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Rheumatology Practice Models for 2016: How 1 + 1 Can Equal 3
The practice of rheumatology has changed during the past 3 decades – and, I would say dramatically for the better, with only few exceptions. In terms of outcomes, all indicators are positive. We see patients with rheumatoid arthritis earlier due to physician and patient awareness. Outcomes in terms of slower erosive disease progression and diminishing requirements for joint replacement speak for themselves. As evidence, even the look and feel of our waiting rooms is different, minus the wheelchairs and the numerous assist devices of the past. As a profession, rheumatologists are now eager to see new cases of rheumatoid arthritis because both patients and physicians likely will be gratified.
However, all is not perfect. The pace of medicine in general and the pace of rheumatology has hastened. As a result, there is less time to “know” our patients during visits. This is a loss that for those who have practiced in less hectic times have perhaps felt more than their younger colleagues who grew up with the rapid pace. Electronic medical records have altered the choreography of physician-patient interactions, which many have found difficult to adjust to as well. In addition, the finances of medicine have dramatically changed and with this comes patient outcomes influenced by access to care and medications, especially biologic therapies.
Collaborative Care Models
Leonard H. Calabrese
One advance in today’s practice of rheumatology is the growth of collaborative care models with advanced care providers, such as nurse practitioners (NPs), registered nurses (RNs) and physician assistants (PAs). In my opinion, this phenomenon has been one of the greatest advances in rheumatology practice of this era. Why is this the case? I believe it is all about patient care. As we know it, medicine is a team sport. Not that the solo practitioner is outmoded — far from it. However, we can only do so much as individuals.
I have practiced with an advanced practitioner (a PA, RN and now a NP) for nearly 30 years. When I first started, there were no good models and many in my group considered it almost experimental. What I have learned from the experience is we each bring strengths to patient care and the patient experience. My early concerns of relegating power and responsibility have been assuaged by the reality that we now provide better care and better caring. It is forged on a relationship that is not “power-over” but “power-with.”
I encourage all rheumatologists who I encounter to consider such a collaborative model more for quality and professional satisfaction reasons than for financial reasons. It only takes one look at my patient satisfaction evaluations to recognize who is central to their satisfaction.
High Quality Workforce
Advances in the field have allowed the development of growing high quality workforce, too. When our current NP joined our team 16 years ago, there were no readily available materials for her to use as a “jumping-off point” for more intensive rheumatology training. Even though her master’s nursing program included more immunology experience than most, I still spent 2 years with her in a so-called “mini-residency.” We worked one-on-one in clinic and in mini-tutorials of my own devising.
Today there are numerous options for NPs and PAs to obtain both basic and advanced rheumatology training. Such training options include the Association of Rheumatology Health Professionals online certification course, which is 12 modules, 1 hour each on a variety of rheumatologic conditions; multiple live and online continuing education offerings through several major academic and health care institutions; The Core Curriculum for Rheumatology Nurses, which is a textbook written by and for rheumatology nurses; and Rheumatology Nurse Practice, a quarterly newsletter published by the Rheumatology Nurses Society.
As I reflect on how I care for patients, especially established patients, I appreciate how valuable my NP’s opinion is in so many daily decisions. While I may have more of a role in the most complex aspects of diagnosis and critical medical decision-making, my NP partner is often more attuned and better equipped to help me appraise shared and informed decisions in which patient goals are primarily patient-centered. When it all works out, it is truly 1 + 1 = 3.
Thanks for reading this issue of Healio Rheumatology. Please send me your comments by email at calabrl@ccf.org or on Twitter @LCalabreseDO.
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- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Disclosure: Calabrese reports he is a consultant for Genentech, Pfizer, Bristol-Myers Squibb, GlaxoSmithKline, Sanofi, Jansen and AbbVie; and is on the speakers bureau for Genentech, AbbVie and Bristol-Myers Squibb and Crescendo Bioscience.