Physician‐Scientist Pipeline for Pediatric Rheumatology: The Current Landscape and Future Perspectives

Abstract

Over the past 50 years, the science of pediatric rheumatology has grown exponentially due to an expansion in the understanding of complex rheumatic conditions and a surge in novel targeted therapeutics. Physician‐scientists in the field of pediatric rheumatology have played major roles in these advancements that have improved the care of children, adolescents, and young adults with chronic and often life‐threatening systemic inflammatory diseases. Despite the critical role of the physician‐scientist in discovering and translating scientific advancements from the bench to the bedside and vice versa, which have catapulted the field of pediatric rheumatology, this role remains an endangered species, with a declining pipeline due to a variety of factors. In this article, we review the current landscape of the physician‐scientist pipeline for pediatric rheumatology on the fiftieth anniversary of the formalization of the specialty in North America. We review challenges to maintaining a thriving physician‐scientist pipeline and discuss future perspectives.

Introduction

In 1976, building on foundational efforts from early pioneers who conducted research and cared for children, adolescents, and young adults with rheumatic diseases, the subspecialty of pediatric rheumatology was formalized in North America. ¹ A year prior, two past presidents of the American Rheumatism Association (ARA; now called the American College of Rheumatology [ACR]), Dr Lawrence Shulman and Dr Gerald Rodnan appointed the Council of Pediatric Rheumatology within the ARA. The landmark international conference, which heralded the formalization of the specialty, was held March 22 to 25, 1976, in Park City, Utah. This conference, organized by the ARA Council of Pediatric Rheumatology, was chaired by Dr Jane Schaller and Dr Virgil Hanson and was also supported by the Arthritis Foundation, the Shriners of North America, and the Jeffrey and Adelaide Lazarus Foundation. With 59 attendees, this conference focused on the current concepts in pathogenesis, advances, and controversies around the care of pediatric rheumatic diseases at the time to propel future directions for the field, including a national program for research, education, and improved therapies. ² Over the past 50 years, physician‐scientists in pediatric rheumatology have greatly expanded the depth and breadth of knowledge of the pathophysiology of complex rheumatic diseases, advanced biotechnological interventions, and optimized novel and effective therapeutics. The current spectrum of research in pediatric rheumatology is vast and includes basic, translational, clinical, epidemiologic, and health services as well as research in outcomes and medical education. Physician‐scientists have been critical to this growth.

By consensus, physician‐scientists are defined as physicians who devote the majority of their professional effort (ie, >50%) to a defined area within the broad continuum of biomedical research at an academic institution, government agency, industry, or independent research centers and institutes. ³ A physician‐scientist holds a medical degree, often with a PhD or other advanced degree in research methods. The physician‐scientist engages in independent biomedical research while often also maintaining a clinical practice, thus functioning at the interface of science and medicine, leading the acceleration of discoveries that would improve the care of patients. This dual role of the physician‐scientist as a clinician and scientist is unique because they translate discoveries to bedside practice and vice versa, thereby propelling transformative discoveries and advancements. As physician‐scientists provide clinical care, they have a vantage opportunity to inform their research with what is most pertinent and pressing to patients. They also disseminate scientific knowledge to the science and medical communities as well as to patients, patients’ families, and the general public. ⁴ Thus, maintaining a pipeline for the entry, training, and growth of physician‐scientists in pediatric rheumatology is key to supporting continued exponential advancements in the science and clinical care of patients with pediatric‐onset rheumatic diseases.

Despite the recognized need for physician‐scientists in general, the path to becoming one is often arduous, and interest in a career as a physician‐scientist is declining. ⁵ , ⁶ In particular, the pipeline for pediatric rheumatology physician‐scientists has been plagued with challenges in research training, academic career advancement, and building independent biomedical research programs. These challenges have been further compounded by an aging pediatric rheumatology workforce and a notable predicted shortfall in the number of pediatric rheumatologists needed to meet the needs of the field. ⁷ , ⁸ The objective of this review is to appraise the current landscape of the physician‐scientist pipeline for pediatric rheumatology on the fiftieth anniversary of the formalization of the specialty and discuss future perspectives and implications for research in the field.

