Can Primary Care Physicians Help Rheumatology’s Workforce Shortages?

His patients face many barriers, such as difficulties navigating the healthcare system and getting to different appointments, says Dr. Bhatt. Moreover, his patients may not be able to get an appointment with a rheumatologist as urgently as he’d like.

“With all these barriers, if we can handle their care without sending them to a specialist, that’s great,” says Dr. Bhatt.

Although Dr. Bhatt feels confident managing certain aspects of rheumatology diagnosis and care, he has felt less certain about other aspects, such as changing a medication’s dose or a approach after first-line treatment failure. This uncertainty may stem from inexperience in rheumatology or from a lack of available expert mentorship in a particular situation, he notes.

Dr. Bhatt

In general, Dr. Bhatt is comfortable differentiating potential autoimmune etiologies from non-autoimmune ones. However, he notes that certain borderline and equivocal cases can be more challenging to interpret. “Is it appropriate to jump to treatment if some of the lab results are positive but others are not? What if the ANA is just a little bit positive? I think there can be a lot of uncertainty for those of us in primary care.”

For the Rheumatology for Primary Care resource, the authors wanted to provide the key information primary care providers would need at the point of care. Part of the challenge is that primary care providers often face significant time pressures during their appointments, and they may only have a few moments to investigate the best approach. Dr. Bhatt points out that resources from the primary literature can be overwhelming to utilize, and even secondary resources, such as UpToDate, don’t always easily provide the information he needs most quickly, and the applicability to his patient may not be clear.

To address such issues, the new Rheumatology for Primary Care resource includes practical information, for example, about when an ANA test should be ordered, its lack of specificity but high sensitivity, and the importance of looking at titers. The resource provides key clinical information on symptoms, testing, diseases and medications, also utilizing case studies to provide clinical pearls and management considerations. The resource is designed not just to benefit physicians, but also other primary care providers, such as nurse practitioners and physician assistants.

Initial Examination & Patient Hand-Off

Dr. Jonas points out that in addition to helping primary care providers successfully manage certain patients without the need for referral, the resource can help primary care providers identify patients who do need specialist care. Given a thorough and appropriate initial evaluation by a primary care provider, a specialist can assess the patient and deliver care more quickly when they do eventually see the patient.