Avert Rheum’s Coming Crisis

Last month’s column promised you a solution to rheumatology’s dual problem of a shrinking workforce and rapidly expanding patient population. Without further ado, here is the solution for rheumatology’s crisis that my colleagues and I devised at the EULAR congress in Barcelona: The members of the ACR, through the Research and Education Foundation, should cooperate with stakeholders – patients, patient organizations, foundations, industry, civic groups, medical schools, hospitals, and government – to raise money so that every academic rheumatology division in the country has an endowment to support its mission.

What is the mission and why is it important? At its core, this mission is to train the next generation of rheumatologists to provide outstanding care to patients and to continue the momentum in treatment advances that our specialty currently enjoys.

This initiative differs fundamentally from other funding mechanisms that focus on raising money for research. Research funding is often a proxy for academic activities and serves as a channel for support of rheumatology divisions. In this model, efforts to bolster the academic units are predicated on grant programs that target rheumatic disease. While grant programs have enormous importance, they do not address the need for the infrastructure for training programs or the presence of clinician-educators to lead, mentor, and inspire trainees. Alas, research programs can involve cost shifting, with funds designated for clinical or laboratory investigation subsidizing the time for teaching.

I can easily argue that, at present, there is no shortage of funding for research in rheumatology and there is likely no shortage of investigators. The issue is distribution. While the ranks of rheumatologists in academic centers may be thin, those in industry are booming. The companies are the source of terrific research and are filling the pipeline with myriad new products, some of which will no doubt be very successful.

Pharmaceutical companies employ large numbers of basic and clinical investigators in rheumatology. Indeed, there has been a remarkable flux of academic rheumatologists to the companies, a trend discussed by ACR past president Peggy Crow in her presidential address. These individuals contribute enormously to the field but their mission is distinct. They do not train rheumatologists for the future.

The other difficulty in trying to help academic centers through research programs is that disease-related research is not the sole province of rheumatologists – nor should it be. Research grants should be awarded to the people with the best ideas, whatever their discipline or academic affiliation. There are many PhD scientists who are outstanding rheumatology investigators and there is every reason to support their research as well as that conducted by physicians.