I read the 2015 ACR Workforce Study Report with great interest as one who served on the 2005 Manpower Taskforce.1,2 I found it disappointing that the deficit in rheumatologist FTEs that we predicted a decade ago has become a fact. Of even greater concern, the strategies we proposed to address this problem have not been implemented, and yet, the 2015 Taskforce has doubled down on more of the same.
Two articles published recently in The Rheumatologist from the Rheumatoid Arthritis Practice Performance (RAPP) Project described clinicians’ efforts to improve rheumatology care and RA disease outcomes in their practices.2,3 Project findings indicate that the care gaps in rheumatology practices go beyond an insufficient number of FTEs to meet demands for necessary care. These highly regarded clinicians generally lacked the visit slots to see their existing RA patients at the frequencies recommended in the ACR Guidelines or to promptly see new patients referred for their evaluation and management. They were bottlenecked, and adding more FTEs wouldn’t solve this problem.
By not including this current workforce capacity gap in its calculations, the 2015 Taskforce has underestimated our current and future manpower deficits. If rheumatologists cannot even see their established patients as often as needed to assess their disease activity and improve their treatment, how can we hope to achieve treat-to-target outcomes or absorb the growing numbers of new patients going forward?
The adage, “When you find yourself in a hole, stop digging,” comes to mind. Rheumatology training and practice must be radically redesigned or we will find ourselves in an even deeper hole in 2025. Simply put, some RAPP Project rheumatologists increased their managed RA populations two- to threefold by implementing interdisciplinary team care and population medicine processes. By adopting the mantra, “I only do what only I can do,” they have shifted the majority of their traditional work to staff, opening their own schedules for additional necessary established and new patient visits. Doing so increases revenues and decreases per-patient costs, so their profits increase as well. Their patients are satisfied, and they get home earlier.
From this different perspective, the shortage of rheumatologists presents an opportunity to improve our care and financial outlook, and perhaps make rheumatology more attractive to future trainees. We can’t wait another decade to figure this out; we need to learn from our early adopters, redesign our existing practices beginning now and teach future rheumatologists to be more effective.5 If we don’t at least double our practice capacity per rheumatologist FTE, we risk becoming irrelevant in the 21st century U.S. health system.
Timothy Harrington, MD University of Wisconsin School of Medicine & Public Health, retired
References
- Deal CL, Hooker R, Harrington T, et al. The United States rheumatology workforce: Supply and demand 2005–2025. Arthritis Rheum. 2007 Mar;56(3):722–729.
- 2015 Workforce Study of Rheumatology Specialists in the United States. American College of Rheumatology, 2016.
- Arnold E, Arnold W, Conaway D, et al. Rheumatoid Arthritis Practice Performance Project spots problems in RA management. The Rheumatologist. 2015 Jun;9(6).
- Harrington T, Arnold E, Arnold W, et al. Help wanted: The rheumatology workforce shortage revisited. 2016 May; 10(5).
- Great Health Care: Making It Happen. Editors JT Harrington and Ed Newman. New York. Springer USA, 2011.
