November 2024

RHEUMATOLOGY

WORKFORCE SHORTAGE IN RHEUMATOLOGY

​Laura C. Arneson, MD, and Brian D. Jaros, MD, shed light on the rheumatology workforce shortage and its consequences. They also explore the measures being taken to address this shortage and bridge the gap.

Can you give a brief overview of the workforce shortage?

A workforce study conducted by the American College of Rheumatology in 2015 predicted a 100% mismatch between the patient demand for rheumatology providers and the available supply by 2030.

What are the main factors contributing to the shortage?

The shortage could be due to several factors including:
  • Rheumatologic diseases are increasing in prevalence and incidence.
  • Funding for rheumatology training programs has not grown to match the growing rheumatology patient population.
  • Many rheumatologists have retired in recent years, and the COVID-19 pandemic accelerated the exit of healthcare professionals from the workforce.

How does the shortage affect patient care?

On a national scale, the wait time for a new patient to establish care with a rheumatologist is around six months. This can be problematic for diseases where time is of the essence, and it leaves patients with unmanaged symptoms for longer periods of time. While efforts can be made to co-manage certain conditions with primary care or other specialties, many complex autoimmune diseases require the expertise of a rheumatologist.
 
Existing patients may also experience longer gaps between visits due to the shortage of providers, and it can be challenging to arrange urgent visits when needed. This issue is further exacerbated for patients in rural areas where there is often a regional lack of rheumatologists.
 
How did the COVID-19 pandemic affect the shortage and burnout in rheumatology?

Essentially, it was an impetus for healthcare professionals who were near or considering retirement to fully retire. This depletion of clinicians has worsened the shortage of rheumatologists.
 
Burnout has been a growing concern in recent years, and the pandemic highlighted the issue further. It emphasized healthcare providers’ need to prioritize their own well-being in order to effectively care for patients.
 
To retain a strong pool of clinicians and mitigate burnout, it is crucial to focus on healthcare provider wellness.
 
Have there been any national efforts or initiatives to address the workforce shortage?

One approach is advocating to fund more fellowship training spots to ultimately increase the pool of rheumatology providers.
 
Additionally, there is a focus on recruiting and retaining advanced practice providers (APPs), including nurse practitioners and physician assistants, in a team-based model of care. This helps offload some patient care responsibilities and allows for more efficient and comprehensive care.
 
In rural areas, there are dedicated training programs to empower primary care physicians to initiate management for common rheumatologic conditions, such as gout.

What are the potential long-term consequences if the workforce shortage in rheumatology isn’t addressed?

Patient care will be affected, with longer wait times for new patients and limited availability for return visits. This can result in delayed diagnosis and treatment of rheumatologic conditions, ultimately affecting outcomes.
 
The distress of not being able to provide timely and coordinated care to patients can also contribute to physician burnout, which may further exacerbate the workforce shortage.

Are there efforts at Northwestern Medicine to reduce provider burnout?
​
Within Northwestern Medicine, one strategy to mitigate burnout is the pairing of new providers with faculty mentors outside of their department. The program provides dedicated time and support to discuss the issues and frustrations that providers may experience when transitioning to a new role, but often don’t have the opportunity to address in their daily work. Peer support and mentorship is an important step in addressing factors that can contribute to burnout.
 
From a logistics standpoint, Northwestern Medicine has invested in a dedicated pool of nurses well-versed in rheumatology. They can triage and address patient-generated messages, which helps manage the workflow of the EMR and allows for more efficient patient communication.
 
Such initiatives aim to provide support, improve workflows and enhance communication, ultimately contributing to better physician well-being and patient care.
Laura Arneson, MD, Assistant Professor of Rheumatology and Co-leader of the Health Equity & Advocacy Curriculum at Northwestern Medicine 
​Brian D. Jaros, MD, Assistant Professor of Rheumatology and Associate Program Director for the Rheumatology Fellowship at Northwestern Medicine

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