Calling All Rheumatologists Page 2

The good news: The number of new rheumatologists has risen in recent years, from 122 in 2000 to 168 in 2006 – a 37-percent increase. The bad news: The healthy-sounding growth will be outpaced by the rate of retirement. The ACR Workforce Study estimates about half of practicing rheumatologists will retire within just eight years, and that by 2025 there will be a shortage of 2,600 rheumatologists in the U.S.

The Downside of Demand
The nation’s more than 4,900 adult rheumatologists already struggle to keep up with an aging population and the resulting growth in patient load, even with primary care physicians and other health-care professionals sharing the load.

“Most people with OA are treated by a primary care physician, a physical therapist or perhaps eventually an orthopaedic surgeon,” says Chad Deal, MD, lead author of the ACR’s study and head of the Center for Osteoporosis and Metabolic Bone Disease at The Cleveland Clinic Foundation in Ohio. The same is true for some people with other forms of arthritis. On the other hand, primary care physicians send some patients to rheumatologists in an effort to diagnose and treat inflammatory forms of arthritis as soon as possible.

“Primary care physicians are now more likely to refer patients to rheumatologists because they realize they don’t have the expertise to provide the new biologic therapies,” says Walter G. Barr, MD, professor of rheumatology at Northwestern University in Chicago and head of the ACR Workforce Committee.

“Through bioengineering and a greater understanding of immunology, we’ve been able to develop extraordinarily powerful medicines that can make a quantum difference in people’s lives. The biologic drugs like abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade) and rituximab (Rituxan) provide the potential for disease modification now that we didn’t have 10 years ago,” says Stephen Paget, MD, physician-in-chief of the rheumatology division at the Hospital for Special Surgery, which is associated with Weill Medical College of Cornell University in New York City. But the best medications in the world won’t do much good f there aren’t enough doctors available to administer them.

Lack of Manpower & Funds
Today’s rheumatologists hope that research advances and new treatment options will draw newly minted doctors to specialize in rheumatology. “The field of rheumatology is on the cutting edge of science, and that makes it more attractive to medical students and residents,” says Dr. Paget. Still, getting future doctors to commit to rheumatology can hit a few snags – all of which boil down to money.

The path to becoming a rheumatologist requires three years as an internal medicine resident and then another two or three years completing a fellowship in the subspecialty of rheumatology. A pediatric rheumatologist will do three years as a resident in pediatrics and then take part in a pediatric rheumatology fellowship. Although the number of fellowship slots available is limited, in rheumatology some slots go unclaimed.

According to the 2005-2006 ACR study, 395 fellowships were available, but only 366 were filled. The good news is that the completion rate for rheumatology fellowships is 100 percent – the doctors who take rheumatology fellowships stay with the field. Practicing rheumatologists often mention the ability to develop long-term relationships with their patients and the challenge of finding the correct diagnosis as top reasons they enjoy their chosen field.

Some slots remain empty, however, because funding isn’t available. Funding for fellowships help a hospital pay for the doctor’s salary and benefits. Increasing the number of fellowship slots also requires increasing the number of full-time faculty to supervise them.

Another problem is that rheumatology remains among the lowest paid of all the internal medicine subspecialties, bringing in far less in reimbursements from insurance companies and Medicare. The American Medical Group Association’s Compensation and Financial Survey found the median compensation per rheumatologist in 2003 was about $180,000, compared with $305,000 for gastroenterology and $335,700 for general cardiology. This also plays a role in new doctors’ desire to go into rheumatology, especially when they finish medical school with $150,000 or more in debt.