News

Regional rheumatologist distribution leaves many patients underserved

View on the News

Regional rheumatologist shortages require attention

The ACR responded to its prior workforce study, and should also respond to the regional shortage of rheumatology services highlighted in this study, according to Dr. Chad L. Deal.

Given the effects that demand for services, supply of physicians, and ease of access to specialty care have on patient access to rheumatology care, as well as the major beneficial impact that biologic therapies and early initiation of treatment can have on patients with rheumatic disease, "availability and ease of access to a trained specialist in the care of inflammatory arthritis [are] essential," he said.

"At the end of the day, the ACR would have to decide whether providing increased access for our services in underserved areas is a high enough priority (considering the many demands on rheumatology in an ever-changing health care environment) to commit resources to addressing this issue," he added, noting that he believes the ACR should, indeed, commit to providing up-to-date information on supply by region, as recommended by Dr. FitzGerald and his colleagues, and that the ACR should use the data from this study as the start of the process to apprise fellows in training and early career rheumatologists.

Because data suggest that an increasing proportion of rheumatology graduates are seeking hospital employment, the ACR should also survey hospitals in rural areas that are interested "in investing in a rheumatologist for their residents," he said.

"In addition, the ACR should consider a task force to develop a strategic plan for the recruitment of [physician assistants] and [nurse practitioners] into rheumatology and into rural areas," he wrote. This could begin, he said, by having the ACR Committee on Rheumatology Training and Workforce Issues engage program directors and discuss whether selection of fellows with rural backgrounds is a regional option, as well as getting the Government Affairs Committee to initiate efforts directed at state and federal authorities to incentivize rheumatology practice in rural areas.

Dr. Deal’s remarks were made in an accompanying editorial (Arthritis Rheum. 2013 Nov. 27 [doi:10.1002/art.38169]). He is a rheumatologist at the Cleveland Clinic and a past member of the ACR’s rheumatologic care, training and workforce, and finance committees. He is currently a member of the ACR’s Government Affairs Committee.


 

FROM ARTHRITIS & RHEUMATISM

For 360 metropolitan areas where median household income data were available, higher income was associated with a greater number of rheumatologists.

This study is limited by the fact that not all practicing rheumatologists are registered with the ACR, and by the inability to account for practice type (such as part time, mixed internal medicine/rheumatology panels, and multisite practices); an assumption of uniform demand across populations; and a lack of consideration of competing sources of care (such as internists, family practitioners, and midlevel providers), the investigators noted.

Better information is needed regarding factors that affect access to rheumatologists in underserved areas, and until this information becomes available, the current findings should be considered preliminary and exploratory, they said.

"More comprehensive practice databases and additional research [are] needed prior to policy implementation or reallocation of current resources. However, the present report identifies ongoing regional shortages in the rheumatology workforce, and highlights potential target communities that might benefit most from addition of a local rheumatologist," they wrote.

The authors reported having no relevant financial conflicts of interest. One author, David A. Elashoff, Ph.D., was supported by a National Institutes of Health/National Center for Advancing Translational Science UCLA CTSI grant.

Pages

Recommended Reading

Doctors keep it simple, ditch insurance
MDedge Rheumatology
Failure to diagnose
MDedge Rheumatology
Murthy nominated to be Surgeon General
MDedge Rheumatology
What is UnitedHealthcare doing?
MDedge Rheumatology
AMA delegates take on SGR, ICD-10, grace period for exchange plans
MDedge Rheumatology
Can Congress fix the SGR this year?
MDedge Rheumatology
Point/Counterpoint: Will Choosing Wisely improve quality of care?
MDedge Rheumatology
Feds delay online enrollment in small business exchange for 1 year
MDedge Rheumatology
Feds make significant progress on HealthCare.gov
MDedge Rheumatology
Medicare finalizes plan for non-face-to-face payments
MDedge Rheumatology