Colossal Shortage of Rheumatologists is Here: Panic?

World-wide shortage of rheumatologists= getting worse. This is why it is getting harder to get an appointment with a rheumatologist.

Map of the USA showing shortage of rheumatologists for lupus patients

This NASA night view of the US looks very similar to the recent US map showing where rheumatologists are concentrated in the US. Some states have none!

The worldwide shortage of rheumatologists is getting worse: hold on to your rheumatologist!

If you have difficulty getting in to see a rheumatologist, there are good reasons why.In 2015, there was a shortage of rheumatologists throughout the US. The American College of Rheumatology (ACR) counted 6,013 rheumatology care providers. 4,997 were full-time rheumatologists, 598 worked part-time, and the other 418 were nurse practitioners and physician assistants specializing in rheumatology. This was 13% fewer rheumatologists than needed by the population, according to the ACR. Since then, the numbers have continued to decrease. Many rheumatologists are retiring, and not enough new ones are entering the specialty. In 2020, 100 doctors who wanted to get into rheumatology training programs could not do so because there were not enough training slots.

By the year 2030, the total number of healthcare providers specializing in rheumatology in the US is predicted to drop from 6,013 to 4,133 nationwide. There will also be a greater need for rheumatologists. The number of older people with arthritis (the baby boomers) will be much higher. It is estimated that there will be only half the number of rheumatology healthcare providers that will be needed to care for rheumatologic patients, such as those with SLE.

Some Areas Have No Rheumatologists!

Another problem is that many areas of the US have few to no rheumatologists. Many patients have to travel hundreds of miles to see the closest one. 21% of rheumatologists are in the Northeast while only 4% are in the Southwest, and this imbalance is predicted to get worse. There are much fewer people in the population per rheumatologist in the Northeast compared to the Southwest.

A 2019 US study showed that more than 60% of US patients had to wait more than a month to get a new patient appointment with a rheumatologist. More than a quarter of patients had to wait more than 2 months.
It’s much worse for children with rheumatic diseases (such as pediatric SLE). Only 1 of 4 children with arthritis can see a pediatric rheumatologist. Those fortunate to see one have an average of an hour’s drive. Nine states have no pediatric rheumatologists, and six states have only one.

A 2019 United Kingdom study showed that patients waited for an average of over 6 months after the onset of rheumatologic symptoms before being able to see a rheumatologist. So this is not just a US problem. 

Author

Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

REFERENCES:
American College of Rheumatology Committee on Rheumatology Training and Workforce Issues, FitzGerald JD, Battistone M, Brown CR Jr, Cannella AC, Chakravarty E, Gelber AC, Lozada CJ, Punaro M, Slusher B, Abelson A, Elashoff DA, Benford L. Regional distribution of adult rheumatologists. Arthritis Rheum. 2013 Dec;65(12):3017-25. doi: 10.1002/art.38167. PMID: 24284967.Battafarano DF, Ditmyer M, Bolster MB, Fitzgerald JD, Deal C, Bass AR, Molina R, Erickson AR, Hausmann JS, Klein-Gitelman M, Imundo LF, Smith BJ, Jones K, Greene K, Monrad SU. 2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030. Arthritis Care Res (Hoboken). 2018 Apr;70(4):617-626. doi: 10.1002/acr.23518. PMID: 29400009.

​Borenstein D. Hug your rheumatologist: the shortage is coming. The Arthritis Connection Summer 2020. Retrieved on 4/11/21 at https:///www.thearthritisconnection.com/rheumatoid-arthritis/hug-your-rheumatologist-the-shortage-is-coming

Johns Hopkins Lupus Center Reviews: 2025 Sunspots & Milder Lupus?

Johns Hopkins Lupus Center Reviews: Could sunspots in 2025 lead to milder lupus?

