Understanding the character and composition of the overall rheumatology workforce is essential to meet the challenges facing our profession and to provide adequate care for patients with rheumatic and musculoskeletal diseases. Assumptions about the future supply of and demand for rheumatologists have broad implications for training, recruitment, practice management and funding in the field, as well as our ability to provide care for increasing numbers of patients.

To address the need for current and accurate information in this area, the ACR, under the guidance of the Committee on Training and Workforce Issues and its Subcommittee on Workforce, contracted with the Lewin Group, a leading firm in the area of workforce projections, to conduct a study of the rheumatology workforce in the United States.

The major findings of this study are published in the March 2007 issue of Arthritis and Rheumatism. Highlights are included here. The entire study report is available to ACR members in pdf format . In addition, an official ACR response to the report is published in the March 2007 issue of A&R. Other efforts to disseminate the results of this study include a summary poster presented at the 2006 ACR Annual Scientific Meeting [for best viewing, save file and open separately] in Washington D.C. and a series of articles in The Rheumatologist, beginning with "Who Will Treat Arthritis in 2025" in the January 2007 issue. Additional information available on this site includes a summary of survey data obtained as part of the workforce study conducted by Lewin to members.

Purpose: Where are We, and Where are we Going?

The purpose of the workforce study was to gain a better understanding of the factors affecting rheumatologist supply and demand, to quantify these factors where possible, to project likely directions for the evolution of the workforce including projections of future supply, and to assess the implications of the findings of the study. Another important goal of the study was to provide more detailed information on the current rheumatology community. Very little of this kind of information is available in public databases and it was important information to inform the workforce study.

The Lewin Group conducted a survey of practicing rheumatologists between November 2005 and February 2006. The survey included the following topics: education and professional qualifications, work effort and productivity, conditions treated, distribution of time across work activities, employment setting characteristics, measures of excess demand, job satisfaction, retirement plans, sources (e.g., grant support, clinical trials, office-based technologies) and level of income.

Guided by Rheumatologists

A major source of information for this study was an Advisory Group formed by the then chairman of the Committee on Training and Workforce Issues, Dr. Walter Barr, and chaired by Dr. Chad Deal. The Advisory Group was a source of institutional and clinical information relevant to the rheumatology physician workforce, as well as guidance for the study itself.1 Other sources of information for the survey included a literature review and survey of national databases. An important component of the Workforce Study was the development of a computer model of supply and demand that provides sensitivity analyses of key components including number of fellows trained, retirement rates, physician assistant/nurse practitioners (NP/PA's), hours worked, gender/age effects, lifestyle changes and macroeconomic factors reflected by changes in Gross Domestic Product. This model will be valuable in evaluating the impact of proposed solutions to the projected workforce shortage.

Results: A Few Surprises, and a Starting Point

Overall, this landmark study represents the most comprehensive evaluation of the practice of rheumatology in the United States. The study gives important insight to the current state of both adult and pediatric rheumatology and has major implications for the future character and health of the profession. The major conclusion of the study is probably not surprising to anyone who takes care of patients with rheumatic and musculoskeletal disease: the model predicts a large shortage of rheumatologists over the next 20 years. However, there are a number of important and some surprising implications raised by the study.

In many ways, this study represents a starting point. Many of the issues raised and addressed in the study deserve additional examination and more focused analysis, including the contribution of women to the rheumatology workforce, supply and demand for pediatric rheumatologic care, rheumatology salary benchmarks and the future of academic rheumatology.

Finally, this study demands that we begin to develop strategies that address the predicted imbalance of supply and demand. We encourage all ACR members to review the study and become involved in a dialogue about any of these issues that are important to you.

The members of the Advisory Group were Walter Barr, Neal Birnbaum, Dennis Boulware, Paul Caldron, Timothy Harrington, Marc Hochberg, Roderick Hooker, Julianne Orlowski, Stephen Paget, Christy Park, Audrey Uknis, and Patience White.