New data collected solely from pediatric and adult fellows in training shed light on new challenges facing the future of rheumatology in the U.S.
Rheumatology fellowships are attracting more international medical school graduates (53%), with 11% osteopathic and 36% from U.S. schools accredited by the Liaison Committee on Medical Education. Seventeen percent of international medical school graduates plan to work abroad, further contributing to the potential shortages of rheumatologists in the future. Of the fellows in training, 18.3% indicated they would work part time, and the great majority (90%) of those who gave that response were women.
By 2030, millennial women are projected to make up 59% of the rheumatology workforce. Why does this matter? Because women physicians tend to work seven fewer hours every week and on average treat 30% fewer patients than their male counterparts, according to the 2015 State Physician Workforce Data Book published by the Centers for Workforce Studies. Since 2005, there has been a 5% decrease in patient load per week for all millennial physicians. Physicians seeing fewer patients will have significant implications for the rheumatology workforce.
Based on these results, the ACR recognizes that the next decade holds some formidable challenges for rheumatology:
- Recruitment for the rheumatology workforce needs to be ramped up;
- The declining number of rheumatologists will make it challenging to provide adequate access to, and reduce barriers to, care for rheumatology patients; and
- The existing workforce will need greater support to meet patient needs.
The challenges in recruitment of clinical and academic rheumatologists include substantial student debt, unfilled fellowship positions and competing specialties.
Potential Solutions
The study also highlights opportunities to increase the number of future rheumatologists, such as by recruiting under-represented minorities; increasing rheumatology exposure in medical school and residency; offering incentives, such as loan repayment programs and innovative mechanisms for GME funding; and increasing the use of nurse practitioners and physician assistants in the management of common musculoskeletal conditions in clinical practice.
Now is the time to develop novel strategies, processes and a multidisciplinary approach to ensure timely access to care for our rheumatology patients.
Where We Go From Here
At the 2016 ACR/ARHP Annual Meeting in Washington, D.C., 11 workforce study-related abstracts (six posters, four oral and one plenary session) were presented. Daniel F. Battafarano, DO, MACP, FACR, San Antonio Military Medical Center, workforce study co-chair and speaker in the session, The Rheumatology Workforce: Present and Future, presented the findings of the current workforce from retirements to gender shifts, regional distributions, academic rheumatology, use of telehealth and musculoskeletal ultrasound and the impact of social media in practice. In the second half of the session, a panel of workforce experts in the areas of academic rheumatology, adult private practice, pediatrics, regional differences, role of mid-level provider and diversity delved into an open discussion in defining strategies to solve the issues raised by the workforce study.