U.S. demand for rheumatologists will greatly surpass the projected growth of the rheumatology workforce over the next 12 years, two studies show.
Overall, the studies point to an increasingly aging population and the retirement of older rheumatologists as two reasons why the growing number of rheumatology fellows being trained won’t be enough to meet demand.
The first study, “2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce (2015-2030),” appeared in the journal Arthritis Care & Research. The second, “2015 Rheumatology Workforce Study: The Role of Graduate Medical Education in Adult Rheumatology,” appeared in Arthritis & Rheumatology.
The first used a modeling approach to project supply and demand of the rheumatology workforce, including physicians, nurse practitioners and physician assistants. The 2015 workforce was estimated at 6,013 providers, with 5,415 clinical full-time equivalent providers. These numbers will likely fall to 4,882 providers or 4,051 clinical full-time equivalent in 2030. Although demand already exceeded supply in 2015 by 700, this problem will get worse; by 2030, demand should exceed supply by 4,133 clinical full-time equivalent providers.
This is happening partly because many baby-boomer rheumatologists are retiring. There’s also been an increase in female and part-time providers — including those doing private practice, or in an academic rheumatology teaching — and growing demand for adult rheumatology due to the aging U.S. population.
“Even though women constitute a growing proportion of the physician workforce, the American Medical Association reported female physicians worked seven fewer hours per week than male physicians, and treated approximately 30 percent fewer patients than did their male counterparts per year,” said researchers.
The study also highlights an unequal distribution of adult rheumatologists, with 3.07 rheumatologists per 100,000 patients in the Northeast, and only 1.28 per 100,000 in the Southwest. These figures are projected to fall to 1.61 and 0.50 by 2025.
“Decreasing insurance barriers and healthcare regulations may allow more rapid, timely, and creative solutions to offset the projected rheumatologist shortage and the maldistribution of rheumatologists in the U.S.,” Dr. Seetha Monrad of the University of Michigan, and the study’s senior author, said in a press release. “Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients.”
In the second study, researchers applied similar modeling methods, predicting an increase in the number of rheumatology programs, as well as the number of fellows being trained. They identified 113 adult rheumatology programs in 2015, with 431 of 468 available positions filled. This corresponded to 107 full-time equivalent providers entering the workforce each year.
Male rheumatologists are likely to account for only 43 percent of the total by 2030, down from 59 percent in 2015. In addition, millennials will comprise 44 percent of the workforce by 2030, up from 6 percent in 2015. Importantly, millennials saw fewer patients in 2015 than did their counterparts in 2005.
In addition, 17 percent of foreign medical graduates indicated their plan to practice outside the United States, leading researchers to warn that “the current U.S. adult rheumatology workforce is in jeopardy of accelerated decline at a time when demands on the workforce face tremendous growth.”
“It is imperative to create innovative ways to expand the rheumatology workforce, and this will involve new ways to fund graduate medical education training,” said Dr. Marcy Bolster of Massachusetts General Hospital and lead author of the Arthritis & Rheumatology study.
“Workforce expansion innovations will require resources devoted to education and training, and it may be helpful to consider incentives to attract new entrants in the workforce to areas in greatest need of rheumatologists,” added the study’s senior author, Dr. Daniel Battafarano of the San Antonio Military Medical Center in Texas.
Addressing workforce needs will require additional approaches such as telemedicine, having nurse practitioners and physician assistants provide care, and creating policies to keep current rheumatology providers in the workforce, Battafarano said.
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