Initiative Trains Clinicians About RA for the Navajo Community

Editor’s note: ACR on Air, the official podcast of the ACR, dives into topics important to the rheumatology community, such as the latest research, solutions for practice management issues, legislative policies, patient care and more. Twice a month, host Jonathan Hausmann, MD, a pediatric and adult rheumatologist in Boston, interviews healthcare professionals and clinicians on the rheumatology front lines. In a series for The Rheumatologist, we provide highlights from these relevant conversations. Listen to the podcast online, or download and subscribe to ACR on Air wherever you get your podcasts. Here we highlight episode 71, “The Rheumatology Access Expansion Initiative,” which aired on Feb. 27, 2024.

Rheumatology is no stranger to specialist shortages. Leaders in the field have attempted to address the rheumatologist shortage by increasing the number of fellowship spots, working with advanced practice providers, improving telemedicine access and other measures, Dr. Hausmann says.

Still, the workforce shortage remains, leaving parts of the U.S. without adequate support from rheumatology. To address this situation’s effect on the Navajo Nation, which spans parts of Arizona, New Mexico and Utah, two rheumatologists created the Rheumatology Access Expansion Initiative, which is designed to help primary care providers care for their patients with rheumatoid arthritis (RA).

Dr. Mandal

Jennifer Mandal, MD, an assistant professor of medicine in the division of rheumatology at the University of California, San Francisco, and Wendy Grant, MD, a rheumatologist at CommonSpirit Rheumatology in Durango, Colo., began the program because of the shortage of rheumatologists and the higher prevalence of RA among those living on the Navajo Nation reservation. The prevalence is 4–5% compared with 1% in many other parts of the U.S.¹

“There are these huge areas of the country where there is just an incredibly dire need for rheumatologists,” Dr. Mandal says. “I started to realize that the people who are actually providing the rheumatology care in these areas are primary care providers. They are dealing with incredibly complex rheumatologic conditions, often with very minimal support.”

With a background in medical education and curriculum development, Dr. Mandal began to consider educational initiatives to help reach patients. Around that same time, she met Dr. Grant and learned more about the situation on Navajo Nation.

Before her rheumatology fellowship, Dr. Grant’s background included working at a hospital on the Navajo Nation reservation. She was working in general internal medicine, and a rheumatologist would come in every two months to see many patients. She herself ended up seeing many patients with RA, as well as those with lupus, scleroderma and vasculitis. That’s when she decided to get more training in rheumatology.