Amid growing concern of a potential shortage of physicians in the near future, the ACR has been looking closely at how we can efficiently handle the increasing demand for patient care. The changes in demographics of our trainees, the need for nurse practitioners (NPs) and physician assistants (PAs), and the initiation of healthcare reform will significantly impact our future projections. Increasing the size and diversity of our workforce requires that we be innovative, from how we run our practices now to thinking about who will run and work in our practices in the future.
Choosing Rheumatology
More than half (58.7%) of the 395 fellows-in-training who participated in the 2010 Adult In-Training Exam indicated that they made the decision to pursue rheumatology during their residency. These numbers are consistent with national trends and highlight the need to increase exposure to rheumatology during the early years of training.
The Association of Program Directors in Internal Medicine and the Association of Specialty Professors recently presented a joint proposal to the ACR suggesting that we change the timing of the match in rheumatology from June of the second year of residency to December of the third year of residency. Under the new schedule, third-year residents would submit fellowship applications in July and interviews would take place from late summer through early November. Applicants and programs would submit rank order lists in mid-November, and the match would take place in early December.
Why the proposed change? In 2004, the American Journal of Medicine published data stating that nearly 69% of internal medicine residents felt the subspecialty match date was too soon to make an informed decision.1 To facilitate an informed decision-making process, residents must have up-to-date and comprehensive information as they make specific plans about their future career path. Information such as professional development opportunities, supply and demand of subspecialists, lifestyle, and compensation packages are important factors to consider. Having such information is not only in the interest of individual students, it is also essential for ensuring the preparation of a physician workforce capable of meeting the needs of an ever-growing population.
When polled about the change, 92% of adult program directors responded they were in favor of it. Both the National Resident Matching Program and the Electronic Residency Application Service have vetted this proposal for feasibility. If implemented, the change would be effective July 1, 2013.
Increased Funding for Fellowship Positions
Findings of the 2008 ACR Academic Workforce Study indicated that nearly 25% of unfilled Accreditation Council for Graduate Medical Education (ACGME)–accredited fellowship positions were empty due primarily to insufficient funding for fellows’ salaries. What can the ACR do to combat the lack of funds for fellowship positions in the short term? We could all think of a dozen or more ways to effectively spend our way out of the funding deficit; however, a key step in reaching the goal of having more rheumatology fellows is building a sustainable organizational structure capable of developing mechanisms to increase fellowship positions across the country.
This spring, the ACR Research and Education Foundation (REF) presented an interim solution to increase funding for fellows-in-training. The REF, in conjunction with the ACR Committee on Rheumatology Training and Workforce Issues, developed a pilot program built on an already successful award program, the Rheumatology Fellowship Training Award. The current award of $25,000 is insufficient to fully fund one year of a fellow’s salary, so the pilot program earmarks two grants at $50,000 each to allow programs to fully fund one fellow for a year. Program directors can leverage this funding to gain additional funding for second- and third-year fellows, or to fund another slot. The pilot program is designed to address three goals: create a new fellowship position, preferably one that was previously ACGME-accredited but unfilled due to lack of sufficient fellow salary funding; increase the number of underrepresented minority fellows-in-training; and fund a fellowship slot committed to fellows-in-training with a high likelihood of pursuing a career in academic rheumatology. The pilot program will continue for at least two cycles while the REF evaluates the efficacy of this funding increase.
Promoting Diversity
An increasingly diverse population, coupled with growing evidence of persistent healthcare disparities faced by minority populations, demonstrates a need for a more diverse rheumatology workforce. The 2006 Rheumatology Workforce Study by the Lewin Group found that only 5% of rheumatologists designated themselves as African-American or Hispanic. By 2050, racial and ethnic minorities are projected to account for half of the U.S. population. Because minority physicians are more likely to treat minority and indigent patients and to practice in underserved communities, it is imperative that we increase the number of minority physicians—and soon.
Increasing diversity in the physician workforce ensures that the healthcare system is representative of the nation’s population and responsive to its healthcare needs. We must continue cultivating a more culturally diverse workforce in order to provide the best care to an increasingly diverse population.
Next Steps
A 10% annual increase in rheumatology fellow trainees is the minimum needed to meet projected needs for clinical rheumatologists. There are many challenges to meeting this workforce demand, and the ACR continues to examine workforce trends and look for ways to improve processes affecting the physician pipeline. While it is certainly true that subspecialty choice depends on the individual decisions of medical students and residents, we, as an organization, must do everything we can to promote rheumatology and encourage students and residents to consider a career in this meaningful area of work. Many factors, including an aging population, rising obesity rates, and prolonged survival of patients with chronic disease are placing our physician workforce under stress. While the ACR makes strides to evaluate the ever-changing landscape, we must remain aware and engaged in the current reality. Increasing the size and diversity of our workforce requires that we be innovative, from how we run our practices now to thinking about who will run and work in our practices in the future.
Dr. Cohen is president of the ACR. Contact him via e-mail at [email protected].
Reference
The Next Six Months Are Critical to Repealing SGR
This year has proven to be a frustrating year for all of us. We have repeatedly faced the prospect of a steep 21 percent cut to our Medicare payments, and have been anxiously waiting for Congress to take action. Although we finally received a temporary fix, our real work lies before us.
The Sustainable Growth Rate (SGR) formula has been flawed from its inception, but Congress has repeatedly placed temporary patches on the problem and ignored the need for a permanent solution. The price tag to implement a permanent fix has grown to over $210 billion and will continue to rapidly increase. The future of Medicare is at risk. This approach cannot continue.
The ACR has been actively engaged in advocacy efforts for several years, urging Congress to permanently repeal the flawed formula. For several years this has been our top legislative priority during the annual Advocates for Arthritis fly-in in Washington D.C. ACR and ARHP members have been encouraged repeatedly to reach out to their respective members of Congress to ask for a permanent fix. That work will continue.
We have developed Medicare posters and fliers for your offices to help you educate and include your patients in our efforts. We have sent, and will continue to send, independent and coalition letters to Congressional leadership informing them that this “kick-the-can” approach to the SGR is unsustainable. We have submitted, and will continue to submit, articles to major media outlets. Patient organizations will continue to be urged to get involved to ensure that seniors maintain access to their physicians.
As your professional organization, the ACR is doing all that it can, but it is through the grassroots efforts—all rheumatologists, all physicians, all health professionals, and especially all of our patients—that must individually and collectively step up, take action, and demonstrate to Congress that this issue is real and it must be addressed now. Mobilizing millions to make phone calls, write personalized letters, and meet with Congressional members is what is absolutely essential to making a difference.
Rheumatology is a small subspecialty, but we see millions of patients. The ACR is committed to working with the American Medical Association, American College of Physicians, and other medical specialties, as well as patient organizations, to mobilize the masses to ensure that by November 30, Congress will pass a permanent repeal to the SGR and Medicare patients will be comforted knowing they are no longer at risk of losing their physicians.
As physicians and healthcare providers, we made a commitment to care for those in need—especially seniors. Don’t allow Congress to use us as pawns in a political game.
Call your U.S. Representative and Senators frequently to express your frustration and encourage your patients to do the same. The ACR staff are available to assist you, and can be reached at [email protected]. The latest news information on the SGR is available online at www.rheumatology.org.
Now is not the time to rest. You have a critical role in this battle.
You must take action.