Methods

For this narrative review, PubMed searches were conducted using the following medical subject heading terms: “Physician Scientist”; “Physician scientist” AND “training” AND “Rheumatology”; and “Physician scientist” AND “training” AND “education” AND “mentoring.” Relevant articles published up to December 2025 were included.

The physician‐scientist pipeline for pediatric rheumatology in North America: the current landscape

In the United States, compared to other pediatric subspecialities (including those with lower procedural burden), pediatric rheumatology still has one of the lowest number of physicians per 100,000 children at 0.27 clinical workforce equivalent. ⁸ Correll et al ⁸ reviewed records from The American Board of Pediatrics, which showed that as of June 2023, the number of board‐certified pediatric rheumatologists ≤70 years of age was 508. Of these, 88% had a faculty appointment at an academic institution, and 49% primarily worked at a medical school or university. Pediatric rheumatologists self‐reported being mostly clinical faculty (71%), and only 15% spent a majority (≥50%) of their time in research. ⁸ This highlights the small proportion of pediatric rheumatologists who are physician‐scientists. The median age of board‐certified pediatric rheumatologists was 45 years old, and one‐third (32%) of the 508 pediatric rheumatologists planned to retire between age 65 to 69 years. Thus, projected estimates indicate a significant decline in the total active pediatric rheumatology workforce by 2040. With such a small proportion of physician‐scientists at baseline, maintaining a vibrant physician‐scientist workforce in pediatric rheumatology will be even more challenging, yet it will remain critical.

Raising awareness of the challenges of the physician‐scientist career track in general, and initiatives to enhance the general medical scientific workforce, is long‐standing because similar challenges, although to varying degrees, exist in other specialties. ⁹ In 1979, James B. Wyngaarden, in his address to the Association of American Physicians titled “The clinical investigator as an endangered species,” highlighted the dwindling numbers of physician‐scientists and was one of the initial prominent voices that raised the importance of maintaining this subset of researchers in the biomedical workforce. ⁹ Dr Wyngaarden was the president of the Association of American Physicians at the time and would later become the director of the National Institutes of Health (NIH). The concern for a diminishing pool of physician‐scientists in medicine in general has been echoed over the past five decades. The NIH Physician‐Scientist Workforce Working Group (PSW‐WG) was convened and charged by the NIH director at the time, Dr Francis Collins, to examine the current landscape of the physician‐scientist biomedical workforce with a view to make recommendations to address the gaps. The report from this group in 2014 cited increases in the cost of medical education, decreases in NIH funding, more attractive financial compensation offered by clinical practice versus research, work‐life imbalance, lack of mentorship, and demanding requirements for maintenance of clinical practice as key challenges confronted by physician‐scientists. ¹⁰

Nearly a decade later, the National Academies of Sciences, Engineering, and Medicine (NASEM) 2023 report on “Trends in the pediatric physician–scientist workforce” also acknowledged the continued decline in the number of physician‐scientists plus other similar issues as the PSW‐WG 2014 report. The NASEM 2023 report also highlighted specific challenges in pediatrics, including MD‐PhD graduates opting for pediatric residencies less often, uncertainties in research funding, an aging physician‐scientist workforce, a decline in the number of new physician‐scientists entering the workforce, and attrition from research careers at various stages as contributors to the diminishing pool of physician‐scientists. ¹¹ There is poor retention of midcareer physician‐scientists in pediatrics in general, and physician‐scientist attrition rates specific to pediatric subspecialties are unknown. It was noted that, on average, <8% of all pediatric subspecialists self‐report spending >50% of their professional efforts on research, from the American Board of Pediatrics 2023 data on maintenance of certifications. Specifically, 14.2% of pediatric rheumatologists self‐reported spending >50% of their professional effort on research.

