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Shortage of rheumatologists, outpaced demand expected by 2030
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The need for rheumatologists will greatly exceed the specialty’s expected workforce growth during the next 15 years, suggesting that a significant rheumatologist shortage is looming, according to a pair of studies published in Arthritis Care and Research and Arthritis and Rheumatology.
“It is apparent that the workforce expansion innovations will require resources devoted to education and training, and it may be helpful to consider incentives to attract new entrants in the workforce to areas in greatest need of rheumatologists,” Daniel Battafarano, DO, MACP, of the San Antonio Military Medical Center, lead author of the Arthritis Care and Research study and coauthor of the Arthritis and Rheumatology article, said in a press release.
“Clearly other workforce expansion tactics such as care provided by nurse practitioners and physician assistants, telemedicine and ensuring that current rheumatology care providers remain in the workforce will be needed as we create a multi-faceted approach to addressing rheumatology workforce needs over the next decade,” he added.
In the Arthritis Care and Research study, entitled “2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce (2015-2030),” researchers used a model that included primary and secondary data sources to project the growth of the rheumatology workforce compared with the expected demand through 2030. Physicians, nurse practitioners and physician assistants were all counted as part of the specialty’s workforce.
According to the researchers, there were an estimated 6,013 health care providers working in rheumatology in 2015, or 5,415 clinical “full-time equivalent providers.”
“Estimating the clinical [full-time equivalent] of rheumatology providers is important to better reflect rheumatology providers working full-time seeing patients versus other rheumatology providers who may work as part-time clinicians in private practice or in an academic rheumatology teaching practice,” the press release said. “Clinical [full-time equivalent] describes the percentage of work effort devoted to clinical care to reflect a more realistic picture of patient access to care (eg, two providers each caring for patients 50% of the time would together equate to 1.0 total clinical [full-time equivalent]).”
By 2030, the researchers warned that the supply of clinical providers in rheumatology could shrink to 4,882, or 4,051 clinical full-time equivalent providers, meaning that demand could exceed supply by 4,133 clinical full-time equivalent providers.
Moreover, the current uneven distribution of rheumatologists is expected to worsen in the coming years. According to the researchers, 21% of adult rheumatologists in 2015 practiced in the northeast, compared with only 3.9% in the southwest. That same year, the ratio of rheumatology providers per 100,000 patients ranged from 3.07 in the northeast to 1.28 in the southwest. By 2025, those ratios are expected to decrease across all regions, ranging from 1.61 in the northeast to 0.5 in the northwest.
In the study published in Arthritis and Rheumatology, entitled “2015 Rheumatology Workforce Study: The Role of Graduate Medical Education in Adult Rheumatology,” researchers found that although there has been an increase in rheumatology fellowship programs, as well as in the number of fellows enrolled in such programs, it is not enough to meet projected workforce needs. According to the researchers, even if the number of fellows in training currently doubled, the workforce would still fail to meet patient demand by 2030.
According to the researchers’ models, which measured adult rheumatology training programs and graduates entering the workforce, there were 113 programs with 431 of 468 available positions filled in 2015. Additionally, the projected number of clinical full-time equivalent providers entering the workforce each year was 107. This figure is “impacted significantly by gender and generational trends, according to the press release.
“For example, men currently comprise 59% of the rheumatology workforce, but the proportion is expected to drop to 43% by 2030,” the release said. “Also, millennials comprise 6% of the current workforce, but by 2030 the percentage will rise to 44%. Prior studies have demonstrated that women work 7 fewer hours per week and see 30% fewer patients than men, and both male and female millennials in 2015 saw fewer patients compared with their counterparts in 2005.”
The researchers also found that 17% of current rheumatology fellows who are international graduates report that they plan to practice outside the United States.
“The supply of rheumatologists in the workforce is dependent upon the training of new rheumatologists to join our specialty,” Marcy Bolster, MD, of Massachusetts General Hospital, lead author of the Arthritis and Rheumatology study and coauthor of the Arthritis Care and Research article, said in the release. “It is imperative to create innovative ways to expand the rheumatology workforce, and this will involve new ways to fund graduate medical education training.” – by Jason Laday
Disclosure: Healio Rheumatology was unable to confirm the researchers’ relevant disclosures.
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Bolster MB, et al. Arthritis Rheumatol. 2018;doi:10.1002/art.40432.
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