Areas of the U.S. with less than 50,000 people (dubbed “micropolitan”) have very little or no access to rheumatologists, a study found. In some of these areas, individuals have to travel more than 200 miles to reach the closest rheumatologist, concluded a workforce study by the American College of Rheumatology.
Researchers analyzed the distribution of rheumatology practices across the U.S. using the association’s membership database. In 2010 there were nearly 4,000 practicing rheumatologists in the database, with 90% practicing in metropolitan regions, 3% in “micropolitan” areas of fewer than 50,000 people, and 7% in rural parts of the country.
In 50 of the 479 micropolitan areas, travel to the nearest rheumatologist was more than 100 miles. Several regions with populations of 200,000 or more people also had no practicing rheumatologist in the area. Researchers did report a higher concentration of rheumatology practices in more populous areas with higher median incomes.
An editorial pointed out that a previously published study from The Netherlands showed that delay in seeing a rheumatologist was associated with a hazard ratio of 1.87 for not achieving a DMARD-free remission and a 1.3 times higher rate of joint destruction. “For patients with autoimmune and inflammatory diseases, rheumatologists are specialist physicians who are central to early diagnosis and treatment, which evidence suggest is most important within the first few months of disease onset to limit joint damage, improve physical function, and induce remission.”
Suggestions included making newly minted rheumatologists aware of practice opportunities; increasing funding for fellow positions in areas that lack rheumatology services; and expanding the roles of nurse practitioners and physician assistants to help care for patients.