Largest sunspot in 2014 picture by NASA may predict lupus flares

2014 photo by NASA showing an 80,000 mile long sun spot (the length of 10 Earths side by side). Photo source Wikipedia Commons and NASA, Greenbelt, MD
Johns Hopkins Lupus Center reviews of sunspot patterns: lupus disease activity varies with sunspot cycles

– The Johns Hopkins Lupus Center reviews many ways that lupus is affected by the environment. It appears that the pattern of sunspot formation may be one of them.
– Previous research in Germany suggested health changes related to magnetic storms and sunspots (specifically while studying heart attacks by Halberg F, et al.)
– The Lupus Clinic at Johns Hopkins compared disease activity in their center from 1996 to 2020 and compared it to solar cycles, sunspots, and geometric disturbances.
– They found that increased sunspots (called solar maximum in the solar cycle) was followed by lower disease activity on average in their patients.
– Increased geomagnetic activity was also associated with lower disease activity.
– This is another study suggesting how important our environment is regarding lupus. 

When will there be milder lupus activity as predicted by sunspots?

– Of course, this is all hypothetical, and this research needs to be reproduced.
– If it is correct, our most recent time of fewer sunspots was DEC 2019 (the least solar activity in 100 years)
– NASA predicts that solar maximum will occur in July 2025 with 115 sunspots (179 is the average)
– The previous solar maximum was in APR 2014 with 114 sunspots. Since Dr. Stojan’s research included that sun cycle, this upcoming cycle should be similar.

– Therefore, SLE patients may look forward to the Fall and Winter, Northern Hemisphere (this was a Northern Hemisphere study) of 2025 as a period of having milder lupus attacks.

Note… this is all very interesting, but I would not put my money on it until further research is done

Author

 Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets

References:
Stojan G, Giammarino F, Petri M. Systemic lupus Erythematosus and geomagnetic disturbances: a time series analysis. Environ Health. 2021 Mar 16;20(1):28. doi: 10.1186/s12940-021-00692-4. PMID: 33722240; PMCID: PMC7962208.

Halberg F, Cornélissen G, Otsuka K, Watanabe Y, Katinas GS, Burioka N, Delyukov A, Gorgo Y, Zhao Z, Weydahl A, Sothern RB, Siegelova J, Fiser B, Dusek J, Syutkina EV, Perfetto F, Tarquini R, Singh RB, Rhees B, Lofstrom D, Lofstrom P, Johnson PW, Schwartzkopff O, the International BIOCOS Study Group. Cross-spectrally coherent ~10.5- and 21-year biological and physical cycles, magnetic storms and myocardial infarctions*. Neuro Endocrinol Lett. 2000;21(3):233-258. PMID: 11455355.

NASA: What Will Solar Cycle 25 Look Like?

The Best Lupus Books? Look in the useful list below

Kelli of “More Than Lupus” describes what she considers the best lupus books

What are your favorite lupus books?

The best lupus books should deal with all aspects of lupus, evaluating the best medical evidence. They may also include eating an anti-inflammatory diet, how to deal with chronic disease, and how to tell others about your lupus!

The research is piling up about the importance of eating a diet that is high in omega-3 fatty acids (such as cold water fishes, flax seed, chia seed, walnuts) and limiting the intake of inflammatory foods. Foods that increase inflammation in the body include omega-6 fatty acids (such as found in red meats).

Taking care of lupus is so much more than just taking your medicines. Of course, taking your lupus medicines and never missing doses is essential. However, make sure to learn about and do everything in “The Lupus Secrets” to learn more.

By the way, I appreciate Kelli mentioning “The Lupus Encyclopedia!”

The Lupus Encyclopedia One of the Best Lupus Books
The Lupus Encyclopedia One of the Best Lupus Books per “More Than Lupus”

If you get “The Lupus Encyclopedia” make sure to read the Preface. It gives you practical advice on exactly how to read the book and make it apply to your situation. Make sure to look up all your medicines and learn all about how to use them at the time of surgery, around vaccines, what side effects are actually associated with them (and not just a laundry list like the pharmacy will give you), what do do if you miss doses, how they work, etc.

Click on “Comments” above and tell us what your best lupus books are and why. I would especially like to hear what your favorite anti-inflammatory diet books are that are high quality and do not promise a “cure” for lupus.

Make sure to share my blog and “Lupus Secrets” with everyone who has lupus!

Author

Donald Thomas, MD: I’m a rheumatologist who specializes in taking care of patients who have lupus, but also educating them on how to take better care of themselves. Remember…

Knowledge is Power!