Traveling Clinics Could Ease the Burden
The findings of the current study demonstrate that regional shortages already exist. “If we simply use the 1.67 number of rheumatologists per 100,000 persons as a definition of insufficient rheumatology supply, then a majority (85%) of the CBSAs would be potentially underserved,” the investigators noted.
When a definition of no practicing rheumatologists within a 50-mile travel distance is used, 24% of CBSAs – representing 18.9 million persons – would still be affected by an insufficient supply of rheumatologists; with a 100-mile cut point, 5% of CBSAs –representing 2.5 million people – would be underserved.
“While this is no surprise to affected local patients, practitioners, or policy makers, this study identifies potential target communities … that might benefit most from addition of a local rheumatologist,” the investigators noted.
One possible intervention for addressing the shortage is simply providing up-to-date information about shortages, as this could lead to migration, expansion of existing practices, or attraction of new rheumatologists. Increasing the supply of trainees in areas with unmet needs and committing additional funds to training programs in underserved areas are also possible interventions, the authors said.
Approaches such as the use of traveling clinics and e-mail or video consultation, which have previously been used to address shortages in rural areas, could also be helpful, they said, adding that it has been suggested that midlevel providers could also effectively help fill workforce shortages.
According to the ACR database, there were 3,920 practicing adult rheumatologists in 2010; 90% practiced in metropolitan areas (areas with at least 50,000 population around a central urban core), 3% practiced in micropolitan areas (areas with 10,000 to less than 50,000 population, excluding rare exceptions centered around a less dense urban cluster), and 7% practiced in rural regions.
“Notably, a greater proportion of rheumatologists were practicing in metropolitan areas (over micropolitan areas) than would be expected based on population distribution alone. While only 31 metropolitan areas (9%) did not have a practicing member rheumatologist, the majority of micropolitan areas (84%) did not have a rheumatologist,” the investigators wrote.
As for areas with no rheumatologist, the distances to the nearest practicing rheumatologist varied widely. Only 1% of metropolitan areas, compared with 16% of micropolitan areas, had a distance of more than 75 miles to the nearest rheumatologist, and CBSAs with populations over 200,000 had a travel distance as great as 94 miles, while some smaller micropolitan regions had travel distances greater than 200 miles, for example.
Many smaller micropolitan areas with populations of at least 40,000 had no practicing rheumatologists, and several more populous areas with populations of 200,000 or more also had no practicing rheumatologist.
Conversely, areas with higher population densities; greater proportions of younger, female, white, and Asian populations; and the presence of an active adult fellowship training program had greater numbers of rheumatologists.