Calling All Rheumatologists Page 3

Even if more doctors choose to specialize in rheumatology, there is no guarantee they will spend their career seeing patients. Among the 4,900 rheumatologists in the country, many incorporate teaching, research or administrative work in addition to seeing patients. Some do not see patients at all. The demand for medical doctors in business roles, from investment banking to management of health-care companies running hospitals, gives doctors other career options.

Group Efforts
To address the shortage, the ACR has developed recruitment materials and raised money from pharmaceutical companies to attract people to rheumatology careers. And it has provided funds to give students exposure to rheumatologists they don’t receive early in their medical school training.

Still, more could be done. Redesigning medical practices to make them more efficient could help reduce costs, balance the supply and demand for rheumatologists, and better serve patients. For instance, group appointments work well for educating patients, doing routine care and answering questions. And group appointments provide patients an instant support group.

Group appointments are only one tactic for improving efficiency, says Timothy Harrington, MD, a rheumatologist in the department of medicine at the University of Wisconsin in Madison and a member of the ACR Workforce Committee. Dr. Harrington also recommends pre-appointment management for new patients. In 2001, he led a study reviewing the medical records of 279 patients referred to a rheumatologist, and found only 59 percent of them needed to see one.

Such changes likely would take years. In the meantime, a lack of rheumatologists will not mean a lack of caregivers or access to care – for adults, anyway. (For children with arthritis, the situation is vastly different. See “Specialists for Children,” below.) The ACR plans to expand high-quality training programs for health-care professionals, such as nurse practitioners and physician assistants.

“Rheumatology relies heavily on teamwork to meet the needs of patients,” says Roderick Hooker, PhD, a physician’s assistant at the Department of Veterans Affairs Medical Center in Dallas and an author of the ACR study. “Physician’s assistants and nurse practitioners provide the continuity of care, which is needed to give the role of the rheumatologist room to expand,” he says.

Creating dependable care takes the understanding and support of all those affected – the patients, doctors and nonphysician clinicians, says Dr. Harrington. “The financing and delivery of health care is broken in the U.S., and people need to advocate for fundamental change.”

Specialists for children: Few – and Far Between
When it comes to pediatric rheumatology, a crisis isn’t coming; it’s here, says Patience White, MD, chief public health officer of the Arthritis Foundation and a pediatric rheumatologist. Although the 218 pediatric rheumatologists in the U.S. are younger, on average, than adult rheumatologists, most are women – who work fewer hours and see 35 percent fewer patients than their male counterparts. And within the next five years, 32 percent of pediatric rheumatologists plan to reduce the time they spend seeing patients, according to the American Academy of Pediatrics.

Although adults often face long waits for appointments with rheumatologists, the situation is far worse for the 300,000 children with rheumatic diseases, who may have to travel hundreds of miles for one appointment. And 10 states don’t have a single pediatric rheumatologist. Today’s shortage means that one-third of children younger than 18 who have arthritis will see an adult rheumatologist.

Legislation wending its way through Congress could improve the situation. When passed, the Arthritis Prevention Control and Cure Act (APCCA), supported by the Arthritis Foundation and the ACR, will help ensure an increase in pediatric rheumatologists by providing support for more pediatric rheumatology fellowships and partial loan forgiveness for medical school debt.

The Arthritis Foundation is stepping up not only through advocacy efforts to get the APCCA passed, says Dr. White, but also by trying to raise $5 million to pay for additional pediatric rheumatology fellowships. “We’ve been stepping up in research for years; now we’re stepping up in access to care and treatment,” says Dr. White.