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Onsite With Loyola Medicine: Chicagoland Rheumatologists Work to Close the Rural Health Care Gap
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Ostrowski
MAYWOOD, Ill. — They come from 2, sometimes 3 hours away, from suburban and rural areas of Illinois and Wisconsin, often after waiting months for their appointment. They come because this suburban, academic medical center is their best, closest option. They come, because they couldn’t find the rheumatology care they needed closer to home.
Located about 12 miles west of downtown Chicago, Loyola University Medical Center is the western-most academic health center in the Chicagoland area. As such, the institution serves many suburban and rural patients who sometimes travel several hours each way to see a rheumatologist. Often, they have severe or atypical forms of their disease, and require care that is unavailable in their town or state.
“We have considerable experience seeing patients who have a wide variety of diseases and conditions, even just in the realm of rheumatology,” Rochella Ostrowski, MD, rheumatologist and associate professor of medicine at Loyola University Medical Center, told Healio Rheumatology. “Many of them have advanced or severe diseases, because we are in a place where we have many of those needs in the population. We are also in an area where we are the most western location for an academic center — there are other academic centers here, too, but they are in the city — so we get many patients from the suburbs as well.”
The medical center employs six rheumatologists, with officials hoping to hire two more in the next year. There are also two physicians in the rheumatology fellowship program. Altogether, these rheumatologists and fellows serve about 190 patients every week. Ostrowski herself sees about 45 per week, she noted, in addition to those she cares for during her part-time shifts at the local VA medical center.
According to Ostrowski, maintaining the pipeline of new rheumatologists, through fellowship and other training programs, is key to preventing even further geographical gaps in coverage for patients in underserved rural and suburban areas.
“I heard a statistic that rheumatologists make up 0.5% of all doctors, and I suspect that number is definitely not meeting the needs that we have,” said Ostrowski, who also directs the rheumatology fellowship program at Loyola Medicine. “I have patients who are coming to see me from Ottawa, Canada. They are coming in from Wisconsin, because they either don’t have local rheumatologists or any rheumatologists nearby who will take their insurance. There is supposedly a projection of a shortage of rheumatologists, even in the next 1 or 2 decades, which is why I think it is important to invest in programs like this.”
“Seeing patients from that far away is not common, but when I see it, I’m not surprised,” she added. “I had a patient a couple of weeks ago who drove three hours to see me — she simply didn’t have anyone nearby who was able to see her.”
According to Melissa Briones, MD, rheumatologist and associate residency program director, clerkship director and director for subinternships for internal medicine at Loyola Medicine, the rheumatology shortage is clearly manifested in their often crowded clinics, and in the wait times experienced by patients.
“Our goal is always to get patients in our clinics in a really timely manner, but we find ourselves having these extremely long wait times — patients will sometimes say they have waited months to see me,” Briones said. “That is reflective of there just not being that many rheumatologists compared to the number of referrals coming in, and the number of patients who want to be seen. Plus, there are the patients we are trying to get back in for a follow-up. It just creates a really crowded clinic situation.”
“There are not many rheumatologists outside the city centers, and there is a huge need in rheumatology, so patients are traveling quite a long distance to see us because of that,” she added. “I think geographically, it makes more sense for people in rural areas to come here rather than travel all the way into the city center. We have a fair number of patients from small, rural towns where they would not even have a private practice rheumatologist out that way.”
Briones said she believes that even with aggressive outreach promoting training and fellowship programs, the need for rheumatology care will most likely still outpace the supply, at least in terms of the number of rheumatologists. However, she stressed the critical importance of continuing to train clinically competent rheumatologists.
“I think there has been some concern over the past couple of years about the number of high-quality applicants for rheumatology fellows,” she said. “Medical student debt is a huge issue right now. Medical students are coming out of school with significant debt, and they are looking to go into fields with high-level reimbursement. Rheumatology probably isn’t the most well-compensated field in medicine, so I think we struggle a bit in that aspect when recruiting.
“That said, I will say that this is such a great job,” Briones added. “It is a wonderful field of medicine. However, I don’t think the trainees get much exposure in their early years, so some of them don’t even know how much they would like rheumatology if they were given the opportunity.” – by Jason Laday
