A microsimulation using the Health Workforce Simulation Model projected rheumatologist supply, demand, and workforce adequacy across U.S. states and metro/non-metro areas from 2025 to 2037, with disparities analyzed by geography and urbanicity.
By 2037, metropolitan areas are projected at 97.3% adequacy (supply 7,600 vs. demand 7,810 FTEs), while nonmetropolitan areas face severe shortfall at 18.5% adequacy (supply 210 vs. demand 1,190 FTEs; P<0.001). Regional adequacy ranges from 73.4% in the South to 128% in the Northeast; the worst-off states are Idaho (14.3%), West Virginia (33.3%), Nevada (44.4%), Arizona (45.8%), Arkansas (50.0%), and Wyoming (50.0%).
Microsimulation projections rely on modeled assumptions that may not capture real-world changes in training pipelines, telehealth adoption, or shifting disease burden. The study does not evaluate specific policy interventions or their feasibility.
Clinicians and health systems in nonmetropolitan areas, the South, and states like Idaho and West Virginia should anticipate severe rheumatology access gaps through at least 2037. Proactive strategies — such as telehealth expansion, task-sharing with advanced practice providers, and targeted training incentives — are warranted in the most underserved regions.
