Calling All Rheumatologists

Jeri Stracner, 48, thinks nothing of driving an hour from her home in Carlisle, Ky., to see her rheumatologist in Lexington. Of course, that’s on a good day. On a bad day – say, if she gets stuck behind a tractor or someone hauling tobacco bales – the 45-mile trip could take up to two hours.

Given the drive she’s willing to make to see this doctor, you might think he provides a level of service that can’t be found elsewhere. Turns out he’s simply the nearest rheumatologist. 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.

Since Stracner first began seeing her rheumatologist 13 years ago for rheumatoid arthritis (RA) and fibromyalgia, the practice has gotten so busy it takes two or three days just to get a return call from a nurse. At least she’s not a new patient; average wait times for those appointments are three months or more. Stracner essentially competes for her doctor’s time.

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,” says Ramesh Pappu, MD, a rheumatologist at Albert Einstein Medical Center in Philadelphia. “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.

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.

What We Know
The American College of Rheumatology (ACR) – the leading professional organization for rheumatologists, scientists and health-care workers who treat those with rheumatic diseases – began to study the situation two years ago. The results were released recently at its 2006 Annual Scientific Meeting.

Calling All Rheumatologists

The number of patients is growing, yet the number of rheumatologists is dwindling. Find out what the future holds.