Rheumatologists in Short Supply

By 2030 the nation will have only half the number of professionals it needs

By Deborah Jeanne Sergeant

If you need to see a rheumatologist, get in line. You will have a long way to go until you see one — and this waiting period won’t improve anytime soon.

By 2030 the nation will have only half the number of rheumatologists it needs. Presently, the U.S. is at 13 percent below the ideal number of rheumatologists, according to research by Rheumatology Service at San Antonio Military Medical Center in Texas.

“It’s been a long-standing problem and hasn’t changed,” said physician Thomas Madejski, who specializes in internal medicine, geriatric medicine, hospice and palliative care, and leads the Medical Society of the State of New York.

He said that many issues have caused the shortage, such as liability issues and, locally, “the hassles” of working in New York.

“The state medical society is working to improve the practice environment in New York state and its liability rate. We want to reduce the regulatory burden and make it less expensive for doctors to practice,” said Madejski.

The demand for care has also increased, including the aging baby boomer population as well as better diagnostic efforts and more treatment options. Madejski said that for 80 to 90 percent of osteoarthritis cases, a primary care, internist or family physician could provide sufficient care; however, some patients demand more care, which has affected the issue to a small degree.

Physician extenders — nurse practitioners and physician assistants — can help rheumatologists see more patients; however, Madejksi said that many primary care physicians even lack the experience and training to feel comfortable in prescribing some of the newer medication to treat patients with rheumatologic disorders.

“We need to re-examine how we educate and train physicians,” Madejksi said. “We should be training physicians more at this level. With telemedicine and tele-health we can leverage rheumatologists more to distill the essence of what we need: diagnosis and treatment so we can make it more efficient for them.”

Locally, the shortage persists as well, which can make setting appointments a struggle.

Physician Peter Deane, who is affiliated with  Allergy, Asthma, Immunology of Rochester, P.C. (AAIR), said that his offices “try to make as many slots available as we can” among the offices’ four rheumatologists.

AAIR has a waiting list some weeks, but generally meets demand. Deane wants more primary care physicians to prioritize referrals more carefully to help rheumatologists see only the patients that truly need their care.

Deane thinks that fewer new physicians are going into the specialty, partly because of the nature of rheumatology. The cases are usually complex and require longer visits with much discussion. While physicians want to meet patients’ needs, they also need to stay in business.

“Talking with people is very poorly rewarded in health care,” Deane said. “In other specialties people are reimbursed better. People going into rheumatology have no special advantage in paying off their student loans.”

AAIR doesn’t use many extenders, because of the specialized training rheumatology requires. Deane said that core medical training doesn’t cover it.

He said that AAIR works hard at recruitment and retaining physicians. Convincing people to want to move to Rochester is the first hurdle. Deane graduated locally and stayed. Selling outside medical students on living in the Flower City is very different.

Deane cited a  cold climate and high cost of living as deterrents.

“It’s not something where people wake up and say, ‘I want to move to Upstate New York,” he said.

He said AAIR tries to offer fair pay and good working conditions to keep physicians onboard.

Deane doesn’t foresee an imminent end to the shortage.

According to salary.com, New York state rheumatologists make an average of $ 231,375. In Rochester, it’s $220,183.