Some much less populated areas that have an academic or specialty medical center such as Rochester, Minn. (Mayo Clinic), and Marshfield, Wis. (Marshfield Clinic), have a high concentration of adult rheumatologists. The need for pediatric rheumatologists is striking in many metropolitan areas, even those with a population of more than one million, including Las Vegas, Nev.; San Antonio, Texas; Charlotte, N.C.; Austin, Texas; and Birmingham, Ala. Areas with the highest concentration of adult rheumatologists are New England and the Mid-Atlantic. The central and mountain states, Hawaii, and Alaska, have the lowest concentration.
A secondary factor that affects the future workforce is the number of rheumatologists who plan to retire in the near future. This number may be offset by the number of medical school graduates who will fill a rheumatology fellowship. The study predicts that the number of fellowship positions is not likely to increase but will remain constant, as will the number of international medical school graduates. There is also likely to be an increase in the demand for both adult and pediatric rheumatologists, based on increases in the U.S. population as a whole and an increase in real personal income per capita.
Dr. Birnbaum says in his response to the study that it is highly unlikely that the number of fellowships in rheumatology can be increased to meet the growing demand. “The expansion of current training capacity in rheumatology would require not only an increase in salary support for fellows,” he says, “but also meaningful growth in training resources including academic faculty, dedicated space for educational endeavors, and increased clinical opportunities.” He continued, “It seems unlikely that we will see any significant growth in the number of rheumatologists entering the workforce any time soon.”
Practice Patterns
Most practicing rheumatologists are white (79%) and married (89%). Nearly half (44%) of women in practice have school-aged children. The primary practice setting is split among group practice (43%), solo or partnership practice (32%), and medical school (16%). Nearly three-quarters (74%) have an infusion unit, 64% densitometry, 55% X-ray, and 61% an on-site laboratory. A growing number (21%) of practices have early arthritis centers. The survey found that the majority of pediatric rheumatologists were unwilling to treat a patient over age 18 (44.9%) or age 21 (33.3%). Among adult rheumatologists, 27.7% says the youngest they would want to treat a patient would be 16 to 17 years, and another 22.4% says they would be reluctant to treat a patient age 12 to 15.
