What can the profession do to meet this demand? The workforce study recommends increasing fellowship positions, increasing the work effort of rheumatologists, improving practice efficiency, and using more allied health professionals including trained rheumatology nurse practitioners and physician’s assistants. Two professionals who played a significant role in identifying these possible solutions are Tim Harrington, MD, a rheumatologist in practice at the University of Wisconsin who has studied and developed alternative practice designs, and Rod Hooker, PhD, PA, a physician assistant in a rheumatology practice at the University of Texas Southwest in Dallas.
Literature Overview
The backdrop for the study results is a review of the literature on the prevalence and costs of musculoskeletal diseases, technological advances in the treatment of RA and lupus, practice efficiency, and changes in Medicare coverage and payment policies.
The review found that arthritis and musculoskeletal disorders are among the most frequently occurring chronic conditions in the U.S. Approximately 47.8 million Americans had arthritis in 2005. That number is expected to rise to 67 million in 2030. Another 2.1 million Americans had rheumatoid arthritis in 2005; juvenile rheumatoid arthritis cases in the U.S. number between 30,000 and 50,000, with half of the cases being inactive. The prevalence of RA is estimated to rise to 2.8 million by 2025. Osteoarthritis is the most common type of arthritis. Estimates are that 20.7 million Americans had osteoarthritis in 2005 and that the prevalence will rise to 28.1 million by 2025. Studies show that women are nearly eight times more likely to have osteoarthritis than men.
Medicare and other payment policies have changed in the past few years in ways that affect the demand for rheumatology services. The Medicare Replacement Drug Demonstration allowed a limited number of beneficiaries with rheumatoid or psoriatic arthritis to receive coverage for self-injecting biologics. Medicare Part D now covers this therapy. Reimbursement for on-site infusion has been decreased, which may require rheumatologists to reduce the number of infusion sites and the size of staff to cover costs.
Current and Future Workforce
Researchers used AMA files supplemented with the ACR membership list to identify 4,946 current adult rheumatologists and 218 pediatric rheumatologists in the U.S. The vast majority (94% adult rheumatologists and 92% pediatric rheumatologists) treat patients. The median age for adult specialists is 51; for pediatric rheumatologists, it’s 47. Approximately 70% of adult rheumatologists are male; 51% of pediatric rheumatologists are female.
The number and geographic location of rheumatology practices in the United States varies significantly. Boston has both the highest number of adult and pediatric rheumatologists. Areas with the highest concentration are in large urban areas such as metropolitan New York/New Jersey and metropolitan Los Angeles. But the distribution patterns are not consistent in all large cities; Dallas-Ft. Worth and Houston have much lower numbers. Phoenix, Ariz., (population 3.5 million) has no pediatric rheumatologists. The areas with the lowest concentration of adult rheumatologists include major population areas such as Baton Rouge, La., and Bakersfield, Calif.
