Rheumatology’s Supply Side
The most important factor affecting the supply of rheumatologists in practice today and in the future is the number completing fellowships each year. The workforce study therefore examined data from adult and pediatric rheumatology fellowships for the past 10 years. Both the number of positions and the number of applicants have increased during this period, and rheumatology has a high rate of fellowship completion overall. There are still a number of existing fellowship positions not filled each year, however, and the overall number of fellows completing programs needs to be even higher to meet the predicted demand.
In the official ACR response to the Workforce Study, Neal S. Birnbaum, MD, president of the ACR said, “The expansion of current training capacity in rheumatology would require not only an increase in salary support for fellows but also meaningful growth in training resources including academic faculty, dedicated space for academic endeavors, and increased clinical opportunities.” In addition, “the Accreditation Council for Graduate Medical Education [ACGME] has created rigorous program requirements that help ensure the quality of training programs to overcome at start-up,” he notes. “In the face of all of these substantial challenges it seems unlikely that we will see any significant growth of rheumatologists entering the workforce anytime soon.”
The specialty has made good use of available training positions. “Our ability to recruit rheumatologists is better than it was 10 years ago and the number of applicants has gone up significantly,” says Walter G. Barr, MD, immediate past chair of the ACR Committee on Training and Workforce Issues, which spearheaded the workforce study advisory group. “There has been a major increase in the quality of those applying.” Dr. Barr contends that managed care’s gatekeeper model was in large part the cause of a move away from rheumatology and other specialties in the last decade. “Students were told by their deans until the late 1990s that managed care would limit their salary abilities,” he says, but the influence of managed care is waning.
Money is certainly an issue for upcoming medical students who have a large debt to repay after graduation, says Christy Park, MD, a young rheumatologist at Northwestern University in Chicago, and a member of the ACR’s young investigators subcommittee. It is also clear, she says, that there are limitations to the expansion of fellowship programs and that one in particular is the challenge of maintaining research funding to establish or support an academic research career. But Dr. Park and other young investigators see a brighter picture for their profession, if not five years out, then seven to 10 years from now.