Currently, training for a physician‐scientist career in pediatric rheumatology is similar to most pediatric subspecialities, beginning with medical school, then residency, and then fellowship (Figure 1). ¹² Structured advanced training in research can occur at any of those levels, such as through an MD‐PhD program, research‐oriented residency program, and/or a graduate degree in a research domain, such as clinical research, epidemiology, immunology, or public health. ¹³ , ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ However, early exposure to the science of pediatric rheumatology is still a challenge because 40% of pediatric residency programs and medical schools do not have pediatric rheumatologists on faculty, which limits trainee exposure to the field. ¹⁹ This lack of exposure to the field of pediatric rheumatology extends to the general public, including primary, secondary, and undergraduate education levels, which are formative periods for decisions on career options, particularly for science, technology, engineering, and mathematics careers. ⁸ , ²⁰ , ²¹ , ²²

Figure 1.

The physician‐scientist career path. A schematic representation of the leaky physician‐scientist pipeline showing transitions from training to independent research and clinical practice. The block arrows represent training opportunities. The rest of the arrows indicate options for transitions between training programs: red arrows denote transitions within the standard research‐based physician‐scientist training pathway; black arrows with dotted lines indicate other options for transitions for on‐ramps; and green arrows indicate points of physician‐scientist attrition from research‐focused careers. *Faculty‐scientists may also obtain graduate‐level training in research, such as master's and/or PhD. PSTP, physician‐scientist training program; RiR, research in residency. Source: Adapted from Williams et al. ¹³ Used with permission of JCI Insight. Permission obtained through Copyright Clearance Center. Re‐created in https://www.biorender.com/ by Dr Ogbu.

To address the biomedical pipeline challenges, several academic institutions, albeit large centers with a critical mass of faculty researchers and resources, have developed programs to increase local physician‐scientist pipelines, which leverage external resources from federal funding and private foundations. ²⁰ , ²¹ The NIH, as the largest funder of biomedical research and training in the United States, has instituted initiatives, such as the predoctoral MD‐PhD medical scientist training program, ¹³ predoctoral and postdoctoral T32 research training grants, K08 and K23 mentored career development awards, the K99 and R00 pathway to independence award, and KL2 and TL1 Clinical and Translational Science Awards for qualifying institutions to award to increase earlier exposure to research and foster successful transition to independent research. ⁷ The Howard Hughes Medical Institute (HHMI) established its Early Career Physician‐Scientist award in 2006, supporting physicians within the HHMI‐NIH Research Scholars program. The Burroughs Wellcome Fund created the Physician‐Scientist Institutional Awards program in 2017, which was instituted to support academic institutions in developing programs that would encourage an influx of physician‐scientists and support effective mentoring. ²³ From publicly available records on NIH RePORTER, in the past 10 years, the NIH K24 Midcareer Investigator Award has supported more pediatric rheumatology scientist faculty to devote time to mentoring early physician‐scientists in patient‐oriented research. All of these mechanisms have been beneficial in training the physician‐scientist workforce, although accurate summative data on the proportion of pediatric rheumatology physician‐scientists who have received these awards are not readily available, so direct impact on the field is hard to quantify. Moreover, “success metrics,” such as summative data on the rate of recipients achieving their first independent NIH R01 or R01‐type award and at what average age or stage of career, are not readily available.

Specific opportunities to support the development of pediatric rheumatologists interested in a career in research have used joint partnerships between national pediatric and rheumatologic associations and foundations. The Association of Medical School Pediatric Department Chairs Pediatric Scientist Development Program added one new position for pediatric rheumatology in 2026. This position is cofunded by the Rheumatology Research Foundation (RRF), Childhood Arthritis and Rheumatology Research Alliance (CARRA), and the Arthritis Foundation, and it will support a pediatric rheumatology fellow (MD, DO, or MD/PhD) who is pursuing a long‐term research career in childhood rheumatic diseases. Other mentored career development awards for pediatric rheumatology physician‐scientists are offered separately by the RRF, CARRA, the Arthritis Foundation, and other disease‐specific foundations, such as the Lupus Research Alliance. Overall, these opportunities can be leveraged to strengthen the current pediatric rheumatology physician‐scientist workforce pipeline, although some specific barriers and facilitators to the field of pediatric rheumatology must be taken into consideration.

