Rheumatology has expanded during recent years, and innovations in immunology, epigenetics and bone metabolisms are constants.1 For this reason, the Societat Catalana de Reumatología (SCR) sponsors studies every 5–7 years which reflect the state of the specialty at that time, and allow us to compare it with previously undertaken studies, providing information and possibilities for improvement in later years.2–5

An observational, descriptive and cross-sectional study, with data collection between January and June 2017. Rheumatologists who practise in the public healthcare system in Catalonia were the study object. Information was obtained using a list of centres included in the Servei Català de la Salut (SCS): Institut Català de la Salut (ICS) and Xarxa Hospitalaria d’Utilització Pública (XHUP).

An online questionnaire was dispatched, collecting individual and collective information (all hospitals were contacted.). Two surveys were carried out (Table 1), one individual and one to those responsible for each service. Each head of unit sent another electronic mail to all the rheumatologists on their team. The email was sent on 3 occasions.

Information was obtained about the number of inhabitants from the different health regions by means of the IDESCAT (statistical yearbook of Catalonia): the resident population in Catalonia from January 1st 2017 was 7,496,276 inhabitants.

Qualitative variables were expressed as absolute value and percentage. Quantitative variables were expressed as mean and standard deviation (SD) if they were normal, and median and interquartile range if they were not.

Given that the work was descriptive it was not considered necessary to go through the research/ethics committee and the professionals accepted participation in the study on completing the questionnaire.

Through hospital lists and answers obtained during the study period it was estimated that 141 rheumatologists had been contracted in the public hospitals of Catalonia, with which we obtained an estimated 69.5% participation rate.

There is an increasing number of rheumatologists in Catalonia, amounting to 8.5% compared with a study conducted 6 years previously.5 It is of note that the growth curve is slower than in other studies: 40% (1997–2005) and 20% (1990–1997).3,4

A progressive increase in the number of female rheumatologists was observed, a trend which had already been previously observed.5 There may be a selection bias due to lower participation of male rheumatologists in this study but we are unaware of the reason. Retirements were not recorded.

Regarding age, this progressively increased but stabilised in the last 5 years, staying at 47 years of age, equal to the study from the year 2012. Participation in the survey of those less than 35 years of age was low, probably due to them not having been contracted by a hospital.

In Canada6,7 similar surveys were conducted, obtaining 68% of responses, a similar percentage to this study. Mean age was 50, and 70% were working full-time in care. These data are similar to the present study.

It has been predicted that there will be a lack of rheumatologists in upcoming years, based on assessment of supply and demand. In the U.S.A. a series of factors have been identified which may impact the lack of rheumatologists: the growing number of rheumatologists who will retire; the increasingly number of females into the specialty and the fact that younger rheumatologists are contracted part-time.8

At present the only route available for obtaining the quantification as a specialist in rheumatology is through the medical residency system. In the next few years rheumatologists who were trained through other systems will retire, and it is predicted that in the next survey 100% of rheumatologists will be trained through the medical residency system.

In 2017 there were 56 medical residency places in rheumatology in the whole of Spain, 2 more than in 2012. In Catalonia there were 10 places, all of them in the province of Barcelona, which was the same number as the previous study.5

Private practice rheumatology was mainly exercised in Catalonia and Madrid.9 Fifty per cent of the rheumatologists who participated in our survey combined their profession in the public and the private healthcare systems. Those who only worked for the private sector were excluded. his data coincided with that published by the private practice commission of the SER,10 where it was estimated that 52% of Catalan rheumatologists worked in private rheumatology, and also with the data published by Alegre C11 where 42% was obtained.

Like in other years, the activity focused on the province of Barcelona, most in Lleida, Tarragona and Girona (slight improvement). There were 6 hospitals without a rheumatologist, in 2012 there were 10 hospitals without this speciality.

The limitations of this study are inherent to the lack of a complete census of rheumatologists in Catalonia, to the presence of new questions which did not exist in previous studies and the inability to differentiate between types of hospitals/reference area. The number of responses was poor, thereby debilitating the study.

Recently EULAR published an article12 with the key points to be considered in the future for this type of survey. It was suggested that the balance between new rheumatologists compared with retired ones be considered, in addition to the type of rheumatic disease, the time used for the visits and the balance between supply and demand.

To conclude, the number of rheumatologists has increased, but only slightly in recent years. Mean age has advanced and rheumatologists are mainly women. A great number of rheumatology services depend on other services. In Catalonia the practice of rheumatology is centred in Barcelona. There are 6 hospitals without a rheumatologist.

Doctors Dolors Grados Canovas and Melania Martínez-Morillo received an internal grant in June in 2016 from the Societat Catalana de Reumatologia (Spain) of 6,000 Euros in total, for creation of this document.