Rheumatologists in Short Supply

By 2030 the nation will have only half the number of professionals it needs

By Deborah Jeanne Sergeant

If you need to see a rheumatologist, get in line. You will have a long way to go until you see one — and this waiting period won’t improve anytime soon.

By 2030 the nation will have only half the number of rheumatologists it needs. Presently, the U.S. is at 13 percent below the ideal number of rheumatologists, according to research by Rheumatology Service at San Antonio Military Medical Center in Texas.

“It’s been a long-standing problem and hasn’t changed,” said physician Thomas Madejski, who specializes in internal medicine, geriatric medicine, hospice and palliative care, and leads the Medical Society of the State of New York.

He said that many issues have caused the shortage, such as liability issues and, locally, “the hassles” of working in New York.

“The state medical society is working to improve the practice environment in New York state and its liability rate. We want to reduce the regulatory burden and make it less expensive for doctors to practice,” said Madejski.

The demand for care from a rheumatologist has increased, including the aging baby boomer population as well as better diagnostic efforts and more treatment options. Madejski said that for 80 to 90 percent of osteoarthritis cases, a primary care, internists or family physician could provide sufficient care; however, some patients demand more care, which has affected the issue to a small degree.

Physician extenders — nurse practitioners and physician assistants — can help rheumatologists see more patients; however, Madejksi said that many primary care physicians even lack the experience and training to feel comfortable in prescribing some of the newer medication to treat patients with rheumatologic disorders.

“We need to re-examine how we educate and train physicians,” Madejksi said. “We should be training physicians more at this level. With telemedicine and tele-health we can leverage rheumatologists more to distill the essence of what we need: diagnosis and treatment so we can make it more efficient for them.”

Locally, the shortage persists as well, according to physician Andras Perl, distinguished professor of medicine, division chief of rheumatology and co-director of the MD/PhD program at Upstate Medical University. Patients aren’t turned away, but scheduling can challenge providers at times.

“There’s no doubt there’s a shortage,” Perl said. “We schedule people when they’re referred to us. We don’t put them on a waiting list. If they have to wait a long time, then we try to fit them in when cancellations occur.”

He said to a large degree, it’s a resource allocation. More students training to be doctors want to specialize in rheumatology than they have opportunities to learn.

“Upstate pays one training position to train rheumatologists out of five slots,” Perl said. “The others are from other sources, like grants, so I have to work hard to support training positions. We would like to increase that.”

For private practices, compensation is a big reason behind the dearth of rheumatologists. Perl added that compensation also influences hospitals to a degree, since they focus on the more lucrative in-patient specialties than out-patient ones such as rheumatology.

Michael Carr, president of Carr Recruiting Solutions in Baldwinsville, said that rheumatology is similar to a lot of other very specific disciplines in the medical field. “Even with a teaching hospital locally and local nursing schools, the competition for qualified medical personnel is intense to say the least, whether a small medical practice or hospitals,” Carr said.

He added that medical organizations are offering perks unheard of in their industry, such as part-time, flex time, and generous relocation packages.

“There’s a lot of creativity to get people to come aboard or relocate here,” Carr said. “Every medical practice and entity is different but we’re seeing them sweeten the package.”

For example, the organization might allow a physician to work two evenings a week to lighten the patient load in addition to their day position elsewhere.

With aging baby boomers and many skilled physicians retiring, Carr feels sure this problem will last.

“At least if you’re good at what you do in this field, you will find work, so that’s a positive,” Carr said.

According to salary.com, New York state rheumatologists make an average of $ 231,375.