A Workforce for the Future

A previous ACR president once stated that “a major issue facing our subspecialty [is] an accurate prediction of clinical and academic manpower requirements during the next decade and beyond.” He commented on the ACR’s “responsibility to manpower planning and attention to the needs of younger clinical rheumatologists,” and put this in context of the fact that “between 160 and 190 fellowship positions are being filled each year.”¹

These comments of Giles Bole, MD, seem as pertinent today as they were in 1981. In 2008, we confront the concurrent development of daunting challenges to both the clinical and academic environments in rheumatology. These circumstances have created new pressures and hurdles at each of the critical transition points in a career in rheumatology: recruitment into our specialty; launching of an academic or clinical career; and transition from the early career phase to long-term stability, productivity, and career satisfaction. In my final TR column as your ACR president, I’ll assess where we stand in developing rheumatology’s future workforce, describe what the ACR is doing to meet the challenges that confront us, and suggest additional steps that the ACR might consider.

Good News About Today’s Trainees

Compared with 10 years ago, important progress has been made. Almost all rheumatology fellowship positions that are offered are filled, versus one-third sitting empty. A rheumatology match has been successfully implemented, thanks to the efforts of Walter Barr, MD, Carlos Lozada, MD, and other current and former members of the ACR’s Committee on Training and Workforce Issues. For the 2009 match, 99 rheumatology fellowship programs participated, and fewer than 10 remained outside it. A total of 181 first-year positions were offered in the match, and 168, or 93%, were filled through the match, with an additional 10 filled soon thereafter. Including positions outside the match, the number of first year fellows in 2009 will be about 190. Currently, 2.9% of internal medicine residents go on to a rheumatology fellowship versus 1.9% at the beginning of this decade. For the past few years the applicant pool has numbered about 365, suggesting that if more positions were available, more could be filled. For 2009, 22 positions were offered in the pediatric rheumatology match; 17 (77%) were filled.

The ACR is playing a more active role in training rheumatology fellows through an updated curriculum, a standardized in-service exam, programs that offer every fellow the chance to attend at least one ACR meeting annually, new and expanded mechanisms for support of fellows’ salaries through the REF and, in 2008, the first ACR Rheumatology Research Workshop (RRW). The workshop, held in August, brought together one hundred rheumatology fellows, students, residents, and junior faculty, together with a smattering of experienced faculty, to present and discuss research, learn about the key steps in developing a career in research, and interact socially in a relaxed setting. Thanks to superb planning by the Committee on Research, led by Bill St.Clair, MD, and the meeting chairs Betty Diamond, MD, and Steve Goldring, MD, the RRW was a terrific success, and it will be held at least every two years going forward. The workshop is one way for the ACR to augment the mentoring of our fellows. Another approach worth considering would be establishment of a national Internet-based mentoring system that would link rheumatology faculty with specific areas of expertise and experience to trainees who can benefit from such interactions. The Fellows’ Subcommittee and the Committee on Training and Workforce Issues are already working on this concept.