Educational Hurdles in a Complex Field Contribute to Workforce Shortage

By Adam J. Brown, MD

Rheumatology is a complex, rapidly changing field. We see a wide range of diseases that have heterogeneous presentations with incompletely understood pathophysiology. The laboratory testing that we utilize often is nondiagnostic and requires interpretation within an appropriate clinical context. The medications we prescribe are specialized, requiring a knowledge of immunology, potential side effects and, often, close laboratory monitoring. The majority of our patients are immunosuppressed to some degree, requiring providers to be wary of infectious complications they may develop while on these specialized medications.

These complexities make rheumatology a difficult field to approach from a learning perspective. Most nonrheumatology physicians do not feel comfortable with the workup, lab interpretation or medications used in the field. When I’m working with internal medicine residents during their rheumatology rotations, a major concern is the lack of educational materials regarding the field, aside from thick unapproachable textbooks meant for rheumatology fellows and rheumatologists. Students and trainees often aren’t exposed to the field to a degree that allows them to feel comfortable with the approach and management of these conditions.

Rheumatology can be approachable

Throughout medical school and my residency in internal medicine, I used a popular textbook entitled, Microbiology Made Ridiculously Simple™. Full disclosure: as an attending rheumatologist, I still have a copy of the latest edition on the bookshelf next to my desk. The textbook is designed to make it easy and enjoyable to learn about the field of infectious diseases. The pictures within the book are farcical, with bacteria, viruses and fungi drawn with scowls and weaponry set to invade the unsuspecting host.

Considering the lack of material for students and residents to learn the basics of rheumatology, I reached out to the Made Ridiculously Simple™ publisher to gauge interest in a rheumatology book for the series. The publisher was very interested, and, over the course of two and a half years, I wrote Rheumatology Made Ridiculously Simple™. I drew pictures and made tables with the express purpose of making the topic as easy to understand as possible. I wrote clinical vignettes at the end of every chapter, giving examples of the disease, workup and treatment approaches. At the end of the book I wrote multiple choice questions along with detailed answers, as well as explanations of why the incorrect choices are wrong – all with the goal of making the complex field of rheumatology as approachable as possible.

Not only are medical students and general medicine trainees uncomfortable with rheumatology, we also face an impending workforce shortage in rheumatology in the next decade.1 Many older rheumatologists are retiring and there aren’t enough training spots to fill to make up for the growing demand. Rheumatology Made Ridiculously Simple™, simplifies the field in the hopes of allowing general and advanced practitioners to feel more comfortable with the workup and treatment of these patients. Many patients live hundreds of miles from regular access to a rheumatologist — this book may be able to help bridge the gap and allow their local providers more familiarity with the patient’s condition and management.

My hope is to have students and residents more engaged and excited about the field of rheumatology and appreciate the diagnostic and therapeutic possibilities this field has. Rheumatology is such an incredible field with diverse diseases, complex immunological pathways and treatments that can make a dramatic change in patient’s lives. I hope students and practitioners will read this book and feel more comfortable with the diagnostic workup, laboratory interpretation and therapeutic options for patients with rheumatologic conditions, but also be entertained by the material.

Reference

1. Battafarano D, Monrad S, Fitzgerald J, Bolster M, Deal C, Bass AR, Molina R, Erickson AR, Smith BJ, Jones KB, Hausmann JS, Gokenbach V, Lewis K, Ditmyer M. 2015 ACR/ARHP Workforce Study in the United States: Adult Rheumatologist Supply and Demand Projections for 2015-2030 [abstract]. Arthritis Rheumatol. 2016;68(suppl 10). https://acrabstracts.org/abstract/2015-acrarhp-workforce-study-in-the-united-states-adult-rheumatologist-supply-and-demand-projections-for-2015-2030/. Accessed October 3, 2019.

About the author: Adam Brown, MD, is board-certified in both rheumatology and internal medicine and did additional specialty training in vasculitis. He has a podcast entitled, “Rheuminations;” you can follow him on Twitter @AdamJBrownMD.