Australia is hundreds of rheumatologists short of demand, with workforce burnout, training bottlenecks and rising chronic disease driving a worsening access crisis.
Australia’s rheumatology workforce crisis is deepening at a pace that risks leaving millions of Australians without timely access to specialist care, according to the Australian Rheumatology Association’s 2025 Workforce Report.
The report warns the nation remains hundreds of specialists short of internationally accepted workforce benchmarks and may not close the gap until 2043 without urgent government intervention.
The report, released at the ARA’s annual scientific meeting this month, is the most comprehensive workforce analysis undertaken by the association and, for the first time, includes data from rheumatologists, advanced trainees and allied healthcare professionals.
The findings reveal mounting pressure across every part of the profession, driven by population ageing, increasing prevalence of autoimmune and musculoskeletal disease, workforce burnout and constrained specialist training capacity.
Australia currently has 506 adult rheumatologists and only 25 paediatric rheumatologists, far below international benchmarks that would require 749 adult and 80 paediatric specialists to meet population need.
The report estimates the nation is short 243 adult rheumatologists and 55 paediatric rheumatologists, with the effective workforce even smaller once part-time work, research, teaching and administrative duties are factored into clinical full-time equivalent capacity.
The shortages are occurring against a backdrop of escalating disease burden.
Musculoskeletal and rheumatic diseases now account for 13% of Australia’s total burden of disease and more than $14.7 billion in annual health expenditure, affecting more than seven million Australians.
The report noted that advances in treatment meant patients were living longer with chronic inflammatory conditions, increasing long-term demand for specialist management rather than reducing it.
New ARA president Dr Helen Keen told The Medical Republic that there was a misconception that musculoskeletal and rheumatic diseases were primarily conditions affecting elderly people.
“There’s a perception also disease of elderly people, and therefore it doesn’t affect the Australian workforce, but absolutely does impact the Australian workforce,” she said.
“Elderly people are deserving of care, but it’s not just our ageing population. As overweight and obesity increases, that that induces more autoimmunity, which also increases our workload, so as it manifests with autoimmune and connective tissue disorders.”
ARA past president Dr Sam Whittle said the workforce lagged well behind comparable countries and that regional Australia was experiencing the greatest strain.
“Today, the rheumatology workforce lags far below international standards for comparable nations,” he said.
“The situation is even more dire away from the major metropolitan hubs, where the population is, on average, older, and more likely to need the support of a comprehensive care team.”
The report shows the workforce remains heavily concentrated in metropolitan areas, with Queensland and Western Australia particularly underrepresented relative to their populations.
While some rural outreach clinics and telehealth services are helping improve access, many regional areas still rely on fly-in specialists and intermittent clinics.
Paediatric rheumatology services are under especially acute pressure. The paediatric workforce has remained largely static since 2022 despite growing caseloads, and several jurisdictions depend entirely on visiting interstate specialists.
The report warned that children with inflammatory arthritis and autoimmune disease faced increasing risks of delayed diagnosis and treatment because of workforce constraints.
Dr Keen said the nature of chronic diseases managed by rheumatologists meant that patients generally could not see a specialist once and be discharged from care.
“It’s developing long-term relationships, so every new patient we see translates into years of follow-up appointments,” she told TMR.
“Not having enough rheumatologists will perpetuate that problem. There will be more Australians dealing with pain and disability for longer, and it’ll also encourage older rheumatologists to delay retirement for longer.”
A major contributor to the shortfall is the limited number of accredited training positions.
Australia currently has about 70 adult rheumatology advanced training positions nationally, with most based exclusively in public hospitals.
According to the ARA this model is no longer sustainable given that most rheumatology care occurs in private practice.
The association is advocating for private clinics to become accredited training sites and for advanced trainees to receive Medicare Benefits Schedule provider numbers similar to GP registrars.
Current workforce modelling suggests that at the existing training rate of approximately 28 new adult rheumatologists annually, Australia will not meet workforce benchmarks until around 2043. Even substantial increases in training numbers would still leave the system operating below projected demand for years.
