I read with interest the report by Deal et al on the rheumatology workforce in the US (1). The model utilized in that study incorporates retirement calculations based on self-reported estimates. However, such self-reported estimates of physician retirement may not correlate with actual retirement rates. In fact, one study demonstrated that self-reported intention to leave clinical practice had 73.3% sensitivity but only 34.5% positive predictive value for actual departure from practice (2).
Several factors may lead rheumatologists to work beyond an estimated retirement age. First, rheumatology is not a physically taxing specialty, thus allowing older practitioners to remain in practice as long as cognitive abilities remain intact. Second, inflation and higher costs of retirement may prompt rheumatologists to continue working. Third, older rheumatologists who are grandfathered out of recertification requirements may have fewer barriers to continued practice. Fourth, generational work ethics may be associated with continued interest in work over retirement; a general survey by the American Association of Retired Persons in 2004 revealed that 79% of baby boomers plan to work in some capacity during their retirement years (3). Last, lengthening life expectancy will require greater savings for a longer retirement, as well as extend a clinician's potential working lifespan. If older rheumatologists do not retire as estimated, but continue working, could we witness an oversupply, or at least adequate supply, of rheumatologists, in contrast to the projections reported by Deal and colleagues?
Finally, Deal et al looked at national supply/demand figures, without addressing regional factors. Large metropolitan areas, especially those with large training programs, could potentially face an oversupply or adequate supply of rheumatologists due to a continued supply of new trainees remaining in the area, as well as inward migration. In contrast, more rural areas could experience an undersupply. While such regional discrepancies may prompt some migration into underserved areas, preferences for living in larger metropolitan areas may continue to promote a maldistribution of the rheumatology workforce.