Barriers and facilitators to physician‐scientist careers in pediatric rheumatology

In 2014, Ogdie et al ²⁴ surveyed US‐based members of the ACR to determine perceived barriers to and facilitators of a career in rheumatology research. They received 502 (9.2%) responses from surveying 5,448 recipients. However, 72 responses were incomplete, duplicates, or from nonrheumatologists and so were excluded. Of the 430 final respondents included in the report, 62 were pediatric rheumatologists, and 17 were pediatric rheumatology fellows. There were 309 adult rheumatologists and 42 adult rheumatology fellows. ²⁴ The majority of respondents (305; 71%) were at academic centers, of which 171 (147 faculty and 24 fellows) were actively pursuing research careers. Of the 171 currently in research, 134 (78%) and 100 (58%) had ≥50% and ≥70% research effort, respectively. The most commonly perceived barriers to a career in research included lack of funding and lack of outstanding mentorship. Provision of these two factors, as well as specific funding for early investigators, protected research time, institutional support, and personal skills or traits (eg, hard work, resilience, initiative, persistence, and passion) were felt to be necessary facilitators for a career in research.

Several of the 430 respondents had received some form of research funding, ranging from foundation fellowship or postdoctoral awards (n = 92; 21%), foundation career development awards (n = 99; 23%), NIH Loan Repayment Programs (n = 24; 6%), NIH K series or Veterans Affairs career development awards (n = 76; 18%), NIH R01 awards (n = 59; 14%), other NIH awards (n = 71; 17%), and any other grants (n = 141; 33%). However, collectively, attrition across the spectrum of basic, clinical, epidemiologic, and translational research career paths was high at 23% (n = 97), often occurring at a median of 7 years after fellowship training (interquartile range 2–14 years). The most common reasons for attrition from a research career included difficulty in obtaining research funding and lack of departmental and divisional support, which included lack of protected time (Table 1). ²⁴ Other reasons included lack of institutional research infrastructure, clear career path, and access to mentorship. Local politics and conflicts, including with division chiefs, were also reasons for leaving. Additional suggestions the authors made for facilitating physician‐scientist careers included early research exposure from medical school through fellowship, grant writing training, peer mentoring, formal research training, standards for research training in fellowship or a core research curriculum, career development workshops, improved investigator compensation, and access to loan repayment programs.

Table 1.

Causes of attrition from research careers from on a survey of 97 US‐based adult and pediatric rheumatology physician‐scientists^*

Factor	Physician‐scientists (N = 97), n (%)
Difficulty obtaining grant funding	55 (57)
Lack of divisional and departmental support	51 (53)
Better compensation	38 (39)
Lack of mentorship	38 (39)
Tired of writing grants	33 (34)
Personal reasons, such as family or moved to preferred geographic location	26 (27)
Desire to spend more time in clinical care	20 (21)
Industry opportunity	10 (10)
Not enjoying research work	6 (6)

^* Source: Adapted from Ogdie et al. ²⁴

With the rising demands of clinical care, the shortfall in the pediatric rheumatology clinical workforce, and clinical care being more financially profitable, protecting time for research is often a challenge for academic health centers. Physician‐scientists hold a “dual identity” as both scholars and active practitioners who generate revenue for the health system, ²⁵ which is a reality that may be hard to navigate as the workforce shrinks and clinical needs in the field grow. Defining the value proposition for pediatric rheumatology clinical care and research may help address this barrier. In such a relatively new subspeciality, the need for scientific innovation is paramount to advance the field. In the same study by Ogdie et al, ²⁴ participants suggested that the ACR had a role in educating department chairs, division chiefs, and fellowship directors on how best to support physician‐scientists, including investigators from institutions without strong research infrastructure. However, specific details on the preferred scope of education or format to adopt in liaising with department and divisional leadership were not reported.

