Background/Purpose:

Caring for children and adults with rheumatic diseases in the future requires training an adequate number of rheumatologists today. As part of the 2015 Workforce Study, rheumatology fellows-in-training (FITs) were surveyed to obtain insight into factors affecting the selection of rheumatology as a specialty and their expected career tracks.

Methods:

FITs completed an electronic survey assessing demographics, fellowship information, student debt, and career decisions. Missing responses were excluded from analysis and percentages were calculated based on the number of respondents answering each question.

Results:

Of 497 pediatric and adult FITs in the US, 415 completed the survey (83.5% response rate). FIT demographics are shown in Table 1. Most FITs were women; almost half (48.9%) were international medical graduates (IMGs). 70% of US graduates had student loan debt.

The most common reasons to choose rheumatology were intellectual interest, lifestyle/work hours, and clinical rotations; the least common reason was income potential. Rheumatologists commonly inspired trainees to pursue rheumatology training, usually during residency.

FITs’ career interests are shown in Figure 1. Although private practice was the most commonly preferred career path overall, it was significantly more common for men than women (51.1% vs 38.2%, p=0.0154). Women were more interested than men in the clinician educator track (37.8% vs 22.0%, p=0.0012).

Upon fellowship completion, 11.3% (n=47) of FITs were planning to work part-time, more commonly by women than men (15.9% vs. 2.8%, p=0.0001). 17.5% (n=72) of FITs plan to practice outside the US, the majority being IMGs, as compared to FITs from US medical schools (33% vs. 2.8%, p<0.0001).

Conclusion:

The current study sheds light on challenges facing the future of rheumatology in the US. Rheumatology fellowships are failing to attract graduates from US medical schools, these graduates also have significant student loan debt. Eleven percent of FITs plan to work part time, and 33% of IMGs plan to work abroad, contributing to a potential shortage of rheumatologists.

This study also highlights opportunities to increase the number of future rheumatologists. These include recruiting underrepresented minorities, increasing rheumatology exposure in medical school and residency, encouraging practicing rheumatologists to mentor trainees, providing incentives with loan repayment programs, and encouraging IMGs to stay in the US after fellowship.

Table 1. FIT Demographics. P-values represent comparisons between US and international medical graduates. Only significant p-values are reported.

Figure 1. FIT career interests for US and international medical graduates (IMGs).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-future-of-rheumatology-pediatric-and-adult-fellows-in-training-results-from-the-2015-acrarhp-workforce-study/