Rheumatologists as an endangered species: A proposal for change

It has been well documented that arthritis is a major health problem in the United States, and it is estimated that the costs of health care for persons with rheumatic diseases and of their lost time from work will approach 1% of the gross national product by the year 2000 (1). Most patients with rheumatic diseases are not cared for by rheumatologists, and the situation will probably worsen if future manpower estimates are correct. In 1980, the Graduate Medical Education National Advisory Committee (GMENAC) concluded that there would be 3,000 rheumatologists in the US by 1990 (2). This proved to be quite accurate, as there are now 3,200 adult rheumatologists in practice and in academia (3). Several studies have projected future needs, and one recent study included a recommendation that there should be 8,600 rheumatologists to handle the 21,000,000 visits projected by the year 2000 (3,4). A study commissioned by the American College of Rheumatology to update the GMENAC report estimated a need for 6,049 rheumatologists in 1990 and 7,071 in 2000 ( 5 ) . Based upon projections of supply, there will only be 4,088 rheumatologists available in the year 2000, thus leaving a deficit of almost 3,000 to meet patient care and research needs. If the trends of a decrease in the number of students entering internal medicine training programs