“The ACR has done a good job of [getting] the word out [about rheumatology] to medical students and residents,” she says. “I think rheumatology faculty are becoming more engaged in exposing residents and trainees earlier in their career decision-making pathway. And people then see how happy we are in rheumatology. It’s becoming more enticing from that perspective, as well.”
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The advances in treatment options in the past decade are another factor. Young physicians see the growing treatment options, which include the addition of biosimilars. They read about scientific breakthroughs related to systemic lupus erythematosus (SLE) and other rheumatic diseases. They are witnessing, Dr. Dua says, that rheumatologists can now offer their patients more treatments and therapies than ever before.
“Because of the increased awareness about medications and research, there’s just so much growth and innovation going on in the field,” Dr. Dua says. “So I feel like there is more interest because people feel like there are tools to actually make a difference [for] these patients’ lives.”
According to Kamilah Greene, director of training and workforce for the ACR, increasing interest in rheumatology as a whole without an increase in available fellowship slots helps create a bottleneck. “It’s no longer a recruitment issue,” she says. “That has been the story … that’s what the data showed. But no longer is it a recruitment issue. Rheumatology is just as attractive and competitive as cardiology, gastroenterology. Those are some of the most competitive specialties to get into.”
But without enough fellowship slots, the workforce shortage won’t improve, Ms. Greene says. She suggests the fight for more spots is three pronged. First, the ACR has to continue to advocate at the federal level for increased funding for residency slots.
Second, the ACR will need to provide institutions with resources, such as positions papers, fellowship funding business models, slide decks and more. Those resources can effectively summarize the ACR’s workforce study shortage findings, delineate the value of rheumatologists and further explain business models to fund fellowship slots.
“These type of resources need to be made readily available for rheumatology academic program and division directors as presentation materials that can be utilized when arguing for fellowship funding,” Ms. Greene says.
Finally, the ACR will need to provide educational resources for academic divisions on how to obtain funding from private foundations, sectors and institutes that can pay for additional fellowship slots, Ms. Greene says.
One positive that Ms. Greene sees in the NRMP data is that nearly 80% of matched applicants in 2018 were from the U.S., a 4% increase from 2017. Overall in 2018, 135 of the 322 rheumatology applicants (41.9%) were from the U.S., up from 34.3% in 2017, according to NRMP.