It’s going to be a busy week for Dr. Robert Katz. Starting Sunday, he is in Philadelphia for the American College of Rheumatology meeting that runs through Thursday. He will present two research papers, returning in time to conduct a professional workshop at the state-sponsored Illinois Women’s Health Conference 2000 in Rosemont. By Thursday afternoon he will be back doing what he does so well — taking care of patients with diseases like rheumatoid arthritis and lupus.
Katz is the type of doctor who calls patients just to see how a new medication is working. Patients have long raved about the guy. He not only listens to them but also offers experiences of others to help the afflicted person feel less isolated and more hopeful about getting better. Remember, these are patients who have likely seen a doctor or three who doesn’t seem to know much about the emotional drag of being in chronic pain and discomfort.
He is up to date on the latest treatments and respectful of patients who don’t like taking any more medications than necessary. He focuses on quality of life rather than blood tests.
This is not simply to single out Katz as a good doctor and rheumatologist with a resume full of awards to confirm it. There are other good rheumatologists out there, especially in a big city like Chicago. The problem is there are not enough to go around — 43 million Americans have osteoarthritis, rheumatoid arthritis and related diseases — and the doctor shortage is going to be worse before it gets better.
In 1990, the Arthritis Foundation and the American College of Rheumatology projected there would be a need for 6,500 rheumatologists in the U.S. by the year 2000. The actual number stands at about half that right now with most specialists clustered around big cities. The number of board-certified pediatric rheumatologists, 162, is woefully short. States like Idaho and North Dakota don’t have a single one.
There is a built-in danger to the shortage. Arthritis and other diseases that affect the joints are conditions you want to catch early. The damage is frequently irreversible. Not getting to the doctor soon enough — or to one who makes the right diagnosis — is trouble.
“We promote early, accurate diagnosis and early, aggressive treatment of arthritis,” says Dr. John Klippel, medical director for the Arthritis Foundation. “But it’s difficult to get early anything when there is not a doctor around, or when every doctor is too booked up to see you for months.”
Rheumatologists might expand a practice (meeting the demand of the market) but can they still return phone calls promptly? How many weeks or months out is the doctor’s appointment schedule booked? These are questions patients should be asking.
There are several reasons for the shortfall of rheumatologists. One critical factor is research published in the New England Journal of Medicine showing MDs who choose to do the two extra years of training don’t necessarily make up the cost. In contrast, a physician who decides to specialize in gastroenterology will be able to charge more over a career for tests such as colonoscopy or liver biopsies. Rheumatology is considered a “cognitive-oriented speciality” or one that requires critical thinking, which is hard to price. To be sure, no insurance company seems willing to pay more for it.
With the lack of rheumatologists, many patients with osteoarthritis in the knees or spine end up in the offices of orthopedic surgeons. The discussion is likely to turn to surgery sooner than if those same individuals visited a rheumatologist.
“I liken it to seeing a cardiac surgeon before you see the cardiologist,” says Katz. “You want to see the non-surgeon first.”
In the 1990s, medical students were told that primary care was the speciality that would most be in demand. But today’s future doctors are seeing a bulging section of want ads for rheumatologists. In 10 years, the number of specialists in this category might be as low as 2,500 if the trend continues in the same direction. Meanwhile, 20 years from now, it is expected 60 million Americans will have arthritis and related diseases.
Something will have to give and, chances are, it won’t be doctors’ appointment books.
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Next week: Some good news (for a change) about women, hormones and autoimmune disorders.
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To contact Bob Condor or find an archive of his columns, visit chicagotribune.com/go/health
His e-mail is bcondor@@tribune.com