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Broader Networks, Not Borders May Aid Rheumatology Workforce Deficit
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Editor’s note:
In this issue, we are fortunate to bring readers a Guest Editorial from Cathy Patty-Resk, MSN, RN, CPNP-PC, from the Division of Pediatric Rheumatology at Children’s Hospital of Michigan and member of the legislative advocacy team of the Rheumatology Nurses Society, to discuss the workforce shortage in rheumatology and where NPs/PAs fit into the mix. Having worked with an advanced practitioner virtually my whole career and having an extraordinary NP — our own Betsy Kirchner MSN, CNP, from the Healio Rheumatology Peer Perspective Board — that can do it all, I am all in. Remember that we are talking about advanced practitioners here, and not what some would dub as ‘non-physician providers,’ ‘midlevels,’ or even ‘physician extenders’ — call them Advanced Practice Providers for that is what they are!
— Leonard H. Calabrese, DO
Chief Medical Editor, Healio Rheumatology
For many months now the rheumatology workforce shortage has plagued my thoughts. I have heard an age-old conversation that sounds more like “us vs. them” regarding physicians, nurse practitioners and physician assistants, heretofore known as APPs for advanced practice providers, not physician extenders and certainly not midlevel providers.
However, that was until I read a recent article by Jack Cush, MD, on the workforce shortage. If you haven’t read it, please do so. His concluding sentence pretty much sums it up: “NPs and PAs offer one potential solution to meet rheumatology workforce deficit. Their education and practice needs are essential to the future delivery of rheumatologic care in the U.S.”
As a pediatric nurse practitioner for 19 years and an RN for 30 years, I can offer my perspectives from the NP position. I have never had a desire to go to medical school or become a physician and have never practiced as what I refer to as an “NP yahoo” — better known as “physician wannabe.” However, that doesn’t mean I don’t desire to practice autonomously; rather, it means that I am able to understand and respect where my knowledge limits are and when I need to collaborate with a physician. I do not have the knowledge depth of a physician for obvious reasons — I did not go to medical school, nor did I complete a residency and fellowship in rheumatology.
Some NPs may say I’m selling out our profession, however, I beg to differ. While there is a great deal of overlap between APPs and physicians, I am proud of the skills I have that set me apart as an NP, just as I am sure PAs are proud of the skillsets they have that are unique to their profession, and just as physicians are proud of the skills that set them apart as physicians.
Instead of physicians and APPs debating who is more qualified to care for rheumatology patients, let’s look at what each has to offer specific patient populations. One thing that won’t suffer — which Dr. Cush does a fabulous job of pointing out in his article — is patient care. Previous studies have consistently shown that NPs not only have high patient satisfaction scores, but also that their patients have outcomes as good as those cared for solely by physicians.
The ACR workforce study data are so bleak. If we don’t do something to change the trajectory, our patients are going to suffer and we will all be so overworked that it will be difficult to attract new talent. Every one of us who really cares about rheumatology as a profession will welcome all the help they can get. If you are a rheumatologist or very experienced rheumatology APP dedicated to alleviating some of the burden of the workforce shortage, now is the time to teach as many new APPs as you can — and teach them well!
This is an opportune time for rheumatologists to help strengthen the rheumatology provider network by not only including APPs, but also embracing them as the colleagues we are. We all know how long it takes to train an APP in rheumatology and we can probably all agree it takes several years just to be proficient, let alone exceptional. If we don’t start collaborating on the workforce shortage, we risk losing control of our specialty. Our patients will not stop getting rheumatic diseases — they will just stop seeing rheumatology providers for care. Each and every one of us is responsible for this amazing, ever changing specialty we all love. So, let’s be rheumatology strong and unite as one provider group, APPs and physicians.
- References:
- Agarwal A, et al. PLoS One. 2016. doi:10.1371/journal.pone.0148522.
- Cush J. The Big Need - NPs and PAs. Rheum Now. Oct. 12, 2017.
- Graves JA, et al. Medical Care. 2016. doi:10.1097/MLR.0000000000000454.
- Perloff J, et al. Health Serv Res. 2016. doi:10.1111/1475-6773.12425.
- Solomon DH, et al. Arthritis Care Res. 2015. doi:10.1002/acr.22643.
- For more information:
- Cathy Patty-Resk, MSN, RN, CPNP, can be reached at 3950 Beaubien, Suite 4026, Detroit, MI, 48201; email: cpatty-r@dmc.org.
Disclosure: Patty-Resk reports no relevant financial disclosures.