Dr. Myers cited the physical exam as a key area in which the rotation was helpful, for example, in learning how to better differentiate inflammatory arthritis from more mechanical arthritis. “That’s a big factor in knowing if I may need to send them for referral. You can watch as many videos as you want, but that’s different from being there and feeling the joint and getting input from someone with expertise.”
Dr. Myers also notes how helpful it was to get input about the next steps in laboratory evaluation and learning more about how to follow up on labs in situations where she might previously have felt stuck.
“You want to be efficient about it, so you aren’t sending the patient to the lab over and over again,” she says, “but you also want to be cost efficient and not order every single lab every time.”
Dr. Myers particularly enjoyed learning more about the nuances of preventive care in the context of rheumatology patients (e.g., vaccine management).
Dr. Engelbrecht shares his great respect for primary care providers, who must maintain a huge breadth of knowledge to manage their patients, and he saw the experience as a great opportunity for bidirectional learning and exchange, a chance for him to review some internal medicine skills and knowledge. Rheumatologists tend to be more holistic in their care than some specialists, but working directly with primary care doctors gives another layer of insight.
“Primary care doctors are really good at seeing the patient as the whole picture,” notes Dr. Myers, “seeing how the rheumatologic disease fits in with their other comorbidities, the effect it has in the workplace and at home, the impact on their families and communities.”
Ideally, Dr. Engelbrecht would like to see shadowing opportunities for primary care providers beyond residency. Theoretically, group and hospital practices could sponsor their employees to spend time shadowing a rheumatologist to gain more expertise and confidence handling these patients. Although this would require a financial investment, it might eventually pay off, and it could certainly improve care in the long term.
Rheumatologists should engage in informal question-and-answer sessions with primary care providers to build overall knowledge of important aspects of rheumatology, says Dr. Engelbrecht.
To support the rheumatology workforce, Dr. Engelbrecht also notes the importance of establishing more rheumatology fellowships, to which there are often more applicants than available slots, and he urges clinicians later in their careers to consider moving to part-time work, as he has done, instead of retiring.
