US Rheumatology Workforce to Sharply Decline by 2030

The US rheumatology workforce will sharply decline during the next 15 years, decreasing from 4,497 full-time equivalent (FTE) positions to 3,455, according to a study by the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP). According to the report, the current adult rheumatology workforce faces a deficit of 1,118 clinical FTE positions.  

The first analysis of the workforce in a decade—presented during the 2016 joint annual meeting of ACR and ARHP—indicates that patient demand will double from 6,115 to 8,184 FTE positions in 2030, creating an estimated shortage of 4,729 FTE positions.

The study examined trends in graduate medical education as well as projected rates of retirement. Two key trends were evident:

• Approximately 50% of the rheumatology workforce is projected to retire within the next 15 years. More than 80% of those planning to retire say they will reduce their patient load by more than 25% in the near future.
• Even if all 215 rheumatology program positions are filled every year, the average number of clinical adult fellows in FTE positions entering the workforce annually will only be 107. The difference is based on the assumptions that many women from the millennial generation will be working part-time (63% of graduates are projected to be women) and that some of the international graduates of fellowship programs will practice outside of the United States.

“It’s an extraordinary problem for a field experiencing a significant increase in demand of its services,” says E. William St. Clair, MD, chief of the Duke Division of Rheumatology and Immunology and former president of ACR. “Fortunately, we are also discussing potential solutions to address the shortage, but making up the deficit will not be easy and will likely require major changes in the ways of delivering care.”

St. Clair, who attended the meeting, says the national workforce challenges are evident at Duke as well as most other major centers across the country and reflect a broader challenge of physician shortages across many different disciplines.

“The demands of care will increase with an aging population,” St. Clair says. “Older patients present with chronic inflammatory conditions and multiple comorbidities—many of them directly in the scope of our work in rheumatology.”

Future recruiting to the specialty was deemed the most important factor in changing the workforce trend, but the work group acknowledged the limits of this solution. Other recommendations included creating financial incentives for rheumatology training, engaging primary care physicians to treat certain diseases, expanding fellowship programs, enhancing the mentoring of young physicians, and incorporating additional nurse practitioners and physician assistants into clinical practice.

The study was presented at the ACR meeting by Marcy Bolster, MD, of Massachusetts General Hospital. Bolster’s work group based its projections on the current workforce, number of practitioners entering and leaving the workforce, practice settings, and generational changes.

Demand projections were based on patient demographics, health care usage, practice trends, disease prevalence, and US population growth and per capita income. The projections assumed 1 clinical practice FTE position to be 1.0 for private practitioners and 0.5 for academic practitioners.