Among the discussions, she says, was a bill introduced this year in the House, the Safe Step Act (H.R.2279), which if passed would provide step therapy exemptions for qualifying patients.
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Explore This IssueNovember 2019
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“We are trying to put guardrails on step therapy so there are ways to get our patients the medications they need without have to fail multiple medications first,” Dr. Craig explains.
Boosting the Workforce
Advocates also discussed the factors that underlie workforce shortages in both pediatric and adult rheumatology. A recent analysis projected a deficit of more than 4,000 rheumatologists by 2030 in the U.S.1
For adult rheumatology, there are simply not enough slots to accommodate the number of interested trainees, Dr. Craig explained. On the pediatric side, about half of the available training slots go unfilled each year because of financial disincentives that keep providers from entering the field.
“We have nine states with zero pediatric rheumatologists and five states with just one; there are wide geographic areas lacking pediatric rheumatologists,” Dr. Craig says. “Doing general pediatrics sets you up better as far as lifetime earnings compared with pediatric rheumatologists, despite the extra training.”
Advocates discussed with legislators two current House bills aimed at incentivizing trainees to enter pediatric rheumatology. The EMPOWER Act (H.R.2781) would provide loan forgiveness for pediatric subspecialties in economically underserved areas. The Resident Education Deferred Interest (REDI) Act (H.R.1554) would defer student loan interest while physicians are in residency to reduce the financial barriers to entering subspecialty training.
“I am a pediatric rheumatology fellow, so I feel especially invested in recruiting people into my very small field,” says Dr. Ballenger.
As a rheumatology health professional, Philadelphia-based Donah Zach Crawford, MA, also feels particularly invested. She is also a rheumatology patient and regular participant in Advocates for Arthritis.
“There have been specific asks through the years, and I really do believe it makes a difference. When we do look back, we’ve had gains over the years,” she says.
“The ACR has really been able to log significant victories despite our small numbers,” says Dr. Worthing. “We led an effort that ultimately resulted in CMS proposing to boost rheumatology reimbursement by 15% instead of reducing it. … Another [win] was preventing MIPS cuts applied to Part B drug costs in clinics.”
Dr. Worthing encourages all rheumatology providers and patients to get involved in advocacy efforts, whether through national events, such as Advocates for Arthritis in D.C., at their local level or “in a minute or two through the ACR website for providers and the Simple Tasks website for patients and families.” The ACR also encourages all rheumatology fellows in the U.S. to participate in Advocacy 101.