Rheumatology’s Chronic Crisis

At the recent EULAR congress in Barcelona, I sat down with a group of American rheumatologists for a late afternoon drink. We gathered in the lounge on the executive floor of the headquarters’ hotel. The hotel was a sleek high rise, Euro-modern in design, and the lounge adjoined a balcony overlooking the Mediterranean Sea. The day was warm and the water sparkled as a strong wind lifted white caps and propelled sail boards over the water like large fins.

The lounge was the perfect place for laughter and idle banter. Given the locale, the buoyant spirit of a beautiful city, and the sun that beamed down gloriously, our conversation should have bubbled and brimmed with optimism and excitement. Instead, the group seemed down. To a person, the Americans sitting in the lounge were reflective and sober as they expressed concern, even anxiety, about the landscape of rheumatology and the prospects for the future.

When I sauntered from my room to the lounge, my intention was to relax after a busy day at the congress. OK, OK. I didn’t go to as many sessions as I could have, but I stayed in the convention center the whole day and talked science and did the requisite networking that is the job (and the fun) of being the Editor of The Rheumatologist (TR). I promise you. I recruited several great articles at the meeting. The articles will be coming soon (yes, my dear friends, the deadlines I gave you are real), and they will embody important research and innovations for practice. My day was busy even if low on CME credits.

Before sitting with my friends, I went to the bar and poured a glass of water called Vichy Catalan. Somehow, I could not believe that a product called Vichy water still existed, but it fizzed nicely and was very refreshing. At the table, my American colleagues, instead of engaging in the usual gossip of academic comings and goings, were deep into a discussion of what many think of the crisis in rheumatology.

Rheumatology’s Paradox

Crisis is not my favorite word for a situation that seems chronic. The term, however, gives weight and seriousness to any discussion and certainly focuses attention. This crisis, which has been the subject of many important ACR initiatives and has been discussed in TR, reflects the collision of two ominous trends: the gap in the workforce as the supply of rheumatologists fails to meet the demand, and the increasingly troubled state of academic rheumatology. According to predictions, in the coming years more people will leave the field than will enter it and training programs can’t keep pace.