Rheumatology recruitment approaching a crisis point

[Guest guest]

Nov 13, 2002

Rheumatology recruitment approaching a crisis point

Ontario, Canada - Rheumatologists are becoming an endangered species, and

the specialty is approaching a crisis, says Dr Jody Lewtas (Markham

Stouffville Health Centre, Markham, ON) in an editorial this month's Journal

of Rheumatology [1].

The American College of Rheumatology predicts that more doctors will be

leaving the specialty than joining it by 2016, and estimates from Canada

suggest a 64% shortfall in rheumatologists by 2026, she notes, but adds that

" medical manpower is a major issue in rheumatology throughout the world. "

One of the reasons contributing to this state of affairs, she argues, is an

ill-conceived perception about the specialty. " The public, governments, and

even many of our colleagues in other specialties continue to perceive that

arthritis care is futile and uninteresting. "

" We have a tradition in rheumatology of being undervalued. And it is

difficult to break with tradition, " she notes. But things can changeif the

barriers to adequate rheumatology care can be identified and rheumatologists

become involved in healthcare reform, the profession can help effect

constructive improvements in providing care for patients with

musculoskeletal disease, she argues.

Barriers are many but can be surmounted

The barriers to rheumatology care are many and varied, Lewtas says, pointing

to the publication of a survey in the same issue of the journal by Dr

Deborah Shipton (Toronto Western Research Institute) and colleagues [2].

They polled rheumatologists in Ontario, Canada, about obstacles to providing

adequate rheumatology care. The 3 most commonly reported barriers were the

cost of drugs for patients, billing policies and regulations for

consultation and follow-up visits, and long waiting times for patients. In

addition, 89% of responding rheumatologists reported having at least some

difficulty in making ends meet from rheumatology practice alone, and 28%

found it was not possible.

None of these should come as a surprise, Lewtas comments. But each of these

problems has a solution, she says. Although most rheumatologists would

consider themselves " reluctant politicians, " the profession is well suited

to the work of reform, because of the breadth of work in which

rheumatologists are involved, she says. " Whether we like it or not,

advocating for our patients for access to therapies has become part of our

daily business. "

One of the most exciting specialties in medicine

Lewtas suggest that the image problem must also be tackled. Rheumatology is

1 of the most exciting specialties in medicine today, she argues. " The

science of immunology, cartilage repair, and bone metabolism is evolving

rapidly. Every year there are new biochemical pathways to learn to keep

current with potential future therapeutics. " And rheumatology is also

" uniquely rewarding " in its practice, she says. " With the appropriate

treatment we can see patients restored to near-normal function who were

completely disabled by inflammatory disease. We do not need studies of

several thousand patients to prove we are making a difference. "

" With the appropriate treatment we can see patients restored to near-normal

function who were completely disabled by inflammatory disease. "

So, she concludes that: " The barriers that have been defined by Shipton et

al . . . can provide opportunities for renewing our specialty. With a lot of

hard and organized work, it is not inconceivable that the best trainees will

flock to rheumatology within the next 10 years. "

Nainggolan

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