In a state that’s experiencing rapid growth, the Tennessee Rheumatology Society (TRS) is keeping pace. A report from the University of Tennessee, Knoxville, shows the state could grow by nearly 1 million people over the next 20 years, with the population reaching 7.87 million by 2040.1
Three years ago, the TRS Board of Directors voted to open its membership to physician assistants (PAs), nurse practitioners (NPs) and other rheumatology providers, reflecting the changing demographics of the medical field while increasing its membership. Today, TRS boasts approximately 105 members from across the state.
“Eighty percent of our members are rheumatologists, but we also welcome residents, fellows and other rheumatology professionals to join TRS,” says TRS President Brett Smith, DO, a rheumatologist with Tennessee Direct Rheumatology, Knoxville.
Based in a state with two rheumatology fellowship programs—at the University of Tennessee and at the Vanderbilt University Medical Center—TRS is committed to supporting both current rheumatologists and future leaders.
“TRS provides funding to the fellowship programs at both universities to encourage fellows to attend our annual conference as well as the ACR’s annual meeting [ACR Convergence],” Dr. Smith says.
In addition to providing fellows with access to continuing education in rheumatology and the chance to meet their colleagues, Dr. Smith says he hopes TRS leads some fellows to establish a practice in Tennessee.
“We probably retain about 50% of the students who go through our state’s fellowship programs,” Dr. Smith says.
Increasing the number of both primary care physicians and specialists in Tennessee is an issue being addressed at the state level. According to the 2021 State Physician Workforce Report issued by the Association of American Medical Colleges, Tennessee has 17,687 active physicians, or 253.6 per 100,000 residents, the 22nd fewest in the U.S.2
In May, Tennessee Gov. Bill Lee made history by signing a bill that makes Tennessee the first state in the country to remove redundant medical residency requirements for international doctors. The legislation aims to help Tennessee attract qualified physicians from around the world to ensure the state has enough doctors.
Improving Access to Care
Dr. Smith says that, like many states, Tennessee is experiencing a shortage of physician specialists and it’s not uncommon for patients to have a three- to six-month wait or to drive one to two hours across the state for a rheumatology appointment.
With rheumatologists in Tennessee primarily practicing in large cities, such as Nashville and Memphis, some practitioners in outlying cities, including Dr. Smith, treat both adults and children with rheumatic diseases.
“We definitely have a need for more pediatric rheumatologists,” he says. “There are only one or two in Memphis and three or four in Nashville.”
Dr. Smith says TRS is interested in partnering with other organizations, including the ACR and the Tennessee Medical Association, to address legislative efforts, such as Medicare reimbursement and prior authorization requirements.
“Over the past two years, we’ve seen Medicare reimbursement cut by 7%,” says Dr. Smith. “Step edits, or step therapy, have also been a big issue over the past two years.”
Last year, Gov. Lee passed a bill to reform step therapy, allowing patients to access the medications prescribed by their doctors without interference from the patient’s insurance company.4
Fostering a Sense of Community
In 2022, Puja Patel, DO, chief rheumatology fellow in the Department of Rheumatology, University of Tennessee Health Sciences Center, Memphis, attended the TRS annual conference as a first-year fellow and presented a case on drug-induced vasculitis. “It’s a rare condition associated with an increasing number of therapeutic agents,” she says.
Dr. Patel says she attended 85% of the conference presentations and enjoyed both the camaraderie and knowledge shared by others in the rheumatology field.
“Rheumatic diseases aren’t always straightforward,” Dr. Patel says. “This conference gives us a forum to discuss these cases with experts in the field, and in doing so, we gain cutting-edge knowledge in both diagnostic and therapeutic interventions.”
Dr. Patel is excited to be moving back to her hometown of San Diego to practice rheumatology. Thanks to her experience with TRS, she hopes to join the California Rheumatology Alliance.
“I tend to learn best in a collaborative environment, and being part of a state society allows you the opportunity to share information and learn from your colleagues,” she says. “I’ve had great mentors, and I hope in the future that I can pay it forward by mentoring other rheumatology fellows.”
TRS member Leslie Crofford, MD, professor and chief of the Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, was chosen this year to receive the organization’s President’s Award.
This honor is given each year to a board-certified rheumatologist in Tennessee who has made significant contributions to the field through scholarly, research, educational, administrative and clinical service. Awardees also represent rheumatologists who have contributed to improving patient care and advancing the role of the profession in Tennessee.
“I was delighted to become a part of TRS when I moved to Tennessee and joined Vanderbilt 10 years ago,” Dr. Crofford says. “Attending the annual conference gives me the chance to interact with colleagues from across the state and to learn from a variety of fantastic speakers.”
This year’s conference, held Feb. 10–11 in Franklin, featured a presentation on IgG4-related disease, which was recognized as a unique, unified autoimmune disease only in the past two decades. The presentation, led by John Stone, MD, MPH, professor of medicine, Harvard Medical School, Boston, introduced rheumatologists to the latest classification criteria and approaches to treatment.
TRS also supports an annual research conference for investigators across the state in conjunction with the annual meeting.
“The research presentations are informative and also allow attendees to interact and identify opportunities for collaboration,” Dr. Crofford says. “We encourage our trainees to participate in the annual meeting, and TRS has done a wonderful job of supporting our fellows and giving them the chance to present at the annual meeting. Fellows also learn more about the current issues facing rheumatology providers and patients.”
Linda Childers is a health writer located in the San Francisco Bay Area.
References
- Tennessee could add nearly 1 million new residents by 2040. The University of Tennessee–Knoxville, Tennessee State Data Center. 2022 Mar 9.
- 2021 state physician workforce report. Washington, D.C.: Association of American Medical Colleges, 2022 Jan.
- Senate Bill 1451; House Bill 1312. Tennessee General Assembly. 2023 Apr 24 (effective date).
- Senate Bill 1310; House Bill 0677. Tennessee General Assembly. 2022 May 11 (effective date).
