https:\/\/www.the-rheumatologist.org\/article\/pediatric-rheumatology-its-launch-present-future\/2\/?singlepage=1"},{"key":"1267_CR23","unstructured":"Miloslavsky E, Sirek G, Chandler M, Ferrandiz R, Wright G, Iversen M, et al. Development of the Academy for Workforce Advancement to Enrich Rheumatology Diversity [abstract]. Arthritis Rheumatol. 2024;76(Suppl 9). Available from: https:\/\/acrabstracts.org\/abstract\/development-of-the-academy-for-workforce-advancement-to-enrich-rheumatology-diversity\/."},{"key":"1267_CR24","doi-asserted-by":"publisher","first-page":"14","DOI":"10.22454\/PRiMER.2023.758379","volume":"7","author":"SM Leonard","year":"2023","unstructured":"Leonard SM, Dixon KS, Ayres JM, Cordner K, Greiner KA, Parente DJ. Perceived value of public health and health policy information among medical students: a cross-sectional study. PRiMER. 2023;7:14.","journal-title":"PRiMER"},{"key":"1267_CR25","doi-asserted-by":"publisher","first-page":"735","DOI":"10.2147\/AMEP.S147212","volume":"8","author":"B Malik","year":"2017","unstructured":"Malik B, Ojha U, Khan H, Begum F, Khan H, Malik Q. Medical student involvement in health policy roles. Adv Med Educ Pract. 2017;8:735\u201343.","journal-title":"Adv Med Educ Pract"}],"container-title":["Pediatric Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-026-01267-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12969-026-01267-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-026-01267-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:29:50Z","timestamp":1791826190000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12969-026-01267-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1267"],"URL":"https:\/\/doi.org\/10.1186\/s12969-026-01267-8","relation":{},"ISSN":["1546-0096"],"issn-type":[{"value":"1546-0096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"assertion":[{"value":"14 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics and Consent to Participate declaration","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Michelle V. Benjamin, MDNo relevant disclosures.Gail Kerr, MD, FRCP(Edin), MACRNo relevant disclosures.S. Amara Ogbonnaya, MDNo relevant disclosures.Gwenesta B. Melton, MDNo relevant disclosures.Sharon Dowell, MBBSAdvisory Board \u2013 AmgenAdvisory Board \u2013 Johnson & JohnsonGrace C. Wright, MD, PhD, FACRNo relevant disclosures.Mia T. Chandler, MD, MPHNo relevant disclosures.Disclosure Statement: The authors declare that they have no conflicts of interest relevant to this manuscript except as noted above.","order":2,"name":"Ethics","label":"Competing Interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"71"}}