The number of new entrants into the adult rheumatology workforce, 107 a year, are not entering at numbers sufficient to replace those who are retiring.
The rheumatology field has cause for concern, as attrition and decreased productivity is resulting in fewer trained clinicians to treat the anticipated future demand. The number of new entrants into the adult rheumatology workforce, 107 a year, are not entering at numbers sufficient to replace those who are retiring, estimated to range from 230 in 2016 to a high of 247 in 2021, with numbers mostly in the low 200 range through 2025. Pediatric rheumatology numbers suffer as well.
The study’s lead author for the adult rheumatology article, Marcy Bolster of Massachusetts General Hospital, presented her results at the American College of Rheumatology annual meeting held in Washington, D.C. on Nov. 14. The other studies relating to the maldistribution of adult rheumatologists, and the need for more in the pediatric rheumatology workforce, were presented by Katrina Lawrence-Wolff and Daniel Battafarano respectively, on Nov. 13.
The 2015 ACR/ARHP Workforce Study projects the rheumatology care supply and demand from 2015-2030. They used data from ACR membership and surveys, AAMC, ACME and ABIM certificates, state licensure data, in addition to National Resident Matching Programs data.
Projections were made for the future numbers of working adult rheumatologists, as well as anticipated demand. They found that the current number of adult rheumatologists will fall by 31% by 2030. While current demand for adult rheumatologists is 36% higher than supply, that will rise to 138% by 2030. Currently there are 431 open rheumatology residency positions to fill each year, and 215 graduating fellows annually. However, the authors note that only half of them, 107, are projected to actually enter the workforce full time. Instead, some female rheumatologists will work part time, and close to 20% of international medical graduates will leave the U.S. to practice. Add retirement into the mix, with half the rheumatologists expected to retire in the next 15 years, and most of them planning to decrease their workload before that.
The study estimated that there are 300 pediatric rheumatologists, though only 287 considered full time equivalents. They are not spread evenly throughout the country, with some states having one to three pediatric rheumatologists covering their state, and two states with no board-certified, practicing pediatric rheumatologists at all. The study showed a 20% lower supply than currently needed, along with an estimated demand of an additional 100% by 2030. That means anticipating that 231 pediatric rheumatologists will be working in 2030, but a need for 461 total.
The distribution problem isn’t just with pediatric rheumatologists, though. The study found disparities because of regional population growth estimates and anticipated retirements. They estimate an increase of future demand for adult rheumatologists in the South Central, North Central and Northwest areas of the U.S.
What’s the solution? The authors suggest several, including financial incentives for those in rheumatology training, like loan repayment and GME funding initiatives. They also recommend supplementing the types of clinical care givers, like increasing the use of nurse practitioners and physician assistants. The last recommendation is for new solutions to caregiving, which might involve a multidisciplinary approach to care and access.
Dr. Bolster has ties with Johnson and Johnson and Eli Lilly. Dr. Battafarano and his co-authors have no disclosures. Dr. Lawrence-Wolff and her co-authors have no disclosures.
Marcy Bolster. "2015 ACR/ARHP Workforce Study in the U.S.: The Role of Graduate Medical Education (GME) in Adult Rheumatology," Abstract number 1960. 12:15 p.m., Nov. 14, 2016. ACR/ARHP 2016 Annual Meeting. http://acrabstracts.org/abstract/2015-acrarhp-workforce-study-in-the-u-s-the-role-of-graduate-medical-education-gme-in-adult-rheumatology/
Daniel Battafarano. "2015 ACR/ARHP Workforce Study in the United States: Pediatric Rheumatologist Supply and Demand Projections for 2015-2030," Abstract number 927. 2:30 p.m., Nov. 13, 2016. http://acrabstracts.org/abstract/2015-acrarhp-workforce-study-in-the-united-states-pediatric-rheumatologist-supply-and-demand-projections-for-2015-2030/
Katrina Lawrence-Wolff. “2015 ACR/ARHP Workforce Study in the United States: A Maldistribution of Adult Rheumatologists,” Abstract number 928. 2:45 p.m., Nov. 13, 2016. http://acrabstracts.org/abstract/2015-acrarhp-workforce-study-in-the-united-states-a-maldistribution-of-adult-rheumatologists/