Background/Purpose: Louisiana, along with other states, has long experienced significant challenges in accessing specialty care, particularly in the field of rheumatology. Limited availability of trained rheumatologists leads to delayed diagnoses, suboptimal disease management, and poor patient outcomes. In response, our institution has strategically expanded rheumatology fellowship training. In addition to two ACGME-accredited fellowship spots annually, we have implemented a model to add one extra fellow when funding is available. This additional fellow is supported through contracts with rural hospitals in the United States or internationally. These hospitals provide financial support for the additional fellow and, in return, the fellow commits to return and practice in the sponsoring institution for a defined period. The prospective fellow participates in the ACGME match process. Importantly, the additional fellow is fully integrated into the accredited training program and all aspects of training meet the ACGME requirements, ensuring parity in educational quality and clinical competence. This initiative aims to address the growing shortage of rheumatology specialists, improve patient access to timely care, and enhance patient outcomes across underserved areas.

Methods: A retrospective cohort study was conducted using Slicer Dicer, a data analytics tool embedded in the Epic Electronic Health Record system. The study spanned the period from 2017 to 2025. The impact of expanding rheumatology fellowship training on patient care was measured as patient access to care: number of referrals, wait time, number of new and follow-up visits. For statistical analysis, a t-test was used.

Results: Yearly referrals to our clinic increased 3.7-fold since 2015 (1,139 in 2015 vs. 4,218 in 2024; p < 0.05). We had 5 fellows during 7/2017–7/2019 and 7/2023–7/2025, with 4 fellows in between. During the academic years 2023–2025, when we had 5 fellows, our clinic saw 8,052 total patients, compared to 4,568 patients in 2019–2021 and 6,125 patients in 2021–2023 during the years with 4 fellows. In 2023–2025, we doubled the number of new patient consults seen in our clinic (2,134 patients vs. 1,072 patients in 2019–2021; p < 0.05). We observed a trend toward an increased number of outpatient prescriptions, corticosteroid injections, and infusions. Before 2017, the average time to the next patient appointment was 118 ± 16 days, which was significantly shortened (p < 0.001) during the years with 5 fellows (47 ± 13 days in 2017–2019 and 53 ± 15 days in 2023–2025). Patient demographics were similar throughout the years.

Conclusion: Our strategic collaboration serves multiple purposes: expanding the workforce by increasing the number of graduating fellows and providing immediate access to care in underserved areas. This model led to an increase in the number of consultations and follow-up appointments, reducing wait times for patients by 40%. Additionally, this initiative enhances our program’s visibility and attracts mission-driven candidates. This initiative exemplifies how academic-community partnerships can produce scalable solutions to subspecialty workforce shortages.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/strengthening-rheumatology-workforce-capacity-and-impact-on-patient-care-in-louisiana-expanding-fellowship-training-opportunities-through-strategic-partnerships/