2015 Workforce Study and the Future for Rheumatologists

Bret S. Stetka, MD

Disclosures

December 09, 2016

Editor's Note: Following the 2016 American College of Rheumatology (ACR) Annual Meeting in Washington, DC, Medscape spoke with Jonathan S. Hausmann, MD, instructor of medicine at Harvard Medical School, pediatric rheumatologist at Boston Children’s Hospital, and adult rheumatologist at Beth Israel Deaconess Medical Center, about research[1] he's involved with exploring the future of the rheumatology work force.

Medscape: Can you give us some background on the 2015 Workforce Study that you presented at ACR?

Dr Hausmann: The 2015 ACR/Association of Rheumatology Health Professionals (ARHP) Workforce Study was done to try to predict the future of the rheumatology workforce in the United States, with the hopes of identifying modifiable factors that the ACR could address to help adequately meet the needs of the future. The work was led by Dr Dan Battafarano and Dr Seetha Monrad.

The purpose was to describe the current workforce, notice demographic trends, predict the future supply of rheumatology professionals, and try to predict the demand for our services. A variety of tools were employed to get this information, including surveys to practicing rheumatologists, nurse practitioners, physical and occupational therapists, rheumatology fellows-in-training (FITs), as well as focus groups with children and adults with rheumatic illnesses and their families. We also looked at existing data regarding the ages of the population, the prevalence of rheumatic diseases in the United States, etc.

The 2015 Workforce Study is a follow-up from the 2005 Workforce Study,[2] which already predicted that there would be increased demand and decreased supply of rheumatologists in the future.

The results of the 2015 Workforce Study did again show an increased demand for rheumatologists, especially with the aging population, combined with a decreased supply, partly explained by the fact that future doctors are more likely to work part time and more likely to be women (who on average see fewer patients per day). In addition, of the large number of international medical grads that make up FITs, about a third are planning to practice outside the United States.

Private practice is the most common career interest, especially by men. If you group clinician educators, investigators, and researchers in the "academic" track, then it is actually more common overall.

Medscape: According to your findings, what were the most common reasons FITs decided to go into rheumatology? What were the least?

Dr Hausmann: My ACR poster only looked at the responses from the FITs. Of about 500 FITs in the United States, we received responses from 415 of them. FITs entered rheumatology mainly for intellectual interest, although lifestyle/work hours was also a common reason. It's really interesting that virtually every FIT was inspired to become a rheumatologist by exposure to a rheumatologist. The least common reason was income potential.

Medscape: What were some of the more concerning findings regarding a potential future shortage of rheumatologists? To your knowledge, how do these findings compare with other specialties?

Dr Hausmann: Over time, we are finding that US graduates seem to be choosing specialties other than rheumatology. In fact, rheumatology is one of the top five specialties with the lowest percentage of US graduates; in 2016, US graduates made up only 40% of entering rheumatology FITs. This compares very unfavorably with other specialties such as orthopedics and dermatology, where over 95% of trainees are US graduates.

Part of the reason for this may be related to student loans. Three quarters of FITs who are US graduates have student loans; most have loans over $100,000 (and 25% have loans over $300,000!). If they don't think that they will be able to pay off their loans by becoming a rheumatologist, they may choose to practice another specialty, regardless of their intellectual interest.

Fortunately, we do have some excellent international medical graduates who are coming to the United States to become rheumatology FITs. The only problem with international medical graduates is that about a third of them do not plan to practice in the United States (either because they want to return to their home countries or because they have difficulties obtaining work visas); and, as a result, they may not help to fill the growing demand for rheumatologists in the United States.

Medscape: What do you feel can be done to encourage more medical students to choose rheumatology as a career path?

Dr Hausmann: As we showed, most FITs became rheumatologists due to exposure to a rheumatologist, most commonly during residency. Therefore, we should all seek to become ambassadors for our specialty, encouraging trainees to shadow us in clinic, participate in our research, and join in a mentee/mentor relationship.

Many residents have no exposure to rheumatology during their training; and when they do, it's haphazard and does not provide a coherent body of knowledge to trainees. I also think it's a mistake to pursue careers because of potential income, especially because payment systems will likely change in the future.

Also, understanding the expected rise in demand for rheumatologists and decreased supply will likely make rheumatologists even more sought after. In the future, this may translate to higher pay.

Medscape: In your opinion, why should students choose rheumatology? What do you feel is attractive and/or rewarding about the field?

Dr Hausmann: Rheumatology is the best specialty, period. It is the most interesting. We take care of a group of interesting diseases, most of which don't have any known causes. It's a wonderful specialty for curious people. Many of us can work to bring further understanding to these diseases.

Fortunately, despite our lack of understanding of most rheumatic illnesses, we do have very good and effective medications, so we're able to really help people get better. It's not just an intellectual specialty where we hypothesize about disease mechanisms; we actually go and deliver effective treatment for patients. We develop tight bonds with our patients and follow them over time.

Also, the lifestyle is really great, there are few emergencies, and it allows you to set your schedule pretty much as you would like. As a rheumatologist, you really need to be an excellent all-around doctor, with sharp skills in history-taking and physical exams; you must have a great understanding of the entire body. As a result, you really develop powerful analytic skills and are often sought after in any complex case in the hospital. We're never bored, and we're always learning something new. I often feel like Sherlock Holmes, trying to uncover complex cases that nobody else can solve. Also, rheumatologists are wonderful people—smart, caring, interesting, interested. It's a great group of colleagues to have.

There is a lot of misunderstanding about rheumatic illnesses by the public, trainees, and practicing physicians. As a result, there are wonderful opportunities for educating others about rheumatic illnesses and making the illnesses less obscure than they seem. Finally, the results of the Workforce Study showed that demand for rheumatologists is only expected to increase in the future, which certainly bodes well for job security.

Jonathan S. Hausmann, MD, has disclosed no relevant financial relationships.

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