With a shortage of rheumatologists in the U.S. already a problem and projected to get far worse, the ACR is advocating for the passage of a variety of laws that would help narrow the gap.
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Explore This IssueAugust 2017
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Legislation being fought for by ACR advocacy leaders involves streamlining visa processing for foreign physicians and promoting incentives for physicians to work in rural and underserved areas (H.R. 2141/S. 898); easing restrictions on medical education and training slots that limit the ability to train new rheumatologists (H.R. 2267); and making pediatric subspecialists, such as pediatric rheumatologists, eligible for scholarships and loan repayments to healthcare providers in exchange for working in regions that are underserved (S. 989).
The ACR is also asking Congress to maintain the viability of programs that help new rheumatologists repay loans and reduce total loan payments, and to reinstate the expedited review process for foreign physicians under the H-1B visa program, says Lennie Shewmaker, senior manager of federal affairs for ACR.
An Urgent Yet Predictable Situation
The ACR’s 2015 Rheumatology Workforce Study Report predicted a deficit of 4,700 full-time equivalent rheumatologists specializing in adult care in the U.S. by 2030, because of a sharp increase in demand along with a sharp decline in supply. Four states already have fewer than 15 rheumatologists who specialize in adult care in their state, and two states have no rheumatologists who specialize in pediatrics, according to the report.
Ms. Shewmaker says the renewed discussion of healthcare reform in Congress has brought a new urgency to the issue.
“It’s something that we see as going hand in hand with the healthcare reform conversation,” she says. “The biggest fear is that although everybody’s celebrating the fact that everybody has access to great and affordable coverage, they don’t have access to the actual care they need.”
Pushing the Hill to Sign Bills
The ACR makes two trips to Washington, D.C., each year: once in May with ACR leadership and another trip in September that includes patients. Ms. Shewmaker says the workforce shortage issue figured prominently during these visits. In May, the ACR participated in more than 100 meetings on Capitol Hill, and “every single one of them included this issue and the fact that the workforce issue is just going to become bigger and worse,” she says.
Rheumatologists can help by emailing Congress, which is made easy with the resources that can be found in the ACR’s Legislative Action Center.
Any measure that would allow more foreign-trained physicians into the U.S. to practice would likely have the biggest impact, Ms. Shewmaker says. But she acknowledges that legislation is a slow-moving pursuit. “I’m not hearing a lot of traction on any of these bills, but that’s also because the conversation is being dominated by other things,” she says.
Shortage = Dire Patient Consequences
Sarah Doaty, MD, a rheumatologist in Alaska and a former member of the ACR’s Government Affairs Committee, says she is confident the ACR is doing all it can to find solutions. The shortage can have devastating consequences for patients.
“Part of the challenge in treating patients where there is a shortage of providers is that patients are often presenting with more advanced disease, and it’s hard to get patients to achieve remission,” says Dr. Doaty, who has a patient who lives about two hours away—by plane—because there is no closer rheumatologist.
She says patients are often taking only anti-inflammatory drugs for years, because the primary care physicians managing their conditions are uncomfortable prescribing disease-modifying drugs.
“There’s just no way,” she says, that “[primary care physicians] can keep up with all the classification criteria and the guidelines.”
Thomas R. Collins is a freelance writer living in South Florida.