Addressing the challenges of a shrinking rheumatology workforce

It’s no secret that the physician shortage is worsening. By 2034, experts believe that the shortage will grow to between 37,800 and 124,000 physicians, according to a 2023 article published by the American Medical Association.^[]

Among the shortage of physicians is rheumatologists, an issue that is exacerbated by the growing prevalence of rheumatic disease among the aging population.^[] In order to help patients get the care they need, practicing rheumatologists may make more regular use of telemedicine alongside burnout reduction strategies.

Behind the rise in rheumatic diseases

According to authors of a 2023 article published by Nature Reviews Rheumatology, a large-scale, population-based study in the UK reveals that socioeconomic and environmental factors may play a big part in the development of rheumatic disease.^[]

The study utilized EHRs of 22,009,375 patients associated with the UK Clinical Practice Research Datalink. Researchers then used these records to analyze the incidence, prevalence, and co-occurrence of the top-19 most common autoimmune diseases (including several rheumatic diseases) between 2000 and 2019.

In addition, rates of co-occurrence of disease spiked among patients with connective tissue diseases, such as systemic lupus erythematosus and systemic sclerosis.

The authors elaborate on the clinical significance of these results: “In our view, the co-occurrence rates we observed are greater than what one would expect by chance or increased screening, and provide important real-world, population-based support for the long-held notion that overlapping genetic or environmental risk factors exist across rheumatic diseases.”

Socioeconomic status had a bearing on the incidence figures. When compared with patients of higher socioeconomic status, individuals in the lowest socioeconomic quintile had a greater chance of developing rheumatoid arthritis (incidence rate ratio, 1.55; 95% CI, 1.45–1.59) or systemic lupus erythematosus (incidence rate ratio, 1.35; 95% CI, 1.25–1.46).

These findings reveal that such variations are unlikely the result of genetic differences exclusively, but suggest that “potentially modifiable risk factors in the environment may be implicated in the development of these diseases.”

Addressing the rheumatologist shortage

Although the rheumatologist shortage in combination with the rise in rheumatic disease presents challenges, there are a handful of strategies physicians can employ to increase patient access to care.

To fully address the rheumatologist shortfall in a time of increasing need, interventions on several levels are required, as discussed in an article published by Seminars in Arthritis and Rheumatism.^[] Clearly, more rheumatologists need to be trained. But until this catches up, outpatient practices can make more use of NPs and PAs to expand the reach of the care they offer. For the individual practitioner, here are two ways you can meet your patients’ needs:

1. Expand the use of telemedicine. As the physician shortage worsens and many patients struggle to access adequate care, practicing rheumatologists may use telemedicine to help bridge the gaps.

The authors cite one small study, conducted through the Veterans Health Administration, which found that tele-rheumatology not only helped patients to access care by cutting down travel time, but it also addressed the timeliness of new patient appointments.

On a follow-up survey, 95% of the patients were reportedly willing to schedule another telemedicine visit, and those with inflammatory conditions had to wait significantly less time in between a telemedicine and an in-person visit.

The authors expand on the importance of telemedicine in addressing patient access to care:

“Telemedicine not only potentially extends our reach to underserved populations, but with rapid integration of phone and video virtual visits, our eyes have been opened to enhanced opportunities to provide care within our usual inpatient and outpatient settings.”

1. Beat burnout. The US rheumatology workforce shortage may be, in part, a result of burnout and overall job dissatisfaction among doctors.

According to authors of the Seminars in Arthritis and Rheumatism article, burnout rates among doctors have risen in recent years, affecting nearly half of physicians in the US.

Physicians can do their part to address symptoms of burnout by taking action to enhance their coping skills, as well as improve personal wellness. You may do this with tools such as mindfulness, cognitive-behavioral techniques, and physical exercise. 

“Interventions to reduce stress, burnout and competing responsibilities among fellows and practicing rheumatologists will be important in order to maximize the ability of rheumatology providers to provide optimal access to care,” the authors wrote.