A shortage of practicing rheumatologists in the U.S. is likely to grow worse over the next decade, according to a new study, delaying treatment for many patients with autoimmune disease and forcing some to travel hundreds of miles reach the nearest rheumatologist.
Using a database of members in the American College of Rheumatology (ACR), a team of researchers analyzed the distribution of rheumatology practices across the U.S.
They found that in 2010 there were 3,920 member rheumatologists in the 48 contiguous states – with 90% of them practicing in metropolitan areas with at least 200,000 people.
Although rheumatologists clearly had a preference for practicing in urban areas with high median incomes, 31 metropolitan areas did not have any practicing rheumatologists, forcing some patients to travel up to 94 miles to see one.
The shortage of rheumatologists was particularly acute in less populated regions. Only 3% of ACR members practiced in “Micropolitan” areas with less than 50,000 residents. A majority of Micropolitan areas (84%) did not have any rheumatologists, forcing patients to travel over 200 miles to be treated by one.
The ACR study is published in the journal Arthritis & Rheumatism.
“Our study highlights that regional shortages of rheumatologists already exist,” said Dr. John FitzGerald from UCLA Rheumatology at the David Geffen School of Medicine in Los Angeles.
“There are a number of communities across the U.S. that would benefit from additional rheumatology services.”
A previous ACR study conducted in 2005 found that there were about 1.7 rheumatologists for every 100,000 persons. At the time, the demand for services and the number of rheumatologists was considered “proportionate.”
However, with the aging of U.S. population and lack of growth in the number of rheumatologists, researchers projected that by 2010 there would be a shortage of 400 rheumatologists and that number would climb to 2,500 by 2025.
“The maldistribution of physicians is not a new problem and may get worse in the coming years,” said Dr. Chad Deal of the Cleveland Clinic in an editorial also published Arthritis & Rheumatism.
“For patients with autoimmune and inflammatory diseases rheumatologists are specialist physicians who are central to early diagnosis and treatment, which evidence suggest is most important within the first few months of disease onset to limit joint damage, improve physical function, and induce remission.”
Deal and the study authors say interventions are needed to increase the supply of rheumatologists in underserved regions. They suggest that the ACR commit to provide information to medical school graduates, so they can be aware of practice opportunities. They also called for expanded roles for nurse practitioners and physician assistants to help care for patients with rheumatic diseases.
The shortage of physicians is not limited to rheumatologists. The American Association of Medical Colleges estimates a potential shortage of 90,000 doctors in the next decade including 46,000 specialists. The U.S has fewer primary care doctors, about 30 for every 100,000 residents, than any other industrialized country.