Issue: April 2021
Disclosures: Jonas and Mehta report no relevant financial disclosures. Smith reports being on the speaker’s bureau and advisory board of and consulting for AbbVie and Sanofi Genzyme, and being on the advisory board of Pfizer.
January 22, 2021
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Residency Match 2021 reveals continued popularity, growth in rheumatology

Issue: April 2021
Disclosures: Jonas and Mehta report no relevant financial disclosures. Smith reports being on the speaker’s bureau and advisory board of and consulting for AbbVie and Sanofi Genzyme, and being on the advisory board of Pfizer.
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Data from the 2021 National Residents Matching Program revealed that for the upcoming academic year, interest in rheumatology among first-year medical school trainees continues to grow.

However, it is uncertain whether that interest is enough to combat looming workforce shortages in the specialty.

Source: Adobe Stock.
“The ACR has a training program, and our colleagues at AHRP are offering solutions to help bridge the gap,” Brett Smith, DO, told Healio Rheumatology. “But the fact remains that more people are retiring than starting in rheumatology, and it is not easy to just churn out new people to take those places.”
Source: Adobe Stock

“Over the last few years, rheumatology has become very popular, and this is a good thing,” Beth Jonas, MD, chair of the ACR’s Committee on Rheumatology Training and Workforce Issues, told Healio Rheumatology. “But there are still ways to create more interest, and more opportunities for people who may not have matched.”

The purpose of the National Resident Matching Program (NRMP) — commonly called “the Match” — is to provide a forum and a time frame for applicants and programs to make their selections for the upcoming year.

Beth Jonas

Findings from the most recent Match showed that for the 2021 appointment year, of 338 applicants interested in rheumatology, 246 matched to the specialty, a rate of 72.8%.

The interest is coupled with an increase in residency opportunities, according to Jonas. “We added 15 new programs and 36 slots for first-year trainees,” she said.

But adding programs and placements is just one solution. “The other complication is that the workforce shortage is not a numbers problem, it is a geography problem,” Jonas said. In short, some regions of the country — major cities and areas surrounding academic medical centers — have plenty of rheumatologists. Other regions have none.

Because there are so few rheumatologists in the country, and because many regions of the country have no rheumatology professionals at all, it creates a self-perpetuating shortage, for one important reason: Many medical trainees are not exposed to the specialty simply because there is no one practicing it nearby. Consequently, they do not benefit from relationships with experienced clinicians in the field who may ultimately become mentors.

“The ACR has a training program, and our colleagues at [Association of Rheumatology Health Professionals (AHRP)] are offering solutions to help bridge the gap,” Brett Smith, DO, of Blount Memorial Physicians Group and East Tennessee Children’s Hospital, said in an interview. “But the fact remains that more people are retiring than starting in rheumatology, and it is not easy to just churn out new people to take those places.”

Brett Smith

A broader issue is that there are even fewer pediatric rheumatologists, according to Smith. “I treat adult and pediatric patients, and I am the only rheumatologist in the eastern side of the state working in a pediatric and adult facility,” he said. “There has never been a formal pediatric rheumatologist in this area.”

Jay Mehta

While many rheumatologists are forced to treat pediatric patients out of necessity, others, like Jay Mehta, MD, MS, attending physician with the division of rheumatology and associate program director of the Pediatrics Residency Program at Children's Hospital of Philadelphia, chose pediatrics. “I love what I do and can’t imagine doing anything else,” he said in an interview. “But I had no idea, going into residency, that I would end up going into the field. Fortunately, I had a mentor who exposed me to it, and helped me contextualize the specialty.”

Growing the Field

While Jonas is encouraged by results of the Match from recent years, she is realistic about the future of the specialty, particularly with regard to the workforce shortage on the horizon. “We are not going to be able to close the gap of that shortage unless we can train more people,” she said.

Jonas noted that the aforementioned increase in programs and slots has been seen over the last four cycles of the Match. “There has been an incremental increase, and that is very positive, but it really only goes a short way to closing the gap,” she said.

While generating interest in the specialty is a key component to growing the field, there are hard, unavoidable realities at play, as well. Namely, money. “It is costly to create training slots and train rheumatologists,” Jonas said. “The ACR has put resources into this, because they obviously recognize the importance of having enough rheumatologists to manage an aging patient population.”

Whether these resources will bear fruit in the form of an uptick in residency matches in the years moving forward remains to be seen.

Coming Attraction

If there is one bright spot, it is that, as a specialty, rheumatology has plenty of features that would attract young doctors-to-be. “The first thing is that the problems we deal with on a day-to-day basis are fascinating,” Jonas said. “The science behind rheumatic disease is still rich and evolving rapidly, with incredible breakthroughs over the last 10 to 15 years.”

To that point, Mehta described the immune system as “by far the coolest system” in the body. “Every day, we get to see the consequences of abnormalities in the immune system, where the pathophysiology is complex,” he said.

A companion point is that rheumatologists have an increasing number of therapeutic options. “We are getting to the point where we can identify cellular pathways and target them,” Mehta said. “It is an exciting time.”

Beyond the science, Jonas cited the “long and rich relationships” that she develops with patients because so many rheumatic and autoimmune diseases are chronic. “We get to know our patients very well,” she said.

In addition, there are few true emergencies in rheumatology, which translates into regular office hours. “This can lead to a good work-life balance, with evenings and weekends free,” Jonas said. “We can tell residents that they can have a rewarding career and personal life.”

All these factors have contributed to rheumatology’s rise in popularity and strong Match results in recent years. In many ways, the specialty sells itself.

But a deeper look at the pediatric subspecialty highlights the ongoing challenges the field is likely to face.

Transitioning to Adulthood

Other findings from the Match showed that 67.9% of pediatric rheumatology programs were filled, leaving 32.1% unfilled.

While many pediatric rheumatology specialists like Mehta report high job satisfaction, he acknowledged some of the drawbacks. “It does require 3 extra years of training,” he said. “And you make less money than a general pediatrician.”

The reason for this applies to all rheumatologists. “Our reimbursement system, unfortunately, values procedures, and we do not do a lot of procedures,” he said. “The other reason is that our patients tend to be quite complex, requiring longer visits, so we are unable to see as many each day.”

Another issue in pediatric rheumatology involves the transition to adult care, which can be a “huge problem,” according to Smith. “The benefit of a situation like mine is that they trust my face, they are used to my care, so they do not have to worry about being transitioned to a new doctor at age 18 or 20,” he said.

The implications of this for attracting talent to the specialty are clear. While residents may understand rheumatology in the broad strokes, they may not fully grasp how the workforce shortage could put them in a position of treating both pediatric and adult patients, and the attendant issues of care and transition.

Smith offered a practical way of mitigating these issues. “We need to be having this conversation earlier,” he said. “I frequently see residents in the fourth year, when they have already made up their mind to go in another direction. We need to intervene early.”

Despite these obstacles, Jonas described the results of the Match as “positive” and “encouraging” for the field. “We are attracting bright and motivated people to rheumatology, which is exciting,” she said. “The fact that it is competitive is not a bad thing. It bodes well for the future of rheumatology.”

For more information:

Beth Jonas, MD, can be reached at 3300 Thurston Building, Campus Box 7280, Chapel Hill, NC 27599; email: beth_jonas@med.unc.edu.

Jay Mehta, MD, MS, can be reached at 3405 Civic Center Blvd., Philadelphia, PA 19104; email: mehtaj@email.chop.edu.

Brett Smith, DO, can be reached at 232 Associates Blvd., Alcoa, TN 37701; email: blsmith@protonmail.com.