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Demand For Rheumatologists


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Not surprising really - it is not as popular of a field for a variety of reasons (extremely important field but lacks a certain for lack of a better term "sexiness" for many - plus until recently there was limited treatment options which made the field not that interesting I think either medically). Lower pay is of course another problem and lack of marketing.


We generally have this problem in medicine - we are very slow to adjust to the population needs because the training cycle is just so long. There is almost no way an internal medicine doc can retrain to another fellowship area with any ease (who wants to take 2-3 years off and become a resident all over again). There is also no easy way to cover as such more than one area unless you go specifically into general internal medicine  - which is the sort of doc you probably really do need in more rural areas - or patient access will still be compromised as the travel distance would still be too far. Even if you match the number of doctors per type X by population as the urban areas, the low population density would still mean elderly patients would have long ways to go.


Plus there is the flip side - even if we did create a huge number of rheumatologists starting now - what happens in 25 years when the demographics begins to shift again the other way and we have now oversupply. The first baby boomers hit 65 in 2011 if I recall being born right after the end of the second world war. You would end up with a bunch of 50 year old doctors without a rapidly declining patient population comparatively speaking.


Fixing this sort of thing requires some hard choices and some leadership at the top.  I have heard a bunch of ideas thrown around - like force all internal med docs to complete the older 4 year general licence and then do fellowship - so in theory every single internal medicine doc would be qualified to shift to other areas as needed, restructure residency position allocations to up the numbers that have to go into key fields (trouble is they need to be trained and trained in this case by rheumatologists - so you are taking a stressed out area and stressing it out even more - residents do not save you time), or of course extend other specialists to do this - like family medicine with a plus one in rheum and popularize that.

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