2015 Rheumatology Workforce Study: The Role of Graduate Medical Education in Adult Rheumatology

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  • This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/art.40432

Abstract

Objective

Graduate medical education (GME), through fellowship training, plays a critical role in providing new rheumatologists into our workforce and is an essential component when addressing the gap of excess demand for adult rheumatology care.

Methods

Primary and secondary data sources were used to develop an integrated workforce model. Factors specific to new graduates entering the workforce included available and filled fellowship positions, gender shifts, planned work schedules (part-time, full- time), practice settings (academic, non-academic private practice), and number of international medical graduates (IMGs) projecting U.S. practice.

Results

In 2015, there were 113 adult rheumatology programs with 431 of 468 available positions filled. Using the 215 actual positions available annually in fellowship programs as a starting point, after all factors were applied, the projected clinical full-time equivalent number entering the workforce each year was 107; this number was impacted significantly by gender and generational trends. In addition, 17% of IMGs self-identified their plan to practice outside the U.S. Confounding predictions included a large proportion of current rheumatologists planning retirement with substantially reduced patient loads by 2030.

Conclusion

The current U.S. adult rheumatology workforce is in jeopardy of accelerated decline at a time when demands on the workforce face tremendous growth. The current GME training structure cannot support the increased demand. Potential strategies to address this gap include innovative mechanisms for GME funding to increase fellowship training positions, incentives for pursuing rheumatology training (e.g., loan repayment programs), and novel means for recruitment of care to underserved areas of the U.S.

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