North Carolina Rheumatology Association Looks to the Future

With more than 100 members, including rheumatologists, physician assistants (PAs) and nurse practitioners (NPs), the North Carolina Rheumatology Association (NCRA) is a dynamic, member-owned organization.

Dr. Harner

Like other states, North Carolina has a shortage of rheumatologists, particularly in the state’s rural areas. “When you get outside big cities, such as Charlotte and Raleigh, patients have limited access to rheumatology care,” says Kyle Harner, MD, current NCRA president and rheumatologist with the Carolina Arthritis Center, Greenville. “They often have to wait several months to secure an appointment with a rheumatologist and then drive a long distance to receive care.”

The NCRA believes in taking a proactive approach to increasing the number of rheumatology providers in the state, Dr. Harner says. To accomplish this, the NCRA supports local fellowship programs and encourages young rheumatologists to establish practices in the state, particularly in underserved rural areas.

Dr. Wolfe

Rachel Wolfe, MD, a rheumatologist at Wake Forest Baptist Health, Winston-Salem, and an assistant professor of rheumatology and immunology and director of the Rheumatology Fellowship Program at Wake Forest School of Medicine, praises the NCRA for their ongoing validation of fellowship trainees.

“The association covers the cost of fellows to attend the annual NCRA conference and also supports fellowships in North Carolina throughout the academic year,” says Dr. Wolfe, who serves as the NCRA’s academic representative. “The fiscal support [the society] gives each fellowship allows us to better prepare our fellows and foster a rheumatology community here in the Carolinas.”

To help fill the need for rheumatology professionals, Dr. Harner says many rheumatology offices, including his own, are also adding NPs and PAs to their staff. “For PAs and NPs who are new to the rheumatology profession, there’s a training period required to integrate them into the practice, but it’s well worth it,” Dr. Harner says.

Improving Access

Telehealth can also help bridge access to care. Many rheumatologists in North Carolina began using telehealth services during the pandemic, and Dr. Harner expects this trend to continue.

Some insurers, including Blue Cross/Blue Shield of North Carolina, have said they will continue to reimburse for telehealth visits as they do for in-person visits through the end of 2021.¹ In addition, states are continuing to refine their telemedicine reimbursement policies with regard to Medicaid and private payer laws. The National Conference of State Legislators offers an interactive map illustrating each state’s current telehealth policies.

However, telehealth is only a partial solution to the rheumatology access issues now and in the future. “In addition to a lack of physicians, many of our rural areas have internet infrastructure problems,” Dr. Harner says. “Without access to high-speed broadband, providing telehealth isn’t an option in many areas.”

As one possible solution to this, UNC Health Southeastern began placing telehealth kiosks in rural areas of the state earlier this year. The kiosks are designed to offer telehealth services to North Carolina residents who live in rural areas and have spotty internet service.

Connecting with Rheumatology Colleagues

Dr. Wolfe praises the camaraderie and sense of community provided by the NCRA.

“I’ve been a member for the past five years, and it’s wonderful to meet other colleagues from across the state and discuss systemic problems, such as insurers denying drug reimbursements,” she says. “We learn ways we can advocate for our patients and support our colleagues who continue to maintain private practices.”

As more rheumatologists opt to join academic hospitals or larger medical groups, Dr. Wolfe sees an important role of the rheumatology community in supporting private practices, which are a vital part of the economy.

“It’s important to keep a diversity of practices and help our colleagues sustain their private medical practices,” she says. “One way I do this is to refer patients to private practice rheumatologists who may have an office closer to where the patient lives and works.”

Looking Ahead

Other healthcare organizations in North Carolina are also working to address the looming physician shortage. This past January, the Cape Fear Valley Health System, Fayetteville, broke ground on a new Center for Medical Education and Research building, which it claims will produce 900 physicians over the next 10 years. The building is expected to open in late 2022 and will allow Cape Fear Valley Health’s residency program to double in size, attracting more physicians and specialists to the area.²

Looking to the future, Dr. Harner would like to see the NCRA become more involved in advocacy efforts for patients and to continue to grow its base, attracting more rheumatologists, PAs and NPs, and finding ways to get more medical students interested in pursuing a rheumatology career, as well as increasing the number of available fellowships.

“There are more medical students who want to complete fellowships in rheumatology than there are spots in the programs,” he says.

“Our association also supports physicians having a national medical license,” Dr. Harner says. “During the pandemic, our rheumatologists often provided care to patients in neighboring states, such as Virginia and West Virginia, that also have a shortage of rheumatologists.”

Dr. Harner would like to continue to emphasize educational opportunities for NCRA members and hopes to offer more workshops via Zoom as well as in person, so rheumatologists and rheumatology providers across the state can participate.

He praises Tammy Bulger, the NCRA’s administrative director, for her hard work in developing meeting agendas, securing venues for events and applying for grants to fund activities.

“Tammy is a senior lecturer in communication studies at the University of North Carolina Wilmington and has been working with the NCRA for over 15 years,” Dr. Harner says. “She does a terrific job keeping the NCRA organized and helping make our annual conference an event everyone looks forward to attending.”

Due to the COVID-19 pandemic, the NCRA canceled its 2020 academic conference and held a virtual conference in 2021. The 2022 NRCA conference is planned for March 19–20, 2022 at the Washington Duke Inn, Durham.

Linda Childers is a health writer located in the San Francisco Bay Area.

References

1. Blue Cross NC extends pandemic telehealth policy through 2021. BlueCross BlueShield of North Carolina. 2021 Apr 13.
2. DeVane S. Cape Fear Valley to build center to train doctors. Here’s what that means for Cumberland County. The Fayetteville Observer. 2021 Feb 15.