Rheumatology workforce shortage needs to be addressed

31 March 2016

Rheumatology workforce shortage needs to be addressed

“A shortage of rheumatologists in New Zealand’s public hospitals means a number of patients who need expert treatment are struggling to get it,” says Ian Powell, Executive Director of the Association of Salaried Medical Specialists (ASMS).

“This is yet another medical specialty which is working seriously short-handed, and this is having an impact on both the doctors and their patients.”

He was commenting on an article in the latest issue of the ASMS magazine, The Specialist, which highlights a rheumatology shortage in public health. The magazine is available on the ASMS website at http://www.asms.org.nz/wp-content/uploads/2016/03/10985-The-Specialist-Mar16-WEB-1.pdf.

In the article, the president of the New Zealand Rheumatology Association, Dr Fiona McQueen, who is a rheumatologist at Southern District Health Board, says more publicly funded rheumatology positions are needed along with incentives to encourage specialists to work in the regions.

“There are a lot of people we can’t get to see, which leaves them reliant on their GP, who may be very good but obviously isn’t a specialist in this area,” she says. “It’s a real concern for rheumatologists.”

Rheumatologists diagnose and treat a range of conditions such as arthritis, autoimmune connective tissue disease, systemic inflammatory diseases such as vasculitis, spinal and soft tissue disorders, certain metabolic bone disorders, and chronic musculoskeletal pain syndromes.

Estimates of how many rheumatologists are needed vary across countries but have been conservatively benchmarked at one rheumatologist for every 100,000 people. The most up-to-date figures available show wide variations across New Zealand, with shortages in two places in particular standing out: in 2012, Northland had just 0.64 FTE per 155,800 people (one full-time rheumatologist to 243,438 people), while Nelson-Marlborough had 0.5 FTE per 136,800 population (one rheumatologist to 273,600 people) over the same period.

And even in regions that appear to be doing well by comparison, the situation is less than rosy, according to Fiona McQueen. For example, patients covered by the Southern DHB face a unique set of hurdles in getting to see a rheumatologist; they need to travel great distances, and in this region there is very limited private rheumatology provision.

Waikato DHB rheumatologist Douglas White and a team of other clinicians have responded to the rheumatology shortage by developing a triaging tool that aims to speed up the referral process from GPs to specialists.

“As a country we have fewer rheumatologists per head of population than many other countries,” he says. “We can’t provide the same service that rheumatologists do in other countries so we have to be selective about the patients we see. The shortage of rheumatologists is driving the need for work-arounds.”

Ian Powell says rheumatology is an example of another medical specialty that has a long-standing shortage.

“We need sustainable long-term solutions to addressing these shortages. It’s not good enough for the Government’s health decision-makers to sit on their hands when it comes to the health of New Zealanders and the ability of medical specialists to provide expert clinical treatment.”

ENDS

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