Challenges in Rheumatology Workforce

Nehad Soloman, MD: The rheumatology workforce is a problem and has been a problem for some time. It will continue to be a problem, and by 2030, we're going to have a large problem on our hands. However, through the efforts of the American College of Rheumatology and other subcommittees, workforce committees, they are finding various solutions. Some of those solutions may include expansion of existing rheumatology fellowships. However, rheumatology fellowships in underserved demand areas are critical. Expansion in the southwest, for example, or parts of the Midwest or the mountain West, are severely underserved. We know most folks will train and then continue to practice where they train. Expanding a fellowship in a major city, a metropolis where there's tons of rheumatologists doesn't necessarily help the workforce shortage situation. The other aspect or the short-term solution is to help identify ways in which rheumatologists can increase their time practicing and decreasing the burnout and the burden if you will. Part of that is the introduction of advanced practice providers. Our group has been the forerunners, if you will, of utilization of advanced practice providers in rheumatology. We've got 37 of them at this point in our practice. They outnumber our physicians. We have nearly 20 rheumatologists practicing. Our ratio is almost a 2:1 ratio where each rheumatologist will have 2 advanced practice clinicians working under them or with them. We like to look at them as colleagues. We spend time training them, educating them, and giving them the tools to be successful while continuing to support them through practice. As these models continue to expand, my hope is an increasing number of fellowships for both PAs and nurse practitioners will arise so that they get a lot of that training before they go out into the workforce and can help struggling rheumatologists who may not necessarily have the time to train a PA or an NP. The idea isn't just to expand the workforce, but also provide quality workforce and so it's very important not to just throw an advanced practice provider into the fire, if you will, but rather give them the tools to be successful. Then the last aspect includes better education of the primary care physicians and which referrals they decide to send us, rather than just sending anybody with any ache and pain or any abnormal lab test, helping them to understand what the first steps in identification of rheumatic disease may be. That starts again, back in residency with better education and exposure to rheumatology, medical school with better education and exposure to rheumatology, increase the interest in both adult and pediatric rheumatology so that we can drive more folks to come in whether it's at the MD level, the DO level, the PA, or NP level. All those factors play a role. It is my firm hope that within the next 5 years, we'll start to impact change by implementing all these modalities.

Transcript Edited for Clarity