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Rheumatology Field has Grown More Attractive Since 2014
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Despite a decrease in applicants from 2008 to 2013, the field of rheumatology has actually grown in popularity among medical students from 2014 to 2017, as evidenced by a 44% increase in fellowship applications, according to findings published in Arthritis Care & Research.
“The 2015 ACR/ARHP (Association of Rheumatology Health Professionals) Workforce Study, based on 2005 to 2013 data, projected a notable discrepancy between expected supply and demand of rheumatologists into the future — a shortfall of 2,329 in 2020, 3,845 in 2025, and 4,729 in 2030,” Huynh W. Tran, MD, of the University of Southern California Keck School of Medicine, and colleagues wrote. “Recent fellowship ‘Match’ data however suggested that interest in rheumatology may have changed.”
To determine the current attractiveness of rheumatology among medical students, compared with other subspecialties, Tran and colleagues conducted a retrospective study using data from the National Resident Matching Program. Focusing on the period from 2008 to 2017, they analyzed annual numbers of applicants to fellowships, the number of fellowship positions, applicant-to-fellowship position ratios, percentage of offered positions filled, percentage of applicants matched and percentage of U.S. medical graduates in fellowships in rheumatology, compared with other internal medicine subspecialties. The other subspecialties included cardiology, pulmonology/critical care, gastroenterology, hematology/oncology, infectious disease, endocrinology and nephrology.
In addition, the researchers used Medscape physician salaries from 2010 to 2017 to determine salary trends in rheumatology and other subspecialties. They then compared data from the 2008 to 2013 period to that of 2014 to 2017.
According to the researchers, the total number of rheumatology applicants fell from 251 to 244, representing a decrease of 3%, from 2008 to 2013. That figure later recovered, however, from 2014 to 2017, when annual applications increased from 230 to 332 — an uptick of 44%, the researchers wrote. In addition, other studied subspecialties did not demonstrate similar increases in applications. Both the ratio of annual applicants to positions in rheumatology, and the percentage of U.S. medical graduates applying to rheumatology, exhibited statistically significant increases. Mean post-fellowship salaries in rheumatology also increased, according to the researchers.
“Rheumatology now seems to be a more competitive field,” Tran told Healio Rheumatology. “While we didn’t directly examine the reasons for this, we speculate that perhaps it is because it offers an attractive balance of intellectual challenge, service, compensation and lifestyle. It is possible that that more rheumatologists than anticipated will be available to care for patients with rheumatologic and musculoskeletal conditions in the coming years. This will be salutary for our specialty, for our patients and for society” – by Jason Laday
Disclosure: Tran reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Amiel Y. Tokayer, MD, FACR
The sales pitch for rheumatology has not really changed in 20 years. When asked why they chose their specialty, most rheumatologists will spit out the same bullet points as suggested in this article: scientific advancements, problem solving, rewarding, long-term relationships with patients, minor procedures and lifestyle.
Likewise, the reasons for not choosing rheumatology have not changed: The average rheumatology post-fellowship annual salary — even after the increase — remains on the low end and the conditions we treat are still incurable, despite advancements in treatment options. What then was the reason behind the dramatic spike in applicants for rheumatology in 2014-2017? Is happiness enough of an attraction?
To better understand the specialty fellowship match trends requires a better understanding of the applicant’s psyche and demographics. The 2014-2017 applicants were of the millennial generation, who tend to value work-life balance and job flexibility over higher-earning and more-demanding jobs. 2017 was a milestone year with more women than men entering medical school; combined with the rise of dual-income households who hold a strong desire for job flexibility, and the looming shortage of rheumatologists, the rheumatology specialty appears more attractive.
Ultimately, understanding the applicant’s priorities and interests can be accomplished with a simple survey of first-year fellows. In the meantime, it is certainly comforting to know that rheumatology fellowship slots are continuing to be filled, which further highlights the need for more fellowship positions to meet the growing rheumatologist demand nationwide.
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