Is There A Doctor In The House?

"Currently, 46 million people have had a doctor tell them they have a form of arthritis, such as osteoarthritis (OA) or RA, or a related condition, such as lupus, gout or fibromyalgia. Within 25 years, as the over-60 population peaks, that number is expected to reach 67 million. And those figures don’t take into account the millions more people who have joint symptoms and may need to see a doctor to find a diagnosis. They initially may see their family physician, but then either request to see a rheumatologist or be referred to one. This growing demand for rheumatologists could affect care significantly for millions of Americans.

For those who don’t live near a major city, long drives to see rheumatologists are common. People in metropolitan areas may live close to a rheumatologist, but they, too, experience the effects of their doctor being overbooked, busy and in demand.

Waiting to see a rheumatologist is more than just inconvenient. For new patients, there’s a window of opportunity for starting treatments that can delay progression of the disease. If treatment is delayed for several months, permanent joint damage could occur. That’s something rheumatologists are concerned about. And for established patients who can’t get in to see their rheumatologists, medication adjustments and critical laboratory tests could be delayed.

Most people with OA are treated by a primary care physician, a physical therapist or perhaps eventually an orthopaedic surgeon. The same is true for some people with other forms of arthritis. On the other hand, primary care physicians send some patients to rheumatologists in an effort to diagnose and treat inflammatory forms of arthritis as soon as possible, because they realize they don’t have the expertise to provide the new biologic therapies. Bio-engineering and a greater understanding of immunology, enabled development of extraordinarily powerful medicines that can make a quantum difference in people’s lives. The biologic drugs like abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade) and rituximab (Rituxan) provide the potential for disease modification now, that wasn't available 10 years ago. But the best medications in the world won’t do much good if there aren’t enough doctors available to administer them.

Getting future doctors to commit to rheumatology often boils down to money:
1. To become a rheumatologist requires three years as an internal medicine resident and another two or three years completing a fellowship in the subspecialty of rheumatology. Although the number of fellowship slots available is limited, in rheumatology some slots go unclaimed because funding isn’t available. (Funding for fellowships help a hospital pay for the doctor’s salary and benefits. Increasing the number of fellowship slots also requires increasing the number of full-time faculty to supervise them.)

2. Rheumatology remains among the lowest paid of all the internal medicine subspecialties, bringing in far less in reimbursements from insurance companies and Medicare. The median compensation per rheumatologist in 2003 was about $180,000, compared with $305,000 for gastro-enterology and $335,700 for general cardiology. This also plays a role in new doctors’ desire to go into rheumatology, especially when they finish medical school with $150,000 or more in debt.

To address the shortage, the ACR (The American College of Rheumatology) has developed recruitment materials and raised money from pharmaceutical companies to attract people to rheumatology careers. And it has provided funds to give students exposure to rheumatologists they don’t receive early in their medical school training. Redesigning medical practices to make them more efficient could help reduce costs, balance the supply and demand for rheumatologists, and better serve patients. For instance:
-Group appointments work well for educating patients, doing routine care and answering questions.
-Group appointments provide patients an instant support group.

Group appointments are only one tactic for improving efficiency. Also recommended is pre-appointment management for new patients. A study reviewing the medical records of 279 patients referred to a rheumatologist found only 59 percent of them needed to see one.

Such changes likely would take years. In the meantime, a lack of rheumatologists will not mean a lack of caregivers or access to care – for adults, anyway. The ACR plans to expand high-quality training programs for health-care professionals, such as nurse practitioners and physician assistants. Rheumatology relies heavily on teamwork to meet the needs of patients. Physician’s assistants and nurse practitioners provide the continuity of care, which is needed to give the role of the rheumatologist room to expand. Creating dependable care takes the understanding and support of all those affected – the patients, doctors and nonphysician clinicians. The financing and delivery of health care is broken in the U.S. and people need to advocate for fundamental change.

The good news: The number of new rheumatologists has risen in recent years, from 122 in 2000 to 168 in 2006 – a 37-percent increase.

The bad news: The healthy-sounding growth will be outpaced by the rate of retirement. The estimates are that about half of practicing rheumatologists will retire within just eight years, and that by 2025 there will be a shortage of 2,600 rheumatologists in the U.S.

Specialists for children:
When it comes to pediatric rheumatology, a crisis is there. Although the 218 pediatric rheumatologists in the U.S. are younger, on average, than adult rheumatologists, most are women – who work fewer hours and see 35 percent fewer patients than their male counterparts. And within the next five years, 32 percent of pediatric rheumatologists plan to reduce the time they spend seeing patients, according to the American Academy of Pediatrics. Although adults often face long waits for appointments with rheumatologists, the situation is far worse for the 300,000 children with rheumatic diseases, who may have to travel hundreds of miles for one appointment. And 10 states don’t have a single pediatric rheumatologist.

Today’s shortage means that one-third of children younger than 18 who have arthritis, will see an adult rheumatologist. Legislation wending its way through Congress could improve the situation. When passed, the Arthritis Prevention Control and Cure Act (APCCA), supported by the Arthritis Foundation and the ACR, will help ensure an increase in pediatric rheumatologists by providing support for more pediatric rheumatology fellowships and partial loan forgiveness for medical school debt. The Arthritis Foundation is stepping up not only through advocacy efforts to get the APCCA passed, but also by trying to raise $5 million to pay for additional pediatric rheumatology fellowships."
~Arthritis Foundation. by Debra Gordon and Donna Rae Siegfried.

Sounds disturbing, huh? A good thing, they are on top of it and doing what needs to be done to try and alter these prognoses. But only God knows the future and He will give what's needed, when it's needed. His care extends far beyond any human care could ever reach! :-)

1 Peter 5:7
casting all your care upon Him, for He cares for you.