With increasing shortages of rheumatologists expected in coming years, primary care providers (PCPs) may need to play an important role in the initial diagnosis of rheumatic illness and patient management before or between visits with the rheumatologist. Ideally, the rheumatology community will find more ways to directly provide guidance to these providers; a new ACR resource, Rheumatology for Primary Care, is a step in the right direction.1
A study conducted by the ACR estimates a shortage of approximately 4,100 rheumatology providers by 2030 in the U.S., with disproportionate needs in certain areas of the country.2 In many areas, such shortages are already affecting care; some patients wait many months—sometimes even a year or longer—before they are seen by a rheumatologist.
Beth L. Jonas, MD, FACR, chief of the Division of Rheumatology, Allergy and Immunology at the University of North Carolina at Chapel Hill, is a member of the ACR Workforce Solutions Committee, a group focused on exploring different avenues to ameliorate these workforce challenges and improve patient access. One of these is the creation of virtual training programs and resources.
Dr. Jonas
Primary Care Management of Rheumatology Patients
According to Dr. Jonas, many rheumatologic conditions—such as osteoarthritis, gout or uncomplicated rheumatoid arthritis—can often be managed in a primary care setting.
Thus, the committee created a working group to create the new resource for primary care providers.
“The more our healthcare provider partners in the community really understand about rheumatology, the better off the patients are going to be,” says Dr. Jonas.
David Engelbrecht, MD, a rheumatologist who divides his time between two underserved areas, Northern Light Maine Coast Hospital in Ellsworth, Maine, and a clinic in the Bronx, New York, agrees that many patients referred to him could be managed by primary care providers. But primary care providers may be uncomfortable with such factors as a positive anti-nuclear antibody (ANA), a slightly elevated erythrocyte sedimentation rate or a low positive rheumatoid factor, he explains.
Dr. Engelbrecht
“I understand them not wanting to miss a potentially serious illness,” says Dr. Engelbrecht. “That’s where I think some education can be very helpful in making them feel more comfortable managing these patients.”
Milap Bhatt, DO, a family medicine physician at Erie Family Health Center, a federally qualified health center, and core faculty member at Swedish Hospital, both in Chicago, was part of the Rheumatology for Primary Care Working Group. He provided feedback on the kind of information primary care providers most need at the point of service.
