‘Stay popular, stay full’: ACR tackles workforce shortage through reimbursement, education

WASHINGTON — Increased reimbursement and expanded educational opportunities are two key solutions to the workforce shortage in adult and pediatric rheumatology, according to two speakers at ACR Convergence 2024.

Beth Jonas, MD, of the University of North Carolina at Chapel Hill, discussed issues and solutions for adult rheumatology shortages, while Colleen Correll, MD, MPH, of the University of Minnesota, addressed those same topics for pediatric rheumatology.

“From 2015 and projected to 2025, there is going to be a significant deficit in rheumatology care throughout the country,” Jonas told attendees, noting that the northwest, central and southwest regions of the United States face particular challenges.

Although a seemingly obvious solution would be to simply increase the number of fellowship-trained rheumatologists, Jonas suggested that this is easier said than done.

“We are not going to train our way out of this problem,” she said.

According to Jonas, particular focus has been placed on training advanced practice providers, such as physician assistants and nurse practitioners.

“We as a subspecialty are doing a better job of this, but there is still work to do,” she said.

In addition, the pandemic led to an increase in use of telehealth services, which Jonas suggested can help solve workforce issues by allowing patients to see providers at long distances.

However, Jonas argued that the American College of Rheumatology needs to think bigger, address issues of burnout, and look at the workforce shortage through a broader lens.

“The initial workforce study came out in 2016, but we realized we were just nibbling around the edges of this problem,” she said.

According to Jonas, the ACR workforce committee has recently taken a “deep dive” into solutions and come up with five domains for intervention.

One of these domains does, in fact, relate to training.

“We did a lot of work to build fellowships, open new fellowships, and support fellowships when feasible,” Jonas said.

The next domain deals with supporting providers throughout their career cycle to sustain the profession.

“Not only get people out there but keep them in the workforce,” Jonas said.

Another domain aims to remove administrative burdens and assist practices with payer issues.

“We wanted to address the financial health of our practices,” Jonas said.

The final domain is to expand ACR educational and research programs.

“We want to stay popular, we want to stay full, we want to keep that pipeline very strong,” Jonas said.

For Correll, it is important to note that the workforce issues plaguing pediatric rheumatology are different from those in adult practice.

“We have a major recruitment problem,” she said. “We are not doing a great job of filling our available slots.”

The current fill rate for pediatric rheumatology is 60% to 75%, according to Correll.

“We have a big room for improvement there,” she said.

Correll also referenced the 2016 workforce study, stating that “even in 2015” there was a gap between the supply of pediatric rheumatologists and patient demand.

“By 2030, that gap will widen even more,” she said. “Demand will be twice the supply by 2030.”

One key solution to this problem may be simply paying pediatric rheumatologists more money. According to Correll, other pediatric providers, as well as neonatal and perinatal caregivers, make significantly more than pediatric rheumatologists.

Moreover, the median salary for a pediatric rheumatologist is $181,000, compared with $281,000 for adult rheumatologists.

To that point, a major goal of the ACR’s pediatric workforce team is to increase Medicaid reimbursement.

“If you are a medical school student who is not sure whether you want to work with children or adults, you might see these numbers and choose adult rheumatology,” Correll said. “Or if you like pediatrics, why would choose to study rheumatology for 3 more years when you could make more money being a general pediatrician?”