I thank Dr. Holman for his comments regarding my presidential address. I had hoped that my comments would generate lively discussion (“as a soon to be past president, I now welcome controversy!”). I certainly appreciate his comments regarding the issue of our specialty and fibromyalgia. In fact, many of our colleagues, including Drs. Bennett, Goldenberg, Smythe, and others, have made extraordinary contributions to this field. Our specialty and our patients are indebted to those investigators in the area of fibromyalgia. However, as I noted in my address, the issue now really is access to care. Wait times for new patients to see rheumatologists are lengthy, ranging from 4 to 24 weeks in both community practices and academic medical centers. This is unacceptable, particularly in light of our new understanding of the disease progression of our core diseases, including rheumatoid arthritis. Delay in treatment of even several months may be deleterious to patients with rheumatoid arthritis (Pincus T, Gibofsky A, Weinblatt ME. Urgent care and tight control of rheumatoid arthritis as in diabetes and hypertension: better treatments but a shortage of rheumatologists. Arthritis Rheum 2002;47:851–4). With the crisis in the number of practicing rheumatologists, we need to develop better systems to reduce the wait times for patients with systemic rheumatic disease. It is unacceptable for patients with rheumatoid arthritis to wait months for a new-patient appointment. We need to triage and manage patients better so that patients with systemic rheumatic diseases can be seen in a more timely manner.
I am delighted that my address generated such lively discussion, having received many calls, letters, and e-mails, particularly regarding my comments about ethics, industry relations, and the work force situation. This crisis in work force must be addressed, because without a sufficient number of rheumatologists to care for all of our patients, rationing of visits for those with nonsystemic rheumatic illnesses (including fibromyalgia) may be required to adequately care for those with systemic rheumatic disease.