Rheumatology Workforce for the 21st Century

More recent data show an increase of 141% for advanced practice providers between 2009 and 2020, and a 23% increase in the number of clinically active rheumatologists.² The data also show that the number of clinically active rheumatology providers grew by more than 20% over the past decade—to a high of 6,036 in 2020. However, that growth appears to be flattening.

Ms. Khalili cited the cost of medical school, medical practice mergers, the rising value of team-based care and task shifting as contributing factors to why the number of advanced practice providers is growing faster than the number of rheumatologists.

Most, if not all, advanced practice providers see patients for routine or urgent follow-up care and are primarily responsible for patient education, adjusting medication doses and conducting physical exams, with a high percentage (70%) also performing new patient evaluations.

Other responsibilities of advanced practice providers, as a part of a team-based approach, include joint injections, baseline ultrasound evaluations, referring patients to triage, infusion management, practice management and advocacy.

2. Integration of PTs is slow & low; innovations are needed.

Daniel White

Daniel K. White, associate professor in the Department of Physical Therapy at the University of Delaware, Newark, spoke about the role of PTs and said their work in helping patients to reduce pain and functional limitations is ideal for patients with chronic illness, such as rheumatic diseases. He said a referral to a PT can also offer patients additional education on understanding their limitations and how to work around those limitations.

However, he called current referral to PTs slow and low, citing a study showing that only 5% of primary visits for knee osteoarthritis result in a referral to a PT.³ Although rheumatology is currently not a separate subspecialty within PT, he said initiatives are underway to improve PTs in rheumatology care. To date, most patients with rheumatic diseases referred to PT are seen in an outpatient orthopedic clinic.

He urged rheumatology practices to refer patients to a PT and suggested using Google Maps to easily find them. Good candidates for PT include patients with impairments in pain, decreased range of motion or weakness, as well as those with such functional limitations as difficulty walking or climbing stairs and who are unable to participate in an enjoyed activity, such as being a parent or grandparent. Mr. White said a good indicator for a referral is when a patient talks about wanting to do something, (e.g., golf). A PT can help that patient meet his or her goal.