Conference Coverage

ACR 2015 Workforce Study: Fewer rheumatologists, more patients, and the struggle to bridge the gap



WASHINGTON – The mass retirement of Baby Boomer workhorses, the changing face of a Millennial workforce, and the graying of America will deliver a triple-whammy to rheumatology over the next 15 years: By 2030, the United States will be short 4,700 full-time rheumatologists – just about as many as are currently in practice.

“This is drastic,” Marcy Bolster, MD, said at the annual meeting of the American College of Rheumatology. “We need to take action now or we will not be able to meet the expected increases in patient demand.”

Dr. Bolster, director of the rheumatology fellowship training program at Massachusetts General Hospital, Boston, was one of 10 clinicians who discussed the ACR’s massive new project, “The 2015 Workforce Study of Rheumatology Specialists in the United States,” a comprehensive assessment of the current supply of rheumatologists in this country, and a sobering prediction of how many will be needed in the future.

Dr. Marcy B. Bolster

Dr. Marcy B. Bolster

The overall picture is stark. There are now 4,997 full-time rheumatologists practicing in the United States, which is already far short of the current demand of 6,115. But those numbers will continue to diverge, Dr. Bolster said. By 2030, as Americans live longer, 8,184 rheumatologists will be needed to care for them. But by that time, as few as 3,455 may be working full-time – a 138% supply/demand discrepancy.

Released at the ACR meeting in Washington, the 2015 survey is the first that ACR has conducted since 2005. The project drew on a number of sources: questionnaires sent out to the entire ACR membership; published research, position papers, and government reports; the Institute of Medicine; and state licensure and National Resident Matching Program data. Four online questionnaires surveyed not only rheumatology clinicians and fellows, but other health professionals, adult and young patients with rheumatic diseases, and the parents of pediatric patients.

The survey response rate of 31% among practicing rheumatologists was not as high as the Committee on Rheumatology Training and Workforce Issues would have liked, said Daniel Battafarano, DO, a study cochair. But fellows had a 95% response rate, offering the study a very solid look at the near future of the specialty.

The 2015 results were a striking contrast to the 2005 report, which examined supply and demand up to 2025. It came to a brighter conclusion: that a relative balance would be maintained. Not so now.

The reasons for this projected imbalance are not overly complicated, and are actually recapitulated in other areas of medicine, said Dr. Battafarano, chief of rheumatology at San Antonio (Tex.) Military Medical Center. Baby Boomer senior physicians are tired of working 70 hours a week, and moving toward retirement in unprecedented numbers. In fact, according to the report, 50% of today’s full-time rheumatologists will retire within the next 15 years, and 80% of those plan to cut back their workload by about 25%.

Dr. Daniel Battafarano and his protege, Dr. Katrina Lawrence-Wolff, discuss the ACR 2015 Workforce Study at the group's annual meeting. Michele G. Sullivan/Frontline Medical News

Dr. Daniel Battafarano and his protege, Dr. Katrina Lawrence-Wolff, discuss the ACR 2015 Workforce Study at the group's annual meeting.

“When I was a fellow, we assumed we’d be working into our 70s. But that’s not the case now,” he said in an interview. “We are tired and burnt out, and retiring earlier and in unprecedented numbers.”

It’s not that new blood isn’t coming into the profession. In fact, Dr. Bolster said during her presentation, the percentage of internal medicine residents moving into rheumatology will stay stable, at about 4%. But the number isn’t projected to increase as patient demand does, and these new doctors will look and practice very differently than the new doctors of 30 or 40 years ago.

“The majority of medical school graduates now – about 60% – are women,” Dr. Battafarano said. “And they are entering the workforce at a very challenging time of life, simultaneously building careers and families.”

Studies have also demonstrated that women have different practice patterns than men. They tend to spend more time with patients, so they sometimes see fewer in a day. In fact, in its supply assessment, the ACR study characterized women rheumatologists as 0.7 of a full-time equivalent position – an important factor in the projected supply gap.

But the projected workforce shortage does not hinge on the practice patterns of women rheumatologists, Dr. Battafarano cautioned. Part of it is based on his own generation of work-a-holism. In general, young physicians now place more importance on a healthy work-life balance than did his generation, and this he sees as a healthy way to approach a new career.

“I’ll admit it: Baby Boomers are dysfunctionally working too hard, and they miss the importance of a health work/life balance. That’s changing, and that’s a good thing.”

His protégé, Katrina Lawrence-Wolff, DO, agrees. A second-year rheumatology fellow, Dr. Lawrence-Wolff is also expecting her first child. She presented the breakout results focusing on the adult rheumatologist supply/demand picture.

“None of us think working 80 hours a week is a good idea for us personally, or a good way to give good medical care to patients,” she said in an interview. “We would rather have more time with family, more time for volunteering in our community, or to do advocacy work. We want to be flexible, and we do understand that this attitude may change the level of our reimbursement. But we are willing to forgo some salary to become a happier, better-balanced person.”

International medical graduates also affect this snapshot of the future, Dr. Bolster said during her lecture. More than half of new medical graduates are international students, and 17% of those intend to leave the United States after their education is complete.

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