Demand for Rheumatologists to Outpace Supply

Arthritis News > Demand Growing for Rheumatologists

Demand for Rheumatologists Expected to Exceed Supply in Coming Decades

An increase in older adults combined with a greater ability to effectively manage many inflammatory musculoskeletal disorders is expected to require an increase in the number of practicing rheumatologists over the coming decades.  In order to anticipate and potentially correct any projected shortfall in practitioners, Deal et al (Arthritis Rheum 2007; 56(3): 722) conducted a workforce projection of rheumatology specialist supply and demand for the period 2005-2025, an undertaking sponsored by the Workforce Study Advisory Group of the American College of Rheumatology (ACR).

Methods

Demographic and practice characteristics of currently practicing rheumatologists were collected from the master files of the American Medical Association (AMA) and ACR and by survey from randomly selected adult and pediatric rheumatologists practicing in the U.S.
Based on these data, a computer-based projection model was created to project the supply of 2005 equivalent rheumatologists required for the period 2005-2025 for demand projections based on anticipated population growth, the prevalence of common rheumatic disorders, and the demographic characteristics of the population.

Results

The 2005 supply of practicing rheumatologists was 4,946.  Based on a random survey of 627 of these (37% of the 1,683 invited to participate), the proportions of male and female rheumatologists, and the number of patients visits, varied by age.  Older rheumatologists (age 44+) were more likely to be male and provide more patient visits than younger rheumatologists.  Equal proportions of males and females were observed in the younger groups.  Male rheumatologists, on average, provided 34% more patient visits than female rheumatologists.
While the supply of 2005 equivalent adult rheumatologists projected to actually decline over the coming 2 decades (projected supply of 4,643 adult rheumatologists in 2025), the demand was projected to increase to 7,219 practitioners by 2025.  This represents a shortfall of 2,576 adult rheumatologists.  The discrepancy was less for pediatric rheumatologists, where the supply of 2005 equivalent rheumatologists was projected to fall short of demand by only 33 practitioners by 2025.

These differences were related to growth in the U.S. population with an increased proportion of the population age greater than 64.  Additional demand was due to projected per capita income growth and the shifting of demographics of the rheumatologist population, with a higher proportion of female practitioners who, on average, were projected to provide fewer patient visits than their male counterparts.

Conclusions

The coming decades will see a substantial shortfall in the number of practicing adult and pediatric rheumatologists in the U.S.  Appropriate measures to train additional rheumatologists and streamline medical practice should be undertaken to correct this projected deficit.

Editorial Comment

These projections are quite striking and highlight the potential for a health crisis within the field in the coming decades.  It should be emphasized that projections of this sort rely on many assumptions, most of which are based on current practices and trends.  In fact, it was only recently (early 1990’s) when projections based on managed care models predicted that the supply of rheumatologists would exceed demand for the present time.  These projections were obviously incorrect, and were invalidated due to unforeseen dramatic changes in the practice of rheumatology (i.e. biologic and other aggressive management of inflammatory arthritis, among others).  However, training more rheumatologists and streamlining clinical practice cannot occur overnight if these projections are valid.  The ACR has proposed a number of measures to address these issues, and the coming years will tell whether these projections proved accurate.

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