Public health

Nation hurtling towards rheumatologist shortage

There are concerns Australia may soon face a rheumatologist shortage due to poor workforce planning.

Already Western Australia has faced a “critical shortfall” of rheumatologists since 2015, according to a state government document which states how trainee throughput is not keeping up with growth in demand and plans for 60 percent of the workforce to retire by 2025.

With the specialty’s workforce ageing – the average age of a rheumatologist is 51 – the Australian Rheumatology Association warns urgent workforce modelling and intervention is needed stop the trend spreading across the nation.

Dr Helen Keen, chair of the ARA Education and Workforce Committee, said a lack of data is hampering efforts to address the issue.

“Whilst we suspect there probably is a shortage and we suspect it’s going to get worse in the next five years or so, we really don’t have great data at the moment,” Dr Keen said.

“We are commissioning that work to try and establish what the state of play is in Australia and try estimate what the future need will be.”

Australia has 360 rheumatologists and a further 60 doctors in training, according to department of health figures.

Ninety percent are located in major cities (MM1) and work for an average 37.3 hours per week.

While the ARA embarks upon its own research, the department of health is undertaking a supply and demand study for 14 physician subspecialties, including rheumatology, due in December.

Predictions about a looming shortage of rheumatologists were described in a paper in Nature Reviews Rheumatology by Eric Morand and Michelle Leech published in 2015.

They calculated Australia has 0.014 rheumatologists per 100,000 people, but said there was little data to indicate what the ideal level would be.

They also pointed out the disparity between well-serviced cities and underserved rural areas.

“On the basis of Canadian data, it can be estimated that a shortfall will result in reduced access to rheumatology specialist care in the coming years and decades”.

Dr Bethan Richards, head of the department of rheumatology at Royal Prince Alfred Hospital in Sydney, said the focus should be on increasing specialist training places – currently just four rheumatologists qualify on average each year.

“Despite previous workforce reviews (2010) reporting that 18% of NSW rheumatologists planned to retire in the next 10 years, an undersupply of rheumatologists in rural areas, a new generation of rheumatologist that will work less hours on average (despite taking the same time to train), there have been no significant moves to address the projected deficits,” Dr Richards said.

“The recent AIHW report on the Burden of MSK disease in Australia showed MSK conditions were the fourth leading contributor to total burden of disease in Australia, with back pain and problems, osteoarthritis and rheumatoid arthritis being the greatest contributors to the musculoskeletal burden,” Dr Richards said.

“To address this issue in a systematic, structured way, we need to stop just opening new medical schools, without having a clear idea of the medical workforce and required training pathways we are trying to create.

“We need to fund more rheumatology training positions and provide support for these.”

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