The ACR Benchmark Survey Results

In 2009, the ACR’s Committe­e on Rheumatologic Care (CORC) began its third Economic Benchmark Survey to update information from the previous surveys conducted in 1999 and 2003.

“The ACR’s primary purpose for this project was to ensure an adequate rheumatology workforce in an era of increased numbers of uninsured and underinsured [people] in the general population, increased [incidence of] chronic and musculoskeletal diseases, and an expanding population of aging citizens,” says Karen Kolba, MD, chair of CORC. There were four main objectives to this survey:

• Collect data and evaluate the work of rheumatologists in both academic settings and private practice;
• Identify the number of full-time equivalent physicians and nonphysician providers (such as physician assistants and nurse practitioners) needed to staff rheumatology practices to maintain the healthcare safety net;
• Collect physician and non-physician provider staffing and personnel data, including minimum and maximum staffing levels, average patient per adjusted hour, staffing levels, turnover rates among staffing categories, vacancy rates, time required to fill vacancies, on-call time, etc.; and
• Collect critical demographic information and characteristics, including information on those rheumatologists expected to close a practice in the near future, the age of the current workforce, likely number of years until retirement or transition to other employment, the number of rheumatologists working less than a full clinical schedule, training qualifications, etc.

To participate in the survey, members must have been currently full-time and actively practicing rheumatologists working in academia or private practice.

Key Results from the Survey

Research from the private practice area showed:

1. There is a fairly even split between solo private (36%), single-specialty group (30%), and multi-specialty group (34%) practices. There are an average of five rheumatologists within the single-specialty group and four within the multi-specialty group.
2. Five in 10 rheumatologists in private practice report all of their practice is adult rheumatology, while four in 10 report that 50% or more of their practice is adult rheumatology. A large majority reported zero primary care (80%) and pediatric rheumatology (70%).
3. The majority of rheumatologists in private practice are compensated by their fee for services rendered. This is particularly true for single-physician clinics. Those practices that offer salary plus incentive bonus drive their bonus mainly off of productivity.
4. Seventy-two percent of rheumatologists in private practice state that all personal sources of compensation come from direct patient care, with multi-specialty averaging the highest at almost 80%, followed by solo private practice at 78% and single specialty at 62%.
5. Rheumatologists in private practice receive the majority of their revenue from Medicare and PPO/HMO insurance programs, regardless of the type of practice they are in.

Research from the academic area showed:

1. Rheumatologists who view themselves primarily as a clinical teacher or clinical investigator see an average of 44 patients per week. Of those, 72% are established patients.
2. More than one-third of rheumatologists practicing in academia report that their primary salary source is from clinical income, while one in five rheumatologists practicing in academia relies on grant support for their salary.
3. Rheumatologists practicing in academia scheduled an average of 16 hours per week of clinic time. Additionally, one in four rheumatologists is in the clinic at least once a week; one in three is in the clinic at least two to three days per week; and nearly one-fourth are in the clinic four to six days per week.
4. More than half of rheumatologists practicing in academia reported that they need about the same number of full-time equivalent rheumatologists. One in four reported they need more full-time equivalent rheumatologists, reporting an average of two needed.

In addition, more than half of rheumatologists practicing in both private practice and the academic setting reported a need for more full-time equivalent rheumatologists to meet the needs of Americans suffering from rheumatoid arthritis and other musculoskeletal disease.

In Comparison

Comparing the 2009 survey results to those of the 1999 and 2003 surveys showed significant changes.

The 2009 survey showed no significant change in salary range; for private practice and academicians, 88% reported an annual income of $150,000–$250, 000. In the 2003 survey, rheumatologists between the ages of 50 and 59 reported that they would greatly reduce direct patient care hours in the next 15 years. In the 2009 survey, this group reported that they now plan to to substantially reduce their direct patient care hours by the time they reach 60–65 years of age.

There was a significant change in the use of advance nurse practitioners (NPs) and/or physician assistants (PAs). Respondents indicated in 2003 that they used NPs and PAs sparingly. In 2009, 24% planned to hire additional NPs and PAs in the next five years, while 73% plan to hire at least one NP or PA.

The 2003 study reported that 48% of rheumatologists were requiring their patients to provide physician referrals; the 2009 survey found that this had increased to 55%.

It is especially important in this era of increased numbers of uninsured or underinsured patients and an aging population that we ensure our nation has the ability to respond to the increasing need for rheumatologic care. While many Americans take for granted the quality and availability of internal medical care in their community, many others are faced with substandard conditions or lack access to rheumatology practices and personnel.

The Economic Benchmark Survey functions as a tool for ACR and its partner organizations to identify the characteristics and trends of rheumatologists and to advocate for legislative, regulatory, and policy changes at the federal, state, and local levels. The results of the 2009 survey will be used to attract the attention of a wide variety of audiences to evoke action and advocacy to reverse the shortage of rheumatologists in the U.S. Moving forward, the ACR plans to add the Economic Benchmark Survey to its website, so that ACR and ARHP members can update their information annually.

Visit the ACR website at www.rheumatology.org/practice under Office Support to view the entire 2009 Economic Benchmark Survey report. For specific questions about the 2009 survey, contact Antanya Chung in the ACR’s practice management department at [email protected] or (404) 633-3777.