Korean rheumatology workforce from 1992 to 2015: current status and future demand

Abstract

Background/aims: Rheumatology in Korea has rapidly advanced in the 24 years since the subspecialty board certification program was established in 1992. The objective of this investigation was to analyze the distribution of rheumatology practices in Korea in order to better understand the rheumatology workforce.

Methods: Using a membership list from the Korean College of Rheumatology (KCR), we obtained information on practicing rheumatologists. We mapped the ratio of rheumatologists to the general population and to patients with rheumatologic disease using data from Statistics Korea and the 2015 Health Insurance Review & Assessment Service (HIRA).

Results: In the 16 administrative districts of Korea in 2015, there were 311 practicing rheumatologists on the list of KCR members. There were 218 members practicing in metropolitan areas and 93 members in the provinces. The mean number of rheumatologists per 100,000 people was 0.60, with 0.33/100,000 in the provinces, but 0.92/100,000 in metropolitan areas, a 2.7-fold difference. The number of rheumatologists per 100,000 patients with chronic rheumatic disease was 17.21 in metropolitan areas but 6.57 in the provinces, according to 2015 HIRA data. This geographic maldistribution emerged as a problem; indeed, the regional disparity in the distribution of Korean rheumatologists was striking when compared to the published medical professional distribution in 2014.

Conclusion: Because of the uneven distribution of rheumatologists, it is likely that some patients with chronic rheumatic conditions have limited access to rheumatology care. Thus, a policy-based approach is needed to alleviate this disparity.

Keywords: Distribution; Rheumatologists; Workforce.

Figure 1.

Growth trend for rheumatologist. After complete training program in centers, rheumatologist has been practicing in each medical institution. From the year of 1997, at least 10 members have been increased annually.

Figure 2.

(A). Internist employment data (2014 published ‘Annual report membership statistics Korean Medical Association’). (B). Rheumatologists working in medical institutes (Group A: hospitals, including tertiary centers; Group B: hospitals offering up to secondary care; Group C: outpatient care).

Figure 3.

Korean rheumatologist: the past and present. In the past 15 years (2001 to 2014), rheumatologist increased four times over; however, physician and orthopedic surgeon has more doubled over. The share of rheumatologist in physician has been grown-up from 1.2% in 2001 to 2.3% in 2014.

Figure 4.

The number of rheumatologist in Korea is in shortage, compared to other countries, despite fast increase in the number of rheumatologist.

Figure 5.

Number of rheumatologist and physician per population, patients in each administrative districts. On map, each color scale implies degree of population density and the far red areas are metropolitan cities with high population density in 2015 (Seoul, Busan, Incheon, Daegu, Gwangju, Daejeon, and Ulsan).

Figure 6.

The 2005 and 2014 published ‘Annual report membership statistics Korean Medical Association.’ In 2014, at internists, orthopedist, physiatrist to populations ratio of seven living areas (A: Seoul area; B: Gyeonggi area; C: Gangwon area; D: Chungcheong area; E: Jeolla area; F: Gyeongsang area; G: Jeju area), difference of regional distribution had been eased compared to 2005.

Figure 7.

Number of patients (seven groups of Table 1) and National Health Insurance Service Charge from 2010 to 2015. This graphs reveals rising in the number of patients and increasing health expenditures annually (based on 2015 Health Insurance Review & Assessment Service data).