One local clinic is booked so far in advance that in late May it wasn’t even making appointments—just taking contact information for a wait list.
It’s not much comfort, but the shortage in the subspecialty is national. A workforce study published last fall by the American College of Rheumatology found that the number of patients needing to be seen exceeded the capacity of physicians to see them by 36 percent. And the prognosis for the future is grim, as an aging population proves to be a double-edged demographic sword: older rheumatologists are cutting back on their practices or retiring, even as older patients, prone to arthritis and other musculoskeletal ailments, increasingly require their services.
“Someone diagnosed with lupus or rheumatoid arthritis requires long-term follow-up care,” says Michigan Medicine’s Seetha Monrad, who co-chaired the group that produced the study. “People’s practices become full with patients they see regularly, which means less opportunity to see new patients.” Determining who needs that kind of care adds to the problem.
“The majority of arthritis is osteoarthritis [so-called ‘wear and tear’ damage], which can be managed by other specialists than rheumatologists,” she says. “But there are an increasing number of referrals to insure that there’s not something else going on.” Making the storm more nearly perfect, “a lot of rheumatologists are retiring or cutting down their practice a little earlier than they might have otherwise.”
Among the leading causes, she says, are the demands of electronic health records (“The Trouble with EHR,” March 2017). The increasing administrative and regulatory pressure for documentation, she says, is “making it harder to do one’s work.”
But with three major medical centers making up a major chunk of the local economy, why is the Ann Arbor area so affected? Part of the reason is that the U-M is a teaching hospital.
“When we made our calculations for the future,” says Monrad, “we assumed that academic rheumatologists on average are spending half their time seeing patients. A key thing that a lot of workforce studies need to start incorporating is that one trained body is not the same as one body seeing patients full time. Although there are more rheumatologists, in general, the number of persons that can be seen is decreasing compared to maybe twenty years ago.”
The last previous workforce study by the ACR, in 2005, offered a prognosis as bleak as last year’s and led to an increase in recruitment and training programs, but “training alone can’t solve the problem,” Monrad says. “You can’t train enough people to meet the demand for assessment and evaluation of musculoskeletal disorders.”
In the meantime, some creativity is in order. One local gout sufferer’s condition had already stumped two primary care physicians, a podiatrist, and a physician’s assistant before the PA suggested seeing a rheumatologist. As it became clear that this could take as long as his gout bout already had, he asked his family practice’s referral specialist what he should do.
“How far are you willing to drive?” she asked.
“At least an hour,” he answered.
She called back the next day with an opening in Chelsea—in “just” six weeks.
