The U.S. rheumatology workforce is in jeopardy of a serious decline, and help with graduate medical education funding – along with other incentives to pursue rheumatology training – could provide relief, according to research findings presented last week at the 2016 American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Washington, D.C.

According to the 2015 ACR/ARHP Workforce Study steering committee, graduate medical education plays a critical role in keeping the flow of rheumatologists at the levels needed to meet the significant need for adult rheumatology services. The study was commissioned to project the supply and demand for rheumatology care now through 2030 – and the results show that while the current supply of U.S. rheumatologists is 4,497 clinical FTEs, by 2030, that number will fall by 31 percent, to 3,455. Considering the current demand for rheumatologists is 5,615 FTE – 36 percent more than the available supply – by 2030, the excess demand will be 4,729, or 138 percent more than supply. Making matters works, there are currently 113 adult rheumatology fellowship training programs with only 431 available positions. Rheumatology fellowship training is a 2-3 year training period. If all positions are filled, 215 fellows would be expected to graduate each year.

Even at a 100 percent position fill rate per year and no reductions in the number of fellow positions offered, the average number of clinical FTE of adult fellows projected to enter the rheumatology workforce each year is only 107. In addition to accounting for those fellows who will enter academic practice, the study found 18 percent of the projected number of female millennials plan to work part-time, and almost 20 percent of international medical graduates who train in U.S. rheumatology programs plan to practice abroad. An aging workforce is another problem. The Workforce Study shows that about 50 percent of those currently practicing plan to retire over the next 15 years, and 80 percent of those retiring plan to reduce their patient load by more than 25 percent.

“The projected deficit of adult rheumatologists in the next 10-15 years exceeds the shortage predicted in the prior 2005 ACR Workforce Study,” says Marcy B. Bolster, MD, a lead author of the study who is an Associate Professor of Medicine at Harvard Medical School and Director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital in Boston. “With an aging population, the need for rheumatology care is increasing. The impact of adult rheumatologist retirements as well as population growth will have a significant impact on available care for patients with rheumatic diseases. The knowledge of the shortfalls in potential access to care over the next 15 years is powerful and provides us with the opportunity for novel solutions to enhance timely access to care for rheumatology patients.”

According to the study’s findings, steps needed to alleviate this workforce gap include recruiting more medical students and residents to pursue rheumatology training; creating financial incentives to pursue this training, such as loan repayment and innovative funding for graduate medical education programs; and enhancing the use of nurse practitioners and physician assistants in rheumatology clinical practice.

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