In the face of significant shortages, heavy workloads and long waiting lists, the ARA outlines the way forward.
Australia has a substantial undersupply of both adult and paediatric rheumatologists, especially in regional and rural areas.
And with an ageing workforce and working hours projected to decrease over the next two years, it’s set to get worse.
These are some of the findings of a report just released on results of the 2021 ARA rheumatology workforce survey, previewed at last year’s ARA ASM.
The significant shortages are predicted to worsen the already long waiting lists, resulting in reduced quality of care and quality of life for people with rheumatic diseases. For rheumatologists, it will mean increased workloads and risk of burnout.
Workforce shortages aside, there were some very positive outcomes from the survey, with high levels of satisfaction with work and work/life balance noted in the report.
To increase the workforce and improve access to rheumatology care, the following key measures are proposed by the ARA:
- Increase advanced training positions through increased state and federal funding.
- Increase public hospital positions to allow access to affordable care.
- Increase support for rheumatologists with initiatives to increase job satisfaction; improve patient access to specialist nursing professionals, including rheumatology and chronic inflammatory nurses; and increase support for rural rheumatology positions.
In raw numbers, there were 380 adult rheumatologists, falling slightly short of the 416 rheumatologists needed to fulfil the estimated ideal number, based on two rheumatologists per 100,000 adults.
However, most survey respondents indicated they were not doing a full-time clinical rheumatology load, with a median of six half-days per week. Based on reported clinical workload, current numbers equated to 231 full-time-equivalent positions – well short of the 416 needed.
This situation was even worse in paediatrics, with 20 part-time paediatric rheumatologists amounting to a clinical full-time-equivalent of 13, again far from the ideal of 32 (based on one per 200,000 children).
Based on current workloads, 682 adult and 61 paediatric rheumatologists are required, leaving an estimated shortfall of 302 adult and 41 paediatric rheumatologists.
The situation for rural and regional rheumatology was particularly problematic. Around 72% of Australians live in major cities, but over 90% of rheumatologists practice there, leaving rural and regional populations underserved.
About a quarter of adult rheumatologists do regional and rural clinics, typically one per month. They are more likely to be older and male. No paediatric rheumatologists reported doing rural or regional clinics.
South Australia had the highest coverage of the states at 2.37 rheumatologists per 100,000 population. At the other end of the scale, Queensland had only 1.34 rheumatologists per 100,000 population. However, the report noted that this doesn’t take the workload of rheumatologists into account, with some variation from state to state.
The survey also found that while 10% of rheumatologists were considering increasing their work hours, 38% were thinking about reducing their workload temporarily or permanently, mostly within the next two years.
The survey analysis considered several trainee scenarios over the next 15 years. If current levels were maintained – that is, around 20 trainees finishing per year – the ideal number of rheumatologists would not be met by 2038.
To do so, an estimated 32 are required each year. And that number doesn’t take into account the ageing population, or the possibility of an increased demand for rheumatology services – for example, if there was a change in therapeutics that required extra input from rheumatologists.
The good news was that work satisfaction was high, with a median score of 4 out of 5, where 5 was extremely satisfied. And 81% were satisfied with their current work/life balance, with males more likely to report higher levels of work/life balance satisfaction than females. The youngest and oldest cohorts were more satisfied than those in the middle years, especially 45-64 years, when people were working more.
The workforce survey was sent to all full financial ARA members and was completed by 323 of the 399 (81%) members, all consultant rheumatologists. It collected demographic data, information about type and location of rheumatology and other clinical and non-clinical work, work intentions and job satisfaction.
You can read the full ARA Rheumatology Workforce Report here.
