Data Show Outreach Is Working, But Does Rheumatology Have Enough Positions Available?

The results of the 2018 National Resident Matching Program (NRMP) Specialties Matching Service are good for rheumatology, but complicated. The program, which matches the preferences of U.S. residency applicants with the preferences of residency program directors and conducts fellowship matches for subspecialties, including rheumatology, found the number of fellowship applicants who ranked rheumatology programs their first choice has risen from 244 in 2013 to 322 in 2018, a 32% increase. The data came from matches conducted in 2017 and early 2018 for fellowship appointments starting in July.¹

But on the other side, the number of fellowship positions offered in the rheumatology match has “increased modestly,” says Mona Signer, NRMP president and chief executive officer. One hundred and ninety-five positions were offered for the 2013 appointment year compared with 221 in 2018, a 13% increase.

“The popularity of core residencies and fellowships ebbs and flows over the years,” Ms. Signer says. “Rheumatology used to be less competitive. Certainly, [it’s] on the upswing now.”

As rheumatologists continue to find themselves worrying about workforce shortages, growing interest in the specialty is an important mile marker that awareness efforts are effectively drawing more physicians to the field, says Anisha Dua, MD, MPH, a member of ACR’s Committee on Rheumatology Training & Workforce Issues. However, the lack of available fellowship slots shows that the specialty needs to draw in more funding to create more slots or those awareness efforts may be for naught.

“It’s obviously a major frustration. It’s very exciting to have all this interest from people who really want to go into rheumatology,” says Dr. Dua, the rheumatology fellowship program director at the University of Chicago Medicine. “But with so much interest on one side, and then the shortages in terms of the workforce and meeting patients’ demands on the other side … the only way to fill that gap is … [to have] the spots and the resources available for people who are interested in and bring passion to the field.”

Dr. Dua says awareness efforts are paying off, as evidenced by the increased number of applicants ranking rheumatology as their first choice. Additionally, the number of rheumatology applicants who prefer the specialty has also risen, from 244 in 2013 to 313 in 2018, according to NRMP. That change shows that not only is interest in the specialty rising, but also the people who are interested in rheumatology aren’t looking at it as a backup specialty. Rather, they truly want to be in rheumatology, Dr. Dua adds.

“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.”

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.”

Beyond Recruitment
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.

“It’s nice to see that 80% of the applicants will remain in the U.S. to practice and treat patients,” she says. “That’s a positive sign.”

Dr. Dua says she is concerned that if enough rheumatology fellowships are not created over the coming years, then rheumatology will not keep pace with increasing excitement and demand, resulting in a reduction in the number of physicians who go into the field.

“If people feel like they can’t get training in the field they want to get into, it’s obviously a negative signal,” she adds. “I think it’s highly critical we get spaces for them.”

Richard Quinn is a freelance writer in New Jersey.

Reference

1. National Resident Matching Program. Results and data: Specialties matching service 2018 appointment year. 2018.