With California’s over-60 population projected to grow faster than any other demographic group, the California Rheumatology Alliance (CRA) is closely looking at how rheumatology professionals can best care for the state’s older adults. By 2030, 10.8 million Californians—one-quarter of the state’s population—will be older than 60.
Even as its population ages, California—like many states— simultaneously has a shortage of rheumatologists. Samy Metyas, MD, MSc, FACR, FACP, current president of the CRA, says the state association is actively addressing this shortage through several initiatives and events.
“One of these initiatives is the Advanced Practitioner Provider (APP) meeting that we’ve been thrilled to offer annually since 2023,” he says. “This meeting is designed to educate and train advanced practice providers, such as nurse practitioners and physician assistants, in rheumatology care. By enhancing the skills and knowledge of these professionals, the CRA aims to fill the gap caused by the shortage of rheumatologists, ensuring that patients continue to receive high-quality care. “
Shanna Castro, the CRA’s executive director, says the recent APP meeting also attracted many rheumatology students, as well as physicians and APPs from various specialties outside rheumatology.
In addition, Dr. Metyas says the CRA has supported the development of future rheumatologists by funding a pediatric rheumatology fellowship through Children’s Hospital Los Angeles (CHLA).
“This initiative is crucial [because] it helps increase the number of trained specialists in the field, particularly in pediatric care, where the demand for rheumatologists is also high,” Dr. Metyas says. “Through these efforts, the CRA is making significant strides in mitigating the impact of the rheumatologist shortage and improving access to specialized care for patients across the state.”
Celebrate the Past While Looking to the Future
One of the largest and most active state rheumatology associations, the CRA held its milestone 20th annual meeting in May.
“The feedback we received about our annual meeting was overwhelmingly positive, reflecting the high quality of the presentations and discussions,” says Ms. Castro.
Dr. Metyas adds, “Our distinguished speakers provided invaluable insights, offering updates and new perspectives and knowledge to rheumatologists and healthcare professionals.”
Among the speakers at the annual meeting were Gary Feldman, MD, assistant clinical professor of medicine, David Geffen School of Medicine, University of California Los Angeles, who discussed private practice survival, and Arthur Kavanaugh, MD, professor of medicine and director of the Center for Innovative Therapy, University of California San Diego, who gave an update on the latest treatments for psoriatic arthritis.
The CRA also has an active advocacy committee that works to ensure patient access to rheumatology care.
“Our legislative efforts on copay assistance, prior authorization and step therapy to assist in covering required medication are also priorities, aimed at caring for the aging population,” Dr. Metyas says.
Tim Madden, partner at Madden Quiñonez Advocacy, who works with the CRA, says the current bills the CRA is working on include:
- AB 2180: Health care coverage: cost sharing. CRA was a co-sponsor with a number of patient advocacy groups including the Hemophilia Council of California, Cystic Fibrosis Research Institute, ALS Association and Sickle Cell Disease Foundation. Although it did not pass the legislature this year, the bill would have required health plans to apply all monies used for out-of-pocket costs toward a patient’s out-of-pocket requirements, regardless of whether the funds were their own or from a third-party source.
- SB 516: Health care coverage: prior authorization. This bill would create a process in which prior authorization would not be required for specified services if those prior authorization requests had been approved more than 90% of the time. This would reduce treatment delays for patients and administrative time and burden for providers.
- SB 966: Pharmacy benefits. This bill would establish oversight authority for the state to regulate pharmacy benefit managers (PBMs). With no current oversight, PBMs can impact the healthcare marketplace in a way that hurts both patients and physicians. The bill also includes provisions prohibiting PBMs from steering patients to a particular pharmacy.
CRA is considering sponsoring legislation in 2025 to prohibit PBMs and health plans from restricting patient access to in-office treatments.
Plans for the 2025 annual meeting are also underway. “We’re looking to do something special by combining all of our programs into one big meeting,” Ms. Castro says. “Our goal is to foster greater networking and collaboration between physicians, APPs and managers. It promises to be an incredible opportunity for everyone to connect, learn and grow together as professionals and a community.”
Linda Childers is a health writer located in the San Francisco Bay Area.
