Warning: Rheumatologist shortage predicted by 2030

Liz Meszaros, MDLinx | March 06, 2018

By 2030, the need for rheumatologists will far surpass the projected growth of the rheumatology workforce, according to two studies published in Arthritis Care & Research and Arthritis & Rheumatology.

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Shrinking rheum workforce

A growing population of aging baby boomers and changing practice trends will all contribute to this shortage, and to combat it, innovative solutions and new approaches to training will be necessary.

In the first study, senior author Seetha Monrad, MD, associate professor, University of Michigan, Ann Arbor, and fellow researchers found that the factors contributing to this shortage include the ever-increasing aging population, retiring baby boomers, and changing practice trends by new rheumatologists.

Dr. Monrad and colleagues conducted the 2015 Workforce Study of Rheumatology Specialists in the US, for which they used both primary and secondary data sources to estimate the baseline adult rheumatology workforce. They then identified which demographic and geographic factors were relevant to workforce modeling.

Using data-driven estimations on the proportion and clinical full-time equivalent (FTE) of academic versus non-academic practitioners, they projected supply and demand through 2030.

In 2015, the adult workforce of physicians, nurse practitioners, and physician assistants consisted of 6,013 providers, including 5,415 clinical full-time equivalent (FTE) practitioners. FTE is the percentage of work effort that is devoted to clinical care, and is calculated to more realistically show patient access to care. So, if two providers each cared for patients for 50% of their time, it would be considered 1.0 total clinical FTE.

At baseline, the estimated demand exceeded the supply of clinical FTE by 12.9%. By 2030, the supply of rheumatology clinical providers was projected to fall to 4,882 providers or 4,051 clinical FTE, which translates to a 25.2% decrease in the supply of providers from baseline. Demand for rheumatology clinical providers was projected to exceed supply by 4,133 clinical FTE, or 102%.

Dr. Monrad and fellow researchers also found an uneven geographic distribution of adult rheumatologists throughout the country, which they predict will worsen in the future.

In 2015, 21% of adult rheumatologists were located in the Northeast, compared with 3.9% in the Southwest. During this same year, the ratio of rheumatology providers per 100,000 patients by region ranged from 3.07 in the Northeast, to 1.28 in the Southwest. By 2025, they predict this ratio will decrease in all regions, ranging from 1.61 in the Northeast to 0.50 in the Northwest.

“Decreasing insurance barriers and health care regulations may allow more rapid, timely, and creative solutions to offset the projected rheumatologist shortage and the maldistribution of rheumatologists in the United States,” said Dr. Monrad.

She added: “Based on our projected rheumatology workforce shortages, innovative strategies will be needed to address access to patient care, as it will not be possible to solve the supply-demand gap by training more rheumatologists alone.”

In the second study—published in Arthritis & Rheumatology—researchers developed an integrated workforce model, with factors specific to new graduates entering the workforce.

They found that in 2015, there were 113 adult rheumatology programs, with 431 of 468 available positions filled. The projected clinical FTE physicians entering the workforce each year was 107, and was significantly impacted by gender and generational trends.

Millennials, for example, comprised 6% of the current workforce, but by 2030, they will comprise 44%. Currently, men make up 59% of the workforce, but this will decrease to 43% by 2030.

Finally, a full 17% of current fellows who were international medical graduates planned to practice outside the US.

“The supply of rheumatologists in the workforce is dependent upon the training of new rheumatologists to join our specialty,” said lead author Marcy Bolster, MD, associate professor of medicine, Massachusetts General Hospital, Boston. “It is imperative to create innovative ways to expand the rheumatology workforce, and this will involve new ways to fund graduate medical education training.”

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