This shortage will be uneven, with rheumatology providers concentrated in urban and suburban areas, and rural areas underserved. The Central U.S., Southwest, Southeast and Northwest will, more broadly, face low provider density.
4 Facets
In the face of these challenges, the ACR has continued to advocate at the state and federal levels to help address the projected workforce shortfall.2 The workforce issue has four facets, says Angus Worthing, MD, FACR, FACP, chair of the ACR’s Government Affairs Committee and partner at Arthritis & Rheumatism Associates in Washington, D.C.:
- A lack of rheumatologists;
- Maldistribution of rheumatologists;
- More demand for adult rheumatology fellowship slots than are currently budgeted for and allotted in the U.S.; and
- Less demand for pediatric fellowship slots than are allotted.
The ACR is approaching these shortfalls in a number of ways, including a push to fund loan forgiveness programs for rheumatologists willing to practice in areas of need and endeavors to fund more training slots.
The Trouble with Training Slots
Earlier efforts, says Beth L. Jonas, MD, FACR, chair of the ACR’s Committee on Rheumatology Training & Workforce Issues (COTW), were successful in recruiting more trainees to adult rheumatology. For years, she says, the ACR and the Rheumatology Research Foundation actively worked to “increase the interest in a career in rheumatology among medical students and residents.” Those efforts were extremely fruitful.
Beth Jonas, MD, FACR, chair of the ACR’s Committee on Rheumatology Training & Workforce Issues.
“The interest in becoming a rheumatologist has been really high the last two to three years,” Dr. Jonas says. “But we don’t have enough fellowship training slots.”
Roughly 100 more physicians applied for slots than there were fellowships available in last year’s match.
“Most rheumatology training programs don’t have adequate funding to train rheumatology fellows, and that’s where the Foundation has helped bridge the gap,” says Dr. Jonas, chief of Rheumatology, Allergy and Immunology at the University of North Carolina School of Medicine, Chapel Hill. “It [partially] funds between 20 and 25 fellowship slots a year. The Arthritis Foundation has a new grant mechanism for programs that are able to increase their training slots, too.”
Dr. Worthing never wastes an opportunity to encourage ACR members and colleagues to donate to the Foundation to support such efforts. He is also heartened by some of the innovative ways program directors across the country are expanding their rheumatology training programs.
George Halko D.O. says
March 17, 2019 at 4:18 pmAs usual the only Organization that represents the working Rheumatologist completely misses the target. I do not know a single Physician in Private Practice regardless of Specialty who feels adequately/overcompensated. Everyone is looking over their shoulder wondering when the next cut in compensation is coming! What is our National Organization busy toiling over? How can we fill the Provider gap with less qualified extenders and people from other countries!! How about addressing the real issue?
Keri Losavio says
March 22, 2019 at 9:17 pmThe ACR Responds: Thank you for your response. Addressing the rheumatology workforce shortage is one of many high priority advocacy issues for the ACR.
On behalf of members, the ACR engages with CMS and Capitol Hill in outreach to secure more appropriate reimbursement, update service codes, and prevent or stop cuts in reimbursement.
You are correct that the value of expertise rheumatologists bring is still not adequately recognized in reimbursements. Among other issues, in the reimbursement realm the ACR is also focused on increasing Medicare payments for evaluation and management (E/M) services for rheumatologists, optimizing MIPS and the Quality Payment Program for rheumatology, and advancing the study of new service codes to reflect rheumatology care in reimbursement, among other priorities. We need the RBRVS to capture the true value of rheumatologists beyond the current E/M codes.
We led recent coalition efforts to stop significant cuts to E/M that were proposed just last year, and were part of coalition efforts to finally repeal the sustainable growth rate cuts to Medicare payments, among other examples.
The ACR is a leader of multiple coalitions focused on attaining better recognition and reimbursement for the expertise and value of rheumatologists and other cognitive specialists.
You can get involved by engaging your lawmakers through the ACR’s Legislative Action Center, attending Advocates for Arthritis on Capitol Hill in September (applications open in June), and reaching out to the ACR’s advocacy team to share concerns and otherwise get involved.