In Canada, impediments to research careers for physician‐scientists, inclusive of pediatric rheumatologists, have been identified as rising medical school tuition costs, salaries and funding for research, and poor mentorship. ²⁶ These challenges were further worsened by the termination of the MD‐PhD program grants by the Canadian Institutes of Health Research in 2016. ²⁶ Thus, a national consensus conference was convened in 2016 to address the declining physician‐scientist workforce, specifically to give recommendations for training programs and support for early career physician‐scientists. ²⁷ It was recommended that an independent national council be established to provide oversight of physician‐scientist training programs, offer multiyear funding, and track outcomes. In addition, funding of a physician‐scientist trainee was to be viewed as portable and distinct from the operational funding provided to a training program. It was recommended to develop capacity for funding and mentorship support, develop diverse networks of physician‐scientists with other scientists, and ensure that research methodologies were integrated in medical school curricula. ²⁶ , ²⁷

Structured research mentorship models in pediatric rheumatology

Lack of effective mentoring is one of the most common barriers to research career success. ²³ There have been multipronged structured mentorship approaches to sustain the physician‐scientist pipeline from trainee level to independent faculty in pediatric rheumatology. Beyond efforts at the academic institution and federal level, initiatives from the ACR, the RRF, and CARRA have also helped to provide platforms for longitudinal mentorship specific to the pediatric rheumatologist.

The ACR/CARRA Mentoring Interest Group (AMIGO) is a collaboration that started in 2010 following a survey of the ACR and CARRA membership that supported mentorship and networking as key unmet needs in pediatric rheumatology as well as a networking symposium in 2011. ²⁸ Mentees and mentors, both from the United States and Canada, are matched based on complementary career paths, including physician‐scientist paths in basic, translational, or clinical research, and other reported career development needs. The AMIGO mentors are at the assistant professor level and above. The AMIGO mentees are fellow trainees or junior faculty (instructors or assistant professors). Junior faculty mentors are matched with fellows, and senior faculty mentors (associate professors and full professors) are matched with junior faculty.

A study to evaluate the outcomes of the AMIGO program from 2011 to 2018 was recently published in 2024. ²⁹ The results showed continued interest in the program by mentees and mentors, with steady growth in the number of active mentor‐mentee dyads, and overall participation in AMIGO at about 66% (331 of 504) of the entire US and Canadian pediatric rheumatology community. However, the long‐term impact of the AMIGO program on the development of the pediatric rheumatology physician‐scientist mentee to independence is yet to be systematically determined.

The Rheumatology Research Workshop, annually organized by the ACR Committee on Research, the ACR Early Career Investigator Committee, and the RRF, provides an avenue for education in the rudiments of successful research careers, peer networking, and establishing longitudinal mentorship between early and established pediatric rheumatology physician‐scientists. Travel grants are provided for investigators to attend the Rheumatology Research Workshop.

Similarly, CARRA's Early Career Investigator Workgroup identifies the needs of this unique subgroup of researchers and provides support, peer mentoring, and advocacy. CARRA also offers grant mechanisms to not only fund mentored career development projects, but also travel grants for early career investigators to attend the VERITY/Brigham Course in Rheumatology Clinical Research, the annual European Paediatric Rheumatology Congress, and the Eureka International Summer Course on Translational Medicine in Utrecht, the Netherlands.

Pediatric rheumatology physician‐scientist pipeline: the global perspective

Maintaining a viable pipeline for physician‐scientists in pediatric rheumatology and a thriving independent research career is a shared global responsibility. Although there are national and regional peculiarities in undergraduate and postgraduate training, such as length of training, there are shared themes in the barriers and solutions to research success. ³⁰ , ³¹ , ³² The end goal of raising the next generation of successful scientists is the same, and the physician‐scientist has a role in driving initiatives that would sustain the research pipeline. ³⁰

