International Medical School Students Filling the Rheumatologist Shortage

The rheumatologist shortage in the United States is a multifaceted problem that requires solutions on every front from retaining highly gifted international students to exposing medical students to the practice of rheumatology.

Unless they’ve been exposed to rheumatology personally or professionally, medical students often pass on pursuing the specialty because it’s an enigma, but that, ironically, is what makes rheumatology so fascinating.

“In rheumatology, we strive to solve puzzles,” said Jonathan Hausmann, M.D., in an interview with Rheumatology Network. “Most residents think of rheumatology as this obscure thing associated with a host of diseases and complex diagnoses.”

But, for some, its puzzling nature is a lure to physicians in training who thrive in the face of challenge.  [[{"type":"media","view_mode":"media_crop","fid":"57274","attributes":{"alt":"Jonathan S. Hausmann, M.D.","class":"media-image media-image-right","id":"media_crop_3661071864080","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7213","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; float: right;","title":"Jonathan S. Hausmann, M.D.","typeof":"foaf:Image"}}]]

Dr. Hausmann, an instructor in medicine at Beth Israel Deaconess Medical Center in Boston, spoke with Rheumatology Network about the challenges associated encouraging medical students to pursue a career in rheumatology. Dr. Hausmann spoke on “The Future of Rheumatology: Pediatric and Adult Fellows-in-Training Results from the 2015 ACR/ARHP Workforce Study,” at ACR 2016. Jonathan S. Hausmann, M.D. 

Rheumatology Network:  How does student debt factor into a student’s decision to pursue rheumatology?

Dr. Hausmann:  Debt repayment can be significant. If you can reduce the debt burden or provide loan repayment programs to encourage U.S. medical residents to choose rheumatology that would help. A large portion of students, 75 percent, have extensive student loan debt with 25 percent having more than $300,000 in student loans. In asking why students chose rheumatology, income potential was the least common reason indicating that they go into rheumatology under the assumption that rheumatology isn’t a good economic decision to pay off loans.

Rheumatology Network:  How critical are international students in rheumatology programs?

Dr. Hausmann:  Many positions would be empty without international students. A recent study compared how international medical students and U.S. medical students cared for hospitalized patients. It found that international students provided better care, which may be due to the fact that many of them are the top people in their countries. Many international students complete multiple residencies and do a second fellowship. They’re highly-qualified people, but unfortunately, getting a work visa can be challenging. While one-third prefer to return home, many more prefer to stay.

As we’ve seen a decrease in the number of U.S. medical graduates, there has been an increase in international medical graduates pursuing rheumatology fellowships.

Rheumatology Network:  Why do medical students opt for pursuing a rheumatology specialty?

Dr. Hausmann:  Almost 100 percent of fellows selected rheumatology because of exposure:  Either they completed electives or were exposed to rheumatology in some other way. Many were encouraged by mentors and people who introduced them to the field. We must become spokespeople and encourage others to explore the field.

Rheumatology Network:  How can programs attract applicants?

Dr. Hausmann:  We must expose medical students and residents to rheumatology. Seeing, first-hand, how interesting rheumatology is from a scientific perspective and how fulfilling it is to diagnose, treat, and take care of patients over long periods of time can be part of the solution. If we have trainees spend a few days or weeks with us, many would get excited about the field.

Rheumatology Network:  What areas within rheumatology are in dire need of physicians?

Dr. Hausmann:  We struggle to meet the demand in pediatric rheumatology today, but it will grow worse in years to come. There are currently states with no pediatric rheumatologists.

Our rheumatology workforce doesn’t represent the patient population we treat. Most fellows, certainly of the U.S. medical graduates, are mostly white or Asian. There are few Hispanic and black rheumatologists, and, unfortunately, that’s not unique to rheumatology. Medicine isn’t diverse. So, programs that encourage interest from other ethnicities can be useful.

Rheumatology Network:  How will the physician shortage affect patient care?

Dr. Hausmann:  In the next decade, the demand for rheumatologists will continue to increase while the supply declines. There will be gaps between what patients need and what we can provide. Many patients currently have to wait several months for a first visit. In pediatric rheumatology, there are states with no pediatric rheumatologists. 

References:

Jonathan S. Hausmann.  “The Future of Rheumatology: Pediatric and Adult Fellows-in-Training Results from the 2015 ACR/ARHP Workforce Study,” ACR 2016. Abstract 1140. 

2015 Workforce Study of Rheumatology Specialists in the United States

, presented November 2016