According to the ACR workforce study published last year, 97% of all rheumatology practices say they accept new patients, but the mean wait time to get a non-urgent appointment is more than a month (37 days). The study found that 15.5% of rheumatology practices employ an NP and another 7.2% employ a PA, while 10% said they were actively seeking to hire an NP or PA. Another 25% of the practices reported a desire to hire a PA or NP within five years. The new NP and PA training program is a direct response to the Workforce Study’s urgent call for practice re-design as a way to preserve and improve the quality of the profession. Additionally, surveys from health professionals indicated a preference for online educational programs that would not involve costs associated with travel.
NPs and PAs in the Practice Setting
Practice redesign is nothing new to Paul Caldron, DO, head of the Arizona Arthritis and Rheumatology Associates in Paradise Valley, Ariz., and a member of the Workforce Study Advisory Group. Caldron has employed an NP for close to 20 years. His practice overall includes nine rheumatologists and nine NPs or PAs. “Our experience with this model is incredibly good,” says Dr. Caldron.
Although state laws differ on how NPs and PAs can practice, and individual rheumatologists may have different models, Dr. Caldron’s practice provides a window into how it can work. “We see six new patients a day on average,” he explains. The nurse practitioner or physician assistant sees the new patient, does a history and physical, and then presents that information to me before I see the patient. We discuss what needs to be done, the NP or PA takes notes and implements the plan of care while I go on to my next patient,” says Dr. Caldron. “I generally see the patient on the second visit, and once a stable course of treatment is set we alternate seeing the patient at each visit. If there is no change, there is no need for me to see the patient.” Dr. Caldron describes the addition of a NP or a PA to the practice as, “having a senior fellow that never goes away.”
Some rheumatologists are reluctant to turn over even some care of their patients (particularly a new patient) to someone who is not a physician, says Rod Hooker, PhD, PA, head of rheumatology research at the Department of Veterans Affairs (VA) in Dallas, Texas. He hears these sentiments within the VA, the largest employer of NPs and PAs in the country. “We have only four PAs doing rheumatology in the entire VA system.” Hooker hopes to see penetration of these practitioners into rheumatology just as it is in other medical specialties. He encourages individual practices to determine the best role of the NP or PA in the rheumatology practice. “There is so much routine care that can be shifted to the NP or PA,” he says. “This allows the rheumatologist to spend more time with patients with more complex needs.” Dr. Hooker also served as a member of the ACR Workforce Study Advisory Group.
