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VBCR - December 2016, Vol 5, No 6 - Rheumatology Update
Alice Goodman

Washington, DC—What does the future of rheumatology specialists look like in the United States? By 2030, there will be an approximately 140% projected increase in demand coupled with a 31% decrease in adult rheumatologists, according to the American College of Rheumatology (ACR)’s 2015 Workforce Study. The last ACR Workforce Study was conducted in 2005.

The aging of the population together with an increase in rheumatologic diseases, a shortage in the supply of rheumatologists, and more rheumatologists expected to go into part-time practice are some of the factors conspiring to create a perfect storm in 2030, when demand will outpace supply by far.

“This is drastic. We have to be very innovative,” said Marcy B. Bolster, MD, Rheumatologist, Massachusetts General Hospital, Boston, who presented the new ACR Workforce Study findings at the 2016 Annual Meeting of the ACR. Dr Bolster suggested innovative approaches for attracting physicians to rheumatology over the next 2 decades.

Alleviating the Workforce Gap

The current supply of adult rheumatologists is an estimated 4997 full-time equivalents. By 2030, a projected 8184 full-time equivalents will be needed, but the supply will fall by 31% to 3455. The current demand for rheumatologists is 515 full-time equivalents, 36% more than the current supply. By 2030, the demand will be for 4729 full-time equivalents, which is a whopping 138% more than the projected supply.

Currently, 113 adult rheumatology fellowship training programs offer 41 available slots. These fellowships are for 2 to 3 years, and if all positions are filled, an expected 215 fellows will graduate each year. Even if the fill rate per year was 100% and there was no reduction in the number of fellow positions available, the average number of clinical full-time equivalents for adult fellows projected to enter the rheumatology workforce each year is 107.

“We need to double the fellowship training programs in rheumatology, and I’m not even sure that will address the gap,” Dr Bolster said.

Of all internal medicine residents entering subspecialties, 4% chose rheumatology from 2014 to 2015, compared with 4.4% in 2005. Approximately 40 to 45 states in the United States have 1 to 2 fellowship training programs, with the larger states offering more (eg, New York, 13; California, 11; Pennsylvania, 9; Massachusetts, Florida, and Illinois, 6 each; Texas, 5; and Louisiana, 3). Approximately 20% of those fellows will enter academic practices.

The sex of practicing rheumatologists is changing. Currently, 59% are men and 41% are women, for a total of 4997 rheumatologists in the United States. By 2030, the projected percentages are expected to be 43% men and 57% women, for a total of 3455.

Other reasons for the gap in supply and demand include a projected 18% of women opting for part-time work, and approximately 20% of international medical graduates training in the United States but planning to practice abroad.

The current rheumatology workforce is also aging. The recent Workforce Study found that approximately 50% of currently practicing rheumatologists plan to retire by 2030, and 80% of those who plan to retire will reduce their patient load by more than 25% over the next few years.

In 2030, the projected deficit in adult rheumatologists is 30.9%, but there is a projected increase in nurse practition­ers (33.3%) and physician assistants (29.0%) treating rheumatologic diseases, leaving a projected deficit of 27.1% for adult rheumatologists, according to the 2015 Workforce Study.

“[This] will have a significant impact on available care for patients with rheumatic diseases,” Dr Bolster stated in an official ACR news release. This shortage could be particularly acute in regions of the country with few fellowship programs, such as the Pacific Northwest and upper Midwest.

Proposed Solutions

What is there to be done about the projected shortage?

“Attract more trainees to rheumatology by providing mentoring opportunities and supporting clinical educators, and create additional fellowship positions,” Dr Bolster suggested.

Approaches to increasing efficiency of clinical practices include recruitment of more nurse practitioners and physician assistants, redesigning practices, having primary care physicians treat some patients with rheumatologic diseases, and implementing more advanced technology.

Access to rheumatology care can be improved by telehealth, increasing recruiting efforts, and improving the geographic distribution of rheumatologists.

Innovative approaches include incentives such as loan repayments, and attracting international medical graduates to remain in the United States. New funding mechanisms are needed for many of these efforts.

It should be noted that shortages are not just projected for rheumatology, but for all physicians. One survey estimated that there will be a shortfall of 85,000 general physicians in the United States in 2020.

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