Objective. To develop and apply a model that allows prediction of current and future supply and demand for rheumatology services in the US.Methods. A supply model was developed using the age and sex distribution of current physicians, retirement and mortality rates, the number of fellowship slots and fill rates, and practice patterns of rheumatologists. increase the number of people with rheumatic disorders, growth in the Gross Domestic Product, and flat rheumatology supply due to fixed numbers entering the workforce and to retirements. The productivity of younger rheumatologists and women, who will make up a greater percentage of the future workforce, may also have important effects on supply. Unknown effects that could influence these projections include technology advances, more efficient practice methods, changes in insurance reimbursements, and shifting lifestyles. Current data suggest that the pediatric rheumatology workforce is experiencing a substantial excess of demand versus supply.Conclusion. Based on assessment of supply and demand under current scenarios, the demand for rheumatologists is expected to exceed supply in the coming decades. Strategies for the profession to adapt to this changing health care landscape include increasing the number of fellows each year, utilizing physician assistants and nurse practitioners in greater numbers, and improving practice efficiency.The American College of Rheumatology (ACR) created the Workforce Study Advisory Group and retained The Lewin Group to conduct a new workforce study of US rheumatologists in 2005, to project demand for rheumatology services, in order to guide policy regarding rheumatology manpower for the next 2 decades. The Lewin Group is an applied research and consulting group specializing in health policy issues. While workforce projections are not an exact science, they attempt to model future needs using information and assumptions from the present.

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Objective To examine associations of anti-cyclic citrullinated peptide antibody (aCCP) and rheumatoid factor (RF) concentrations with future disease burden in patients with rheumatoid arthritis (RA). Methods Outcome measures were examined in U.S. veterans with RA and included: 1) proportion of observation in remission (Disease Activity Score [DAS]28 ≤ 2.6), 2) remission for ≥ 3 consecutive months, and 3) area under the curve [AUC] for DAS28. Associations of autoantibody concentration (per 100 unit increments) with outcomes were examined using multivariate regression. Results Patients (n = 855) were predominantly men (91%) with mean (SD) age of 66 (11) years and 2.3 (1.2) years of follow-up. Most were aCCP (75%) and RF (80%) positive. After multivariate adjustment, aCCP (OR 0.93; 95% CI 0.91-0.96) and RF concentrations (OR 0.92; 95% CI 0.90-0.95) were associated with a lower odds of remission, a lower proportion of observation in remission (p = 0.054 and p = 0.014, respectively), and greater AUC DAS28 (p = 0.05 and p = 0.002, respectively). In aCCP+ / RF- patients, higher aCCP concentrations were associated with an increased likelihood of remission (OR 1.10; 95% CI 1.00-1.20). Among aCCP- / RF+ patients, higher RF concentrations trended towards an inverse association with remission (OR 0.81; 95% CI 0.58-1.13). Conclusions aCCP concentrations (particularly in RF positive patients) are associated with poor prognosis in U.S. veterans with RA. Analyses of autoantibody discordant patients suggest that RF concentrations may be a stronger predictor of disease burden than aCCP concentration.

We suggest that NPs and PAs may provide a role that is similar to that of physicians in primary care based on prescribing behavior. The prescribing behavior of PAs and NPs parallels that of physicians by the number of medications per visit, the types of therapeutic classes, and the type of patient. However, in nonmetropolitan areas, prescribing differences emerge between the three types of providers that bear further exploration.

Shortages of primary care doctors are occurring globally; one means of meeting this demand has been the use of physician assistants (PAs). Introduced in the United States in the late 1960s to address doctor shortages, the PA movement has grown to over 75,000 providers in 2011 and spread to Australia, Canada, Great Britain, The Netherlands, Germany, Ghana, and South Africa. A purposeful literature review was undertaken to assess the contribution of PAs to primary care systems. Contemporary studies suggest that PAs can contribute to the successful attainment of primary care functions, particularly the provision of comprehensive care, accessibility, and accountability. Employing PAs seems a reasonable strategy for providing primary care for diverse populations.