BANGOR, Maine — Rheumatologist Dr. Sidney Block is 65 years old and has practiced in Bangor since 1975. He’s not about to retire, he emphasized in a recent conversation — and that is a good thing, since he is one of only about a dozen rheumatologists in Maine and one of just three practicing in Bangor.
Block recently received national recognition from the American College of Rheumatology for his scholarly contributions to the field. On Monday, he took advantage of his celebrity to discuss the shortage of rheumatologists in Maine and called on hospitals to step up their recruitment efforts.
Block has practiced since 1977 with Dr. Geoffrey Gratwick, who is also 65. Their colleague at St. Joseph Hospital, Dr. Donald Krause, is about the same age. Block said rumors of the three rheumatologists’ impending retirements have been greatly exaggerated. But eventually, he said, they will retire and when that happens, specialized care for conditions such as osteoarthritis, rheumatoid arthritis, lupus, gout, chronic fatigue syndrome and Sjogren’s syndrome will be hard to come by.
Already, Block said, the Bangor rheumatologists must triage the patients that are referred to them.
“We’re concentrating on those with potentially crippling or deforming disease,” he said. Other patients are put on long waiting lists or must seek treatment in Portland, where there is a group of about six rheumatologists, or in Boston.
Rheumatologists also are located in Lewiston, Waterville, Rockland and Ellsworth. Rheumatologists have recently left practices in Fort Kent and Farmington.
Block said there are several factors contributing to the scarcity of rheumatologists in Maine. For one thing, the specialty doesn’t pay as well as some others, discouraging younger physicians — burdened with astronomical medical school loans — from entering the field at all.
In addition, Block said, rural states such as Maine are at a special disadvantage when it comes to recruiting new physicians. That’s because many younger doctors are disinclined to take on the complications of managing a small private practice and prefer the practical and professional support of working in larger group practices or hospitals, typically located in more populous areas.
“We’ve been trying for a decade to get more rheumatologists up here,” Block said. “But these days, it takes an adventuresome practitioner to enter a private practice.”
Block said it is up to Maine hospitals to persuade a new generation of rheumatologists to settle in northern and eastern Maine.
“Back in the ’70s, many [doctors] came up here because it was a nice place to live and raise children. And it still is,” Block said. But now, he added, lifestyle alone is not enough.
At Eastern Maine Medical Center in Bangor, Vice President and Chief Medical Officer Dr. James Raczek said the hospital has been trying to attract a rheumatologist to its staff for about two years, in recognition of the ages of the area’s three specialists. Despite a few responses to advertisements in medical journals and the efforts of professional headhunter agencies, Raczek said EMMC has not reached the point of offering a contract to a rheumatologist.
He said there are just a few rheumatology fellowship programs, which turn out a total of about 200 graduates a year. “That’s a small number to disperse across the country,” he said, adding that most specialists choose to practice in the communities where they train.
EMMC offers a competitive salary, Raczek said — the average for rheumatologists is between $170,000 and $218,000 a year — but so far that hasn’t been enough to offset the perceived disadvantages of living in a remote area such as the northern half of Maine. He added that the problem extends to all medical specialties; the hospital is looking now to fill at least 35 physician vacancies, he said.
Gordon Smith, executive vice president of the Maine Medical Association, said Tuesday that the need for rheumatology services is growing. As the population of the state ages, he said, so will the incidence of the age-related conditions that doctors treat.
“Until the supply [of rheumatologists] gets better, people are just going to have to travel further to get the care they need,” Smith said.
Block was recognized as a master of the American College of Rheumatology at the group’s annual meeting last month in San Francisco. According to the ACR Web site, “recognition as a Master of the American College of Rheumatology is one of the highest honors the College bestows, … conferred on ACR members, age 65 or older, who have made outstanding contributions to the field of rheumatology through scholarly achievement and-or service to their patients, students, and profession.”
