The ARA is collecting data it believes will provide crucial – and currently unavailable – hard evidence that Australia is in the midst of a deepening rheumatologist shortage which the government cannot ignore.
The British Society of Rheumatology recommends a benchmark of one rheumatologist per 80,000 people as a minimum standard to meet community need.
New Australian Rheumatology Association (ARA) president Associate Professor Dave Nicholls said the Department of Health believes Australia is more or less hitting the benchmark.
But it has reached this conclusion by counting every rheumatologist registered with AHPRA as a 1 FTE (full-time equivalent doctor working in clinical practice), when the reality is many are working part-time and in research, he told the limbic.
“Last year ARA board members attended a briefing with the department of health… and they said ‘there are enough rheumatologists’,” said Professor Nicholls, who practices on Queensland’s Sunshine Coast and is co-director of the Rheumatology Research Unit at the University of Queensland.
“But when we asked them ‘do you know where these rheumatologists work and how many clinics they do per week, how many patients they see per week?’ that was the gap. They had no way of gathering that information.”
In response, about six weeks ago the ARA launched a workforce survey which will ask members to provide those details. The survey will close once it receives response from at least 70% of the membership – which represents over 99% of the specialty, he said.
“We are asking people to specify how much of their work is direct patient care, how much is to do with research, how much is medical students and how much is on rheumatology work. Then we’ll be able to tell them (DoH) this is how many full-time equivalents we actually have in Australia.
“We are going to match that with population data and show where the gaps are and try to go to the government with some suggestions of how we can fill the gaps.”
The biggest gaps are anticipated to be in regional Australia; where the maldistribution of all specialist doctors is a well-known problem.
“Our rural and remote outreach committee have clearly identified that there are vast small towns and even small cities that have no resident rheumatologist. There is no shortage if you want to see a rheumatologists in the middle of Sydney – the waiting time is just a few weeks. But there are areas in Australia where the waiting time for public appointments in excess of a year. The challenge is to be able to encourage people to live and work in those cities.”
The AMA has repeatedly called for additional specialist training places to address the bottleneck in the medical training pipeline, these calls went ignored in this year’s budget.
There are unique challenges here for rheumatology, says Professor Nicholls, where the majority of care is delivered in private practice but the majority of training is in public hospitals.
This has meant neither state governments or the Commonwealth have traditionally “seen it as their responsibility to tackle the issue of where and how many rheumatologists there are”.
But, according to Professor Nicholls, a focus on increasing medical training in the bush – part of the $83 million Stronger Rural Health strategy – in this year’s budget are a good start.
“One of the challenges for the ARA is to show not only this is the deficit in training now and moving into the future, but these are the communities that don’t have enough rheumatologists, and we have to think outside the square about how we train them. There are certainly many opportunities for training them outside the system.”
The federally-funded Specialist Training Program is one funding pot that supports that approach, but currently very few of the over 1000 places are dedicated to rheumatology – something the ARA hopes to change once it can prove the need.
On a positive note, when it comes to future-proofing the profession there will be no difficulty in recruiting people to take on the job.
“We roughly get about twice as many applicants as we have training posts. We have no shortage of young doctors who would love to be rheumatologists.”