Will there be enough rheumatology clinicians available to treat a growing patient population in the future? Not unless serious steps are taken now, according to the American College of Rheumatology’s 2015 Workforce Study of Rheumatology Specialists in the United States. The study’s complete findings will be presented at a panel discussion session at the 2016 ACR/ARHP Annual Meeting in Washington, D.C.
This is the first ACR workforce study conducted since 2005, and the findings reveal significant shortfalls that may only worsen in coming years due to retirements and more professionals working fewer hours.
“This study used an integrative, patient-centered approach to provide a realistic projection regarding the future workforce supply and access to care for patients,” says Seetha U. Monrad, MD, assistant professor of internal medicine at the University of Michigan and one of the study group’s two co-chairs.
The workforce study group measured current and projected future numbers of rheumatologists and pediatric rheumatologists, as well as rheumatology nurse practitioners (NPs) and physician assistants (PAs). They also measured clinical full-time employees (FTE) based on the amount of time these professionals actually spent in the clinic.
“While the supply and demand projections appear to be precise, the primary purpose of projections is not to set distant targets, but rather to identify what actions need to be taken in the near future to ensure movement toward achieving long-term objectives,” says study group co-chair Daniel Battafarano, DO, MACP, professor of medicine at the Uniformed Services University of the Health Sciences and chief of rheumatology service at the San Antonio Military Medical Center.
The study’s key findings include the following current primary rheumatology workforce figures:
- 5,595 board-certified rheumatologists in the U.S. (4,997 clinical FTEs);
- 300 board-certified pediatric rheumatologists (287 clinical FTEs);
- 248 adult rheumatology NPs (228 clinical FTEs);
- 207 adult rheumatology PAs (190 clinical FTEs);
- Total active primary providers to treat adult patients: 6,050 (5,415 clinical FTEs); and
- Total active primary providers to treat pediatric patients: 326 (311 clinical FTEs).
By 2030, the study projects 3,455 adult rheumatology clinicians will be available to treat adult patients, and there would be a clinical demand for 8,184; it further projects 230 rheumatologists will be available to care for pediatric patients, and the patient demand would require 461.
“These trends reflect higher-than-anticipated retirements, changing workforce demographics and estimating clinical FTE,” says Dr. Battafarano. By 2020, more than 50% of the adult rheumatologists will be women, he adds. Another challenge: About 50% of rheumatologists and 32% of pediatric rheumatologists practicing now are projected to retire by 2025.
One lesson from the workforce study is that time-consuming calls and paperwork, including prior authorizations and dealing with formulary restrictions, create hurdles that rheumatology clinicians must overcome daily. This cuts into their time to provide care and makes it harder to maximize staff resources.
Burdensome school debt may cause some medical students and residents to choose more lucrative specialties like orthopedic surgery or cardiology, says Dr. Battafarano. Health professionals could ease the burden, but “if you’re going to train a nurse practitioner or physician assistant in rheumatology, how will you do that effectively? The ARHP does have some online training modules, but we don’t have one formal training program in the U.S. now. Not one.”
Regional distribution of rheumatology care providers is also uneven. More than 20% of rheumatologists work in the Northeast, but the Southwest and Northwest each have less than 5%.
“There are regions of the country where patients have significant difficulty obtaining rheumatologic care. We will need to come up with innovative strategies to improve access to care,” says Dr. Monrad.
Recruiting future rheumatologists while still in medical school is a major, ongoing effort for the ACR, such as their Choose Rheumatology campaign, she notes.
“Addressing barriers to choosing rheumatology as a career, along with providing support to rheumatology professionals in both academic and non-academic settings, will enhance our ability to recruit and retain our future workforce,” says Dr. Monrad.
Data sources for the study included white papers, position papers, government and Institute of Medicine reports, and four online questionnaires sent to primary rheumatology providers, health professionals, fellows in training, adult patients and parents of pediatric patients.
Susan Bernstein is a freelance medical journalist based in Atlanta.