When you get sick, you go to the doctor.
But what happens when there’s no doctor to go to?
The number of doctors specializing in rheumatology is starting to dwindle.
As a result, these specialists — especially pediatric rheumatologists — are in high demand.
To combat this trend, organizations like the Rheumatology Research Foundation, the American College of Rheumatology (ACR), the Arthritis Foundation, and others, are trying to pique the interest of medical students and attract new doctors to the field.
Rheumatologists — doctors who specialize in autoimmune conditions — are of vital importance to people with diseases like rheumatoid arthritis (RA), lupus, and osteoporosis.
But rheumatology as a field doesn’t seem to be attracting enough new doctors to treat an ever-expanding group of patients.
An estimated 25 percent of adults in the Unites States have arthritis, and 1.5 million of them have RA. Additionally, there are more than 100 known unique rheumatic diseases.
However, there are few specialists available to treat these patients. There are only 1.7 rheumatologists per 100,000 people in the United States.
A need to meet a growing demand
A nonprofit called the Rheumatology Research Foundation is trying to lure medical students into rheumatology by offering them scholarships.
“Arthritis and other musculoskeletal problems are the number one cause of disability in America,” Foundation officials wrote in a recent press release.
Additionally, arthritis and other rheumatic diseases result higher medical costs than cancer, according to the foundation. They estimated that in the United States each year at least $127 billion is spent on medical costs related to rheumatic conditions compared with $104 billion in medical costs for cancer care.
“The shortage of doctors, especially rheumatologists, is a concern that drastically impacts the lives of people diagnosed with rheumatic disease,” said Mary Wheatley, IOM, CAE, the Foundation’s executive director. “Many patients must wait months to see a rheumatologist, which prolongs treatment and has a negative impact on their health. Not to mention the impact that missed days at work and the cost of disability insurance has on the economy.”
Living in a rural or less-populated area can make finding a specialist difficult. In 2013, the American College of Rheumatology published a study that found there may be no rheumatologists in some of these areas, causing patients to drive 200 or more miles to see a rheumatology specialist.
A 2007 study, also done by the ACR, concluded that demand for rheumatologists would likely exceed the number of practicing specialists in the coming decades, and that new strategies should be utilized to “adapt to this changing healthcare landscape.”
The ACR also noted that strategies “include increasing the number of fellows each year, utilizing physician assistants and nurse practitioners in greater numbers, and improving practice efficiency.”
To help untreated patients, the ACR has focused on patient registries and developed a consortium of rheumatologists to try to figure out how to provide better and more accessible care for people.
The ACR’s recent workforce study, like the 2007 study, showed that demand for adult rheumatology care exceeded supply; In 2015 it was 36 percent. Researchers expect that by the year 2025, approximately 3,800 more rheumatologists will be needed to meet patient demand.
Group taking action
The Arthritis Foundation is taking it a step further, using advocacy and going to Capitol Hill to make an impact when it comes to a specific type of rheumatoid arthritis — juvenile rheumatoid arthritis, now known as juvenile idiopathic arthritis.
The foundation is hoping to combat the serious pediatric rheumatology shortage. Currently there are fewer than 350 board-certified pediatric rheumatologists nationwide despite the fact there are nearly 300,000 juvenile arthritis patients.
In 2015, along with other groups, the foundation hosted a policy briefing in Washington D.C. to explain to lawmakers that this shortage could hurt patients.
In an effort to help these young patients, more rheumatologists may start treating people of all ages.
“I know for me it was hard to find a good rheumatologist who I trusted when I moved to West Virginia from Pittsburgh — so I continued making the one-and-a-half hours’ drive back to my rheumatologist in Pittsburgh,” said patient Chelsea Walker. “There’s no pediatric rheumatologists around that I know of.”
In addition to these steps, the ACR launched the Simple Tasks campaign. This initiative is busily addressing the issue — even going so far as to attempt to educate and work with congressional representatives on the topic.
They are advocating for student loan forgiveness for rheumatology doctors, allowing more international doctors to practice in the United States, and increase residency slots.
They’ve also formed a special committee to work on the topic in Congress, and are supporting a new bill: Conrad State 30 & Physician Access Act. The bill would keep premium visa processing for international doctors, which would allow them stay in the United States after finishing residencies, if they would agree to practice in rural or underserved communities where rheumatologists are scarce.