“Rheumatology relies heavily on teamwork to meet the needs of patients,” says Roderick Hooker, PhD, a physician’s assistant at the Department of Veterans Affairs Medical Center in Dallas and an author of the ACR study. “Physician’s assistants and nurse practitioners provide the continuity of care, which is needed to give the role of the rheumatologist room to expand,” he says.
Creating dependable care takes the understanding and support of all those affected – the patients, doctors and non-physician clinicians, says Dr. Harrington. “The financing and delivery of health care is broken in the U.S., and people need to advocate for fundamental change.”
Specialists for children: few and far between
When it comes to pediatric rheumatology, a crisis isn’t coming; it’s here, says Patience White, MD, chief public health officer of the Arthritis Foundation and a pediatric rheumatologist. 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, says Dr. White, but also by trying to raise $5 million to pay for additional pediatric rheumatology fellowships. “We’ve been stepping up in research for years; now we’re stepping up in access to care and treatment,” says Dr. White.