The report also raises concerns about future workforce participation patterns. More than half of advanced trainees surveyed said they did not intend to undertake a full clinical workload, while only 72.2% expected to work solely in rheumatology.
The report said these findings meant future workforce projections based on simple headcount were likely to underestimate the real scale of the shortage.
Demographic shifts within the profession are also reshaping workforce planning.
Rheumatology is approaching gender parity, with women now representing nearly half of practising rheumatologists and a majority of advanced trainees.
The report noted that while this reflected broader changes in medical education, workforce models must better account for flexible working arrangements and caring responsibilities if long-term workforce supply is to be maintained.
At the same time, the profession was ageing, the report said.
The number of rheumatologists aged over 70 years continues to increase “at an alarming rate”, with many delaying retirement because there are no younger specialists available to assume care of their patients.
“As expressed to the author [of the report] by one member of that cohort, they continue to work into advanced age because there is nobody behind them to take on the patient caseload, and they do not want their patients to be left without care,” the report said.
“The ARA considers that this demographic segment creates a significant risk to Australians suffering from musculoskeletal and rheumatic conditions, as the retirement of these older rheumatologists may leave large numbers of patients without care at short notice, particular in regional and rural Australia.
“This further reinforces the urgent need to increase the training throughput to build and retain a sufficient buffer against sudden drops in workforce numbers.”
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Financial pressures were compounding access problems, the report revealed.
About 60% of rheumatology care is delivered through private practice, yet only 5–10% of consultations are bulk billed.
The report suggests rising out-of-pocket costs are pushing more patients into public hospital outpatient systems that are already overstretched and facing lengthy waiting lists.
Burnout has emerged as another major workforce threat. Survey data revealed high levels of emotional exhaustion across the profession, with the report describing a pattern of “overextended” burnout in which clinicians maintain a strong sense of professional accomplishment despite escalating workload pressures.
The ARA warned this combination created significant retention risks over coming years.
The report also highlighted the growing reliance on multidisciplinary care teams to offset workforce shortages.
Rheumatology nurses, nurse practitioners, physiotherapists, pharmacists and other allied health professionals were increasingly central to patient management, particularly in triage, chronic disease monitoring and education.
The ARA has called for greater investment in specialist rheumatology nursing and nurse practitioner roles to help manage immediate service gaps.
“Holistic care of rheumatic diseases requires multidisciplinary teams, so we should be working in teams with the allied health professionals,” Dr Keen told TMR.
“The government is an advocate for extending the scope of practice of allied health practitioners, and we recognise that we need to look at new models of care to help deliver care to our patients, and certainly nurse practitioners have long been established as people who can certainly initiate and medications to people with rheumatic diseases and provide follow-up care independently.
“Ideally we all should be working in a team and certainly there’s other opportunities, for example, extended scope of care for physios, and even pharmacists assisting us with up-titrating medications in gout.”
To address the crisis, the ARA is urging federal and state governments to immediately increase rheumatology training positions, prioritising Queensland, Western Australia and paediatric rheumatology; to establish a coordinated national workforce strategy; expand funding for alternative models of care; and enable private practice training.
The report estimated that increasing annual training intake to 45–50 graduates would cost between $12 million and $16 million annually but said the investment would produce substantial downstream savings given the economic burden of inflammatory disease.
In its conclusion, the report warned the consequences of inaction would extend far beyond the specialty itself, affecting workforce participation, disability rates and long-term health system sustainability across Australia.
“Policy makers are now faced with a choice. Do they allow many Australians to remain in ongoing pain and an inability to participate in the workforce, or they engage with stakeholders such as the ARA to develop new training and staffing pathways that will support Australians in both metropolitan, and most importantly, regional Australia,” the report said.
“Musculoskeletal and rheumatic diseases affect large proportions of the Australian population, and that proportion will only get bigger.
“It is now up to governments, both federal and of state/territories to accept their responsibilities and ensure that the care that these more than seven million Australians need is provided, where and when they need it.”
For the full report see here.
The ARA’s ASM was held on the Gold Coast from 16-19 May.
