Number of Rheumatologists Increased More Than 20% Over Last Decade

Melissa L Mannion, MD, MSPH

Credit: Children's of Alabama

The number of clinically active rheumatologists grew 23% within the last decade, reaching a high of 6046 in 2019, according to a study published in Arthritis and Rheumatology.¹ However, this growth seems to be flattening off in recent years.

“The most recent American College of Rheumatology (ACR) estimate of adult rheumatology providers in 2015 included 5595 physicians, 248 nurse practitioners (NP), and 207 physician assistants (PA),” wrote a team of investigators led by Melissa L Mannion, MD, MSPH, instructor in the Department of Pediatrics’ division of Pediatric Rheumatology at the University of Alabama at Birmingham. “Using estimates of clinical full-time equivalents (cFTE), the study projected a demand for 1769 new cFTE in 2020 that would grow to 3269 in 2025 and 4133 in 2030.”

However, the study expected a reduction in the total number of rheumatologists due to retirement as well as a reduction in cFTE due to changes in the gender of actively practicing rheumatologists, changes in full- or part-time positions, and reductions in the clinical workload. This is of particular importance as approximately 1 in 4 US adults have self-reported arthritis and 50.4% of individuals over age 65 have an arthritis diagnosis.²

To evaluate changes in rheumatology providers over time, as well as recognize variations in rheumatology practice characteristics, investigators used national Medicare claims data between 2006 and 2020 to identify rheumatologists and advanced practice providers (APP). For each year, providers entering, exiting, or continuing practice were determined based on their presence or absence in either prior or subsequent years of available data. The demographics of physicians both entering or exiting the rheumatology workforce were compared with those who were stable.

Information including age, gender, region, rural, and practice type were collected for 2019 as well as in mutually exclusive study periods between 2009 — 2011, 2012 — 2015, and 2016 — 2019. Larger private practices were defined as > 3 rheumatology providers and rural practice location was defined as level 5 (micropolitan) or level 6 (nonmetropolitan). Billing tax identification was used to determine the location of the rheumatology practice.

According to US Medicare, in 2019, the number of clinically active adult rheumatologists was 5667 and the number of APP was 379. Between 2009 and 2020, the number of rheumatologists increased 23%, from 4557 to 5600, and the number of APP increased 141%. Based on linear regression, the stable rheumatology workforce grew by 100 providers per year.

Additionally, female rheumatologists increased over the past decade, rising to 43% in 2019, and more entered the workforce than exited (61% vs 37%). Female providers and those employed by a healthcare system were among those more likely to exit the rheumatology workforce, while those residing in the South or working in a small practice were less likely to exit.

Results showed many providers were joining larger-sized practices (36% between 2012 — 2015; 54% between 2016 — 2019), and very few (5%) were practicing in rural regions.

Investigators noted the number of rheumatologists entering the workforce may be undercounted due to delays in updating the National Provider Identifier (NPI) taxonomy code for change in specialty or subspecialty, which must be made by the provider or an employer organization.

“Even with the growth of the rheumatology workforce supply identified in this analysis, there remains a greater demand for rheumatologic care that may need to be solved with more efficient care through digital health tools such as remote therapeutic monitoring, precision medicine, and others,” investigators concluded. “The results of this analysis can be used to inform additional studies and future policies to promote growth of the adult rheumatology workforce and alternative solutions to providing rheumatologic care to the US adult population.

References

1. ^{Mannion ML, Xie F, FitzGerald JD, et al. Changes in the Workforce Characteristics of Providers who Care for Adult Patients with Rheumatologic and Musculoskeletal Disease in the United States. Arthritis Rheumatol. Published online February 25, 2024. doi:10.1002/art.42833}
2. ^{Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030. Arthritis Care Res (Hoboken). 2018;70(4):617-626. doi:10.1002/acr.23518}