TOPLINE:

From 2009 to 2024, the number of rheumatology programs and training positions in the US increased. However, a persistent increase in the number of applicants and decrease in the numbers of unfilled positions and first-choice matches indicated growing competition and suggested that expanding training positions could increase the workforce.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis of all applicants for US rheumatology training from 2009 to 2024 to characterize trends in the annual numbers of rheumatology programs, training positions, and applicants over the 16-year study period.
• Data were obtained from the National Resident Matching Program, and annual trends were analyzed using linear regression.

TAKEAWAY:

• The number of rheumatology training positions increased by 52.5% over 16 years, while the number of programs grew by 28.3% and that of applicants by 47.7% (P < .001 for all); however, the annual applicant-to-training position ratio remained unchanged (P = .489).
• The annual percentage of unfilled training positions declined significantly from 7.2% in 2009 to 1.1% in 2024 (P < .001), but no significant changes in the annual match rate were observed (P = .781).
• The percentage of applicants matching at their first-choice fellowship decreased significantly from 49.4% to 33.4% (P = .001), whereas those matching at their fourth or lower-ranked choice increased from 5.8% to 18.1% (P < .001).
• Representation of US osteopathic graduates increased from 4.2% to 13.9% (P < .001).

IN PRACTICE:

“These results highlight the competitive nature of rheumatology training in the US and suggest an ability to increase the number of recently trained rheumatologists by increasing the number of available training positions,” the authors wrote.

SOURCE:

This study was led by Jason Silvestre, MD, Medical University of South Carolina in Charleston, South Carolina. It was published online on October 10, 2025, in Seminars in Arthritis and Rheumatism.

LIMITATIONS:

The reasons for the observed changes in training positions and applicants remain unknown due to the retrospective study design. Findings were limited to the rheumatology match and did not reveal where matched applicants ultimately practiced or what careers they chose. The researchers could not assess which rheumatology fellowship program characteristics were associated with being highly desired by applicants.

DISCLOSURES:

The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.