The Eureka Institute for Translational Medicine was founded in 2008 by Drs Berent Prakken and Salvatore Albani, both pediatric rheumatologists. Based in Italy, this nonprofit supports a global network of universities and research organizations by offering virtual schools and international courses at the graduate and postgraduate levels for clinician‐scientists, inclusive of physician‐scientists and nonclinician‐scientists. ⁶ , ³³ , ³⁴ Specific to pediatric rheumatology, the Eureka Institute for Translational Medicine has had a long‐standing partnership with CARRA to support a one‐week summer experience in the Netherlands in translational medicine for trainees and early stage investigators. This model has provided longitudinal external mentorship within a scientific community for budding pediatric rheumatology physician‐scientists. ³⁵ In 2017, there was a meeting of The International Expert Group on the Clinician–Scientist Workforce comprising representatives from the Eureka Institute of Translational Medicine, Association of American Medical Colleges, Association of Faculties of Medicine of Canada, and Royal College of Physicians and Surgeons of Canada, as well as trainees and independent researchers. Their two‐day meeting aimed to identify the current institutional and societal gaps in supporting future physician‐scientists and other scientists and generate solutions for addressing those gaps. ³⁶ Three key proposed solutions came from this meeting: (1) appropriately articulate the value proposition of clinician‐scientists, inclusive of physician‐scientists. The value proposition of the clinician‐scientist has been hampered by lack of clear definitions and measurable metrics that capture the broad impact of the clinician‐scientist within the biomedical sciences and health care stratosphere. (2) Support professionalization and professional identity development of the clinician‐scientist. The rationale was the perception that most funding and promotion structures rewarded full‐time scientists and clinicians but did not adequately address those combining clinical practice and research. Finally, (3) continue integration of clinical and research training, as through MD‐PhD programs, and at the postgraduate and postdoctoral level. ³⁶

Similar to North America, the Emerging EULAR Network (EMEUNET), which is a network of young rheumatologists and researchers within EULAR, has initiatives to support emerging researchers in pediatric and adult rheumatology. ³⁷ EMEUNET conducted a survey in 2012 to understand the perceptions of the landscape of mentoring for rheumatology in Europe and the benefit of having a structured mentoring program within EULAR. Of the 248 responses from 30 European countries, 52% (n = 128) reported the existence of formal mentoring programs in their countries. Only 2 of 248 reported completing pediatric rheumatology specialty training. However, the majority of responses (82%; n = 181 of 221) agreed with the need for a formal mentoring program through EULAR.

Future perspectives on the pediatric rheumatology physician‐scientist pipeline

Physician‐scientists will continue to play a key role in future biomedical advancements in the field of pediatric rheumatology. Intentionally building a physician‐scientist workforce across the various research categories for pediatric rheumatology remains necessary to maintain this specialty at the cutting‐edge of discovery and innovative clinical care delivery. Sustaining a vibrant pediatric rheumatology physician‐scientist workforce must involve measures that (1) increase interest in pediatric rheumatology as a career for research as well as clinical care; (2) increase opportunities to engage in research at different career stages; (3) support resiliency in research; (4) decrease departures from the physician‐scientist pipeline; (5) promote and sustain effective mentorship systems; and (6) strengthen a diverse, comprehensive scientific community in terms of the focus of science (from bench to bedside), inclusive of those disadvantaged from accessing opportunities to pursue research careers (such as individuals underrepresented in medicine and trainees from academic institutions without established strong research training or infrastructure). ³⁸ , ³⁹ , ⁴⁰ , ⁴¹ , ⁴²

