WASHINGTON -- A shortage of rheumatologists in the U.S. is likely to get worse between now and 2030, according to results from a workforce study presented here.
Led by a work group of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals, the study -- the first one done in a decade -- found that the supply of the rheumatology labor force will decline sharply over the next 15 years, from 4,497 full-time equivalent FTE to 3,455, pushing excess demand to more than double supply at 138%, or a gap of 4,729, by 2030.
Action Points
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"This is drastic," said presenter Marcy Bolster, MD, of Massachusetts General Hospital in Boston, at the ACR annual meeting.
"We have to be very innovative," she said, calling for innovative approaches in graduate medical education (GME) and funding strategies to address this expected gap.
GME feeds the supply, Bolster noted, and the study found that if all positions at rheumatology programs fill every year, the average number of clinical FTE adult fellows projected to enter the workforce yearly is 107 -- about half the 215 rheumatologists expected to finish training. That figure is based on the projected number of female Millennials who plan to work part-time (63% of new graduates are projected to be female), and international medical graduates who plan to practice outside the U.S.
The 113 adult rheumatology fellowship training programs currently offer 431 positions combined, according to the study. "We need to double the positions in rheumatology," Bolster told MedPage Today, "and I'm not even sure that will (fully) address the gap."
That's partly because about 50% of the rheumatology workforce is projected to retire over the next 15 years, and more than 80% of those who say they will retire plan to reduce their patient load by more than 25% in the near term.
The projected shortage exceeds the deficit projected in the 2005 study and, with an aging U.S. population increasing the need for rheumatology care, Bolster expects "a significant impact on available care for patients with rheumatic diseases," she said in a news release. The problem could be especially acute in the Pacific Northwest and upper Midwest, because of the regions' limited fellowship programs. Fellows tend to stay nearby when they finish, Bolster pointed out.
As for proposed solutions, "while it remains critical to recruit medical students and residents to pursue training in rheumatology, this will not provide ample numbers of rheumatologists to meet the deficit in supply," Bolster's group wrote. The work group outlined a few other potential solutions, in addition to recruiting:
- Create financial incentives for students to pursue training, such as loan repayment and innovative funding for graduate programs
- Ask primary care physicians to take an expanded role in treating certain diseases
- Create additional fellowship positions and enhance mentoring of young physicians
- Incorporate nurse practitioners and physicians assistants into clinical practice more
Even if physicians are able to maximize the latter, Bolster said, the FTE demand will still far exceed labor supply. Addressing the shortage will require a "multi-focal" approach, she said, "and it's not just rheumatology." Indeed, the latest Association of American Medical Colleges report predicts widespread physician shortages.
The work group collected practitioner demographics, work settings, full/part-time status, retirement planning, and numbers of fellows in training (FIT) via ACR member data, state licensure registries, and American Board of Internal Medicine certificates. They also used data medical educational associations, the National Resident Matching Program data, and an online survey of ACR members.
They crafted projections based on the current workforce, fellowship graduation rates, succession planning, workload, practice settings, and generational changes. Factors used in demand projections included patient demographics, healthcare usage, practice trends, disease prevalence, U.S. population growth, and per capita income. They assumed one clinical practice FTE to be 1.0 for private practitioners and 0.5 for academic practitioners.
Limitations for the study included data from different practice settings, a survey focused on ACR membership and more surveys completed by academic rheumatologists. The survey also could not reflect changes across time.
Disclosures
Bolster disclosed relevant relationships with Johnson & Johnson, Eli Lilly, and Amgen. One co-author disclosed a relevant relationship with ABIM.
Primary Source
American College of Rheumatology
Source Reference: Bolster M, et al "2015 ACR/ARHP workforce sStudy in the U.S.: The role of graduate medical education (GME) in adult rheumatology" ACR 2016; Abstract 1960.