The other day I was in my rheumatologist’s office and I was inquiring about making an appointment. The receptionist asked me, “When would you like to see your doctor?” I answered, “The sooner the better.” She replied, “The earliest your doctor can see you is in 4 months.”
After the initial shock began to wear off and I picked myself up off the floor, I was able to listen to her explanation. “There is a massive shortage of rheumatologists. People are retiring and no new doctors are replacing them.” At first I thought, “How unfortunate for the Pacific Northwest.” But when I got home, I wondered if this was only something that was affecting my area. So I began to research the subject and sadly, it is not. This is a nation-wide problem. In fact, in some areas individuals have to travel more than 200 miles to see the closest rheumatologist.
Wait, how far?
Considering that arthritis and other musculoskeletal and rheumatic diseases (like lupus) affect nearly 50 million Americans (300,000 being children) and are the #1 cause of disability, this is astounding. On top of that, rheumatic diseases are responsible for $127.8 billion in medical costs in the U.S. (beating cancer care costs by nearly a quarter more). Having medical support for those suffering from these health conditions is not a luxury, it is a necessity. When a person suffering from SLE or other related illnesses does not see his or her doctor, it can result in worsening of symptoms, organ damage (or failure), depression, isolation or even in severe cases, death.
In 2005, The American College of Rheumatology conducted a study examining the number of rheumatologists in the U.S. The findings of the study were bleak, to say the least. Roughly ten years ago it was estimated that in America, there was 1.7 adult rheumatologists per 100,000 people. It was projected that by 2010 there would be a shortage of 400 rheumatologists, raising to a shortage of 2,500 by the year 2025. Sadly, 90% of existing doctors are practicing in metropolitan areas, and so those living in smaller micropolitan have few or no practicing adult rheumatologists at all.
My research led me to ask why? Why the shortage? Why is it so hard to attract more medical students to the field of rheumatology? In an article posted in The Rheumatologist by Simon M. Helfgott, MD, (associate professor of medicine in the Division of Rheumatology, Immunology and Allergy Harvard Medical School), he states, “Despite the best intentions of the American College of Rheumatology, the Foundation and Fellowship programs to recruit the next generation of rheumatologists, our workforce census remains flat.” Factually, doctors specializing in rheumatology are close to the bottom on the salary totem poll. With the top pay scale winners being orthopedic surgeons, cardiologists and anesthesiologists. But, in regards to quality of life, they rank pretty high. So what else is it then? Why are the minds of millennial medical students choosing different paths?
Let’s take a look at med school. The majority of med students will have exposure to the field of rheumatology in their second and third year after typically doing an internal medicine or pediatrics residency. They will spend an additional two to three years in a rheumatology fellowship learning the details and subtleties of the field. Studies by the American College of Rheumatology have shown that 75% of students solidified their decision to choose the field during internship and residency. Role models and mentors during clinical rotations were pivotal in keeping them there and their intellectual interest in the field is what sealed the deal. So if these med students are not getting connected with strong leaders and mentors, they are being drawn to different specialties. Specialties that pay more. Specialities that will help them pay off their med school loans. Boo.
Rheumatologists are physicians who treat and diagnose people who have lupus and we desperately need them. Their knowledge, and dedication to this field is immensely valuable! Only time will tell if this issue will get better or worse. And in the meantime, if you find a rheumatologist you like, make sure you don’t move to a remote town. Just kidding! In all seriousness, if you do relocate, make sure to always get copies of your original labs, initial doctor’s notes, biopsy results and x-rays!
Sources: cbsnews.com/media/what-doctors-earn-highest-and-lowest-paid-specialties, the-rheumatologist.org/article/attracting-more-medical-students-to-rheumatology, www.rheumatology.org/I-Am-A/Student-Resident/Explore-Rheumatology/Choose-Rheumatology, wiley.com/WileyCDA/PressRelease, nationalpainreport.com/shortage-rheumatologists-growing-worse, amazon.com/Lupus-Encyclopedia-Comprehensive-Patients-Families
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