Rheumatology is a medical specialty focused on the diagnosis and treatment of complex musculoskeletal diseases and systemic autoimmune conditions, such as rheumatoid arthritis, lupus, and gout. These conditions are typically chronic, requiring long-term, specialized management to maintain a patient’s quality of life and prevent permanent damage. The size and distribution of the rheumatology workforce is a subject of national interest. Understanding the current count of practitioners and the factors that influence their numbers is the first step in addressing access challenges for millions of Americans with rheumatic disease.
The Current US Rheumatology Workforce Count
The total number of rheumatologists actively licensed to practice in the United States is estimated to be approximately 6,420 physicians, according to 2021 data from the Association of American Medical Colleges. A slightly more conservative count, based on 2019 Medicare claims, identified 5,667 clinically active adult rheumatologists, a figure that specifically tracks physicians engaged in patient care. This clinically active group includes both Doctors of Medicine (MDs) and Doctors of Osteopathic Medicine (DOs).
The demographics of this workforce are currently undergoing a significant shift, especially concerning gender. Data shows that the proportion of female rheumatologists has increased over time, reaching 50.4% in 2021. The median age of stable, clinically active rheumatologists is around 52 years, suggesting that a large segment of the workforce is approaching traditional retirement age.
Geographic Distribution and Access to Care
The distribution of rheumatologists across the country is highly uneven, creating significant challenges for patient access outside of major metropolitan areas. Nearly 95% of all rheumatology practices are located in urban or suburban settings, which leaves vast swaths of the nation underserved. This maldistribution results in what are often termed “rheumatology deserts,” where residents have extremely limited or no local access to specialty care.
The unequal concentration directly impacts patients living in rural counties, with data showing that 93% of these counties have zero adult rheumatologists. Patients in these areas face the necessity of traveling long distances to receive a diagnosis or ongoing treatment. This logistical burden can lead to delayed care, which is detrimental for progressive autoimmune diseases where early intervention can prevent joint destruction and organ damage. Telehealth has emerged as one method to mitigate these access issues by allowing for remote consultations.
Factors Influencing Workforce Supply
The size of the rheumatology workforce is determined by the balance between the number of new physicians entering the field and the rate of attrition. The inflow into the specialty is driven by the number of available fellowship training slots, which has been steadily increasing, reaching 276 positions across 127 programs in 2024. Nearly all adult rheumatology fellowship positions were filled in 2023, demonstrating a high interest in the specialty among new physicians.
The outflow is dominated by retirements and changing practice patterns among younger physicians. Approximately 50% of the current workforce is projected to retire within a 15-year window. Furthermore, a trend toward improved work-life balance means that new practitioners may work fewer hours than their predecessors. This results in a reduction in the clinical full-time equivalent (cFTE) capacity of the workforce, even if the total number of licensed physicians increases.
Projected Patient Demand and Future Needs
The need for rheumatologists is expected to grow substantially in the coming years, primarily driven by demographic changes in the US population. The population is aging, and since the prevalence of chronic conditions like arthritis and other rheumatic diseases increases significantly with age, the demand for specialty care will rise. Approximately one in four US adults already self-reports a diagnosis of arthritis, and the prevalence is over 50% for those aged 65 and older.
The projected increase in patient volume is set to outpace the growth of the workforce, even with the current strong interest in fellowship programs. By the year 2030, the demand for rheumatology care is expected to exceed the available supply by more than 4,000 clinical full-time equivalents. This substantial gap indicates that the current supply of physicians will be insufficient to meet the needs of a growing and aging patient population.