Preserving entry to the pediatric rheumatology physician‐scientist pipeline would require specific consideration when changes to medical school, residency, and fellowship curricular and competencies are being determined. ⁴³ , ⁴⁴ , ⁴⁵ , ⁴⁶ New changes in US pediatric residency program requirements by the Accreditation Council of Graduate Medical Education were proposed in 2025. ⁴⁷ These changes include an increase in individualized curriculum time, which could provide an opportunity for additional and earlier exposure to the pediatric rheumatology specialty. An increasing number of publications related to length of subspecialty fellowship training, inclusive of pediatric rheumatology, have emerged. Many note that excellent competency‐based clinical training can be achieved in less than the currently prescribed three‐year period, and distinct additional training pathways for fellows interested in a long‐term career as physician‐scientists could be considered. ⁴⁸ , ⁴⁹ , ⁵⁰ , ⁵¹ , ⁵² , ⁵³ Although flexibility in pediatric rheumatology fellowship training has several merits, the potential impact of curriculum adjustments on physician‐scientist training needs to be thoughtfully weighed to sustain interest in this career path and early exposure to research methodology and mentorship. Entrustable Professional Activities have previously been defined for translational scientists, which could be applied to pediatric rheumatology. ⁵⁴

Additionally, research training for the pediatric rheumatology physician‐scientist should include preparedness for diverse research career trajectories and effective mentorship. ⁵⁵ , ⁵⁶ , ⁵⁷ , ⁵⁸ , ⁵⁹ The NIH Biomedical Research Workforce Working Group was tasked with developing a model for sustainable and diverse biomedical research workforce. The 2012 executive summary from this group highlighted the limitation of graduate training programs in preparing graduates for diverse careers in research in various aspects (such as academia, pharmaceuticals, and research institutes), and although training should be improved by the programs, it should not add to the length of training. ⁶⁰

Supporting resiliency through mentorship is necessary for retention of the pediatric rheumatology physician‐scientist workforce. Dr Michelle Kahlenberg, a renowned rheumatology physician‐scientist, emphasized the benefit of longitudinal supportive mentorship and openness of mentors in her editorial, “Mentorship of physician scientists: a critical imperative,” discussing both successes and seeming failures in research with their mentees to support resiliency in research. ⁶¹ , ⁶² , ⁶³ , ⁶⁴ Dr Kahlenberg noted,

“Roughly 90% of grants are not funded. Acceptance rates at top‐tier journals vary but run at around 10%. Failure in academic medicine is the norm, not the exception.” (Dr Michelle Kahlenberg) ⁶¹

A perspective commentary from the Society for Pediatric Research also supports this stance, noting that effective mentorship is relevant in all stages of the research career, including early and midcareer. ²² Effective mentoring builds on a strong mentor‐mentee relationship, which is defined as a dynamic, reciprocal relationship in a work environment between an advanced career incumbent (the mentor) and a beginner (the mentee), aimed at promoting the development of both. ⁶² Undoubtedly, structured institutional mentoring programs tailored toward the physician‐scientist is beneficial for cultivating an effective mentoring atmosphere. In addition, given the success of the unique AMIGO model for fostering networking in the North American pediatric rheumatology community beyond practice location and academic institutional confines, harnessing this already existing model to specifically offer effective mentorship for physician‐scientists and track outcomes is feasible and will be of utmost value.

Conclusions

Since formalization of the field in North America 50 years ago, pediatric rheumatologists have continued to improve the care provided to children, adolescents, and young adults with rheumatic diseases, despite a small workforce that is in jeopardy of more significant future shortfalls. The role of the physician‐scientist is particularly at risk, yet it is crucial to advancing the understanding of the complex autoimmune and autoinflammatory conditions faced in the clinic and optimizing ways to treat and even cure these conditions. Thoughtful, intentional, multipronged global approaches are necessary to preserve and enhance the pediatric rheumatology physician‐scientist pipeline. This will be necessary to advance our understanding of complex and severe immunologic diseases, develop biotechnological interventions, and optimize clinical care that will improve outcomes for children, adolescents, and young adults with rheumatic diseases.

AUTHOR CONTRIBUTIONS

All authors contributed to at least one of the following manuscript preparation roles: conceptualization AND/OR methodology, software, investigation, formal analysis, data curation, visualization, and validation AND drafting or reviewing/editing the final draft. As corresponding author, Dr Ogbu confirms that all authors have provided the final approval of the version to be published and takes responsibility for the affirmations regarding article submission (eg, not under consideration by another journal), the integrity of the data presented, and the statements regarding compliance with institutional review board/Declaration of Helsinki requirements.

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