From the Expert: Dr. Anne Bass Addresses Fellowship Training in Rheumatology

Maybe Anne Bass, MD, is biased because of her position as program director for the Rheumatology Fellowship Program at the Hospital for Special Surgery in New York, but she sees as strong a fellows pipeline as the country has ever had.

In 2006, there were 398 fellows nationwide in adult rheumatology, she says. Now, there are more than 440. The number of pediatric rheumatologists over the same time has grown from 58 to 79, a 36% jump. Whether or not those numbers will be enough to replenish the rheumatology workforce as retirement rates increase remains to be seen.

“It’s a small field, but it’s continuing to grow,” says Dr. Bass, an associate professor of clinical medicine at Weill Cornell Medical College (N.Y.).

She recently talked with The Rheumatologist about the state of fellowship.

Question: We have more rheumatologists becoming fellows. Are they in the right places?
Answer: Most training centers and academic centers are in urban areas, but that’s, of course, where most of the people are as well. There is still a mismatch. … In particular, there are many states that have no fellowship programs at all and where the ratio of practicing rheumatologists to the population is low. We definitely need to do a better job of distributing rheumatologists [to] where they’re really needed.

Q: How do we accomplish that?
A: That’s the perennial question. When the [Rheumatology Research Foundation] funds fellowship programs, one of the questions is always, “How do you decide what to fund and what not to fund?” I think we look at a lot of different things. We look at the strength of the program, but we also look at geographic area. Are [programs] serving that need, in other words, training people in areas where they maybe otherwise wouldn’t have a trainee?

Q: The demand for fellows seems clear: growing populations, the need for more trained rheumatologists. What is the biggest challenge to supply?
A: Medical students and residents get very little exposure to rheumatology during their training, and in some places, it’s almost random whether they’re going to see any cases of, [for example], severe lupus or vasculitis. That’s really the biggest challenge, because if you have never been exposed to rheumatology, then what would make you choose that specialty?

Richard Quinn is a freelance writer in New Jersey.