By Frederique H. Evans, MBS
The American College of Rheumatology (ACR) Committee on Rheumatology Training and Workforce Issues found ongoing regional shortages in the rheumatology workforce and highlighted potential target communities that may benefit the most from the addition of a local rheumatologist, according to a recent report in the December 2013 issue of Arthritis & Rheumatism (American College of Rheumatology Committee on Rheumatology Training and Workforce Issues. 2013;65:3017-3025).
In an effort to better understand the regional number of rheumatologists, the investigators used the ACR membership database to map all adult practicing rheumatologist office addresses and calculate the number of rheumatologists per Core Based Statistical Area (CBSA) and their density. Data pertaining to age, sex, race/ethnicity, and median household income were collected from the 2010 US Census to determine whether sociodemographic factors impacted rheumatologist clusters. Regional areas were defined as metropolitan if they included a population of 50,000 or more, and micropolitan if the population was 10,000 or more and less than 50,000. Potentially underserved areas were defined using a modified Lewin report–defined threshold of 1.67 rheumatologists per 100,000 persons to include travel distances to the nearest rheumatologist.
Overall, 3920 practicing rheumatologists from 48 states and the District of Columbia were identified from the ACR database. Ninety percent of rheumatologists practiced in metropolitan areas, 3% in micropolitan areas, and 7% in rural areas. A greater proportion of rheumatologists practiced in metropolitan areas than would be expected based on population distribution alone (P <.001), the committee observed. Nine percent of metropolitan areas did not have a practicing rheumatologist, compared with 84% of micropolitan areas. In addition, they found that some large CBSAs (population >200,000) were without a practicing rheumatologist, and some had a travel distance of 94 miles to the nearest rheumatologist. Some smaller micropolitans, however, had a travel distance of more than 200 miles to the nearest rheumatologist.
Taking a closer look at regional characteristics associated with the distribution of rheumatologists, the committee found that rheumatologists were more likely to practice in areas with higher population densities and median incomes. Rheumatologists were also more likely to practice in CBSAs with training programs.
“Simply providing up-to-date information about the local supply of rheumatologists could attract more rheumatologists to underserved regions through migration, expansion, or attraction of new rheumatologists,” they suggested. Additional funds to training programs in these areas may also increase the number of rheumatologists, the committee added. Other solutions included traveling clinics, e-mail, as well as videoconsultation via direct care rheumatologist-to-patient interview or peer-to-peer consultation. The committee also briefly touched upon the Affordable Care Act, which provides funds for primary care training as well as a loan forgiveness program, noting that rheumatologists are not eligible for these programs.
This research is critical for identifying underserved areas, the ACR Committee on Rheumatology Training and Workforce Issues concluded. Additional research is warranted before the implementation of policies and reallocation of resources are considered.