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Training, Trust in APCs may Forestall Workforce Shortage
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FORT WORT, Texas — With the need for rheumatologists expected to outpace national demand by 2030, employing more advanced practice clinicians could help stem the tide of a growing population of aging baby boomers, provided rheumatologists correctly utilize clinicians to the top of their licenses, according to a presentation at the Rheumatology Nurses Society Annual Conference.
“Although we have discussed the problem of ‘baby boomer’ retirement, over the past few decades, we have also had this ‘opportunity cost’ issue,” Paul H. Caldron, DO, PhD, FACP, FACR, MBA, of Arizona Arthritis and Rheumatology Associates, said. “If you consider a medical student graduating with half a million dollars in debt, they want to go into a field where they can make that back pretty quickly – that field isn’t rheumatology. For the additional years spent training as a rheumatologist, there is virtually no return on the investment beyond internal medicine.”
Echoing findings from the 2005 American College of Rheumatology Workforce Study — which reported a severe gap between rheumatology supply-demand by 2025 — Caldron said that the updated 2015 data projects that, by 2030, the supply of clinical providers in rheumatology will shrink by 31% as demand for services increase by 138%. However, he noted, utilizing advanced practice clinicians (APCs) could offer hope in forestalling the inevitable shortage.
“As APCS, we all function a little differently in our clinics depending on where you are, but there is always the question about how we can practice at the top of our scopes,” Amanda Mixon, PA-C, a physician assistant with the Arthritis and Rheumatology Clinic of Northern Colorado, said. “We are capable of diagnosing and treating all rheumatologic conditions according to the ACR and EULAR diagnostic criteria, as well as identify patient concerns regarding treatment plans. APCs can also independently perform physical assessments, prescribe and/or administer medications, and interpret labs and radiographic results to customize a treatment plan.”
Mixon noted that, in her experience, the additional time that APCs and nurses spend with patients has fostered a better rapport between staff and patients than is typically found between rheumatologists and their patients. “Patients feel that we really listen, that we understand what they are going through precisely because we put in the time,” she said. “Patients really resonate with the APCs and nurse.”
Despite the apparent benefits to patient-staff communication and improved patient experience, Caldron noted that only 25% of rheumatology practices in the United States utilize APCs – and that rheumatologists themselves may represent the biggest barrier.
“We know that the number of APCs nationally is increasing but how does rheumatology get our fair share of what we need?” Caldron said. “I think the biggest required change is in the mindset of rheumatologists. Many rheumatologists ask themselves ‘Can I train a nurse practitioner or physician assistant to do what I would want done with my patients?’ and if they do employ an APC, rheumatologists tend to under-employ them or not employ them to the top of their license, so there is a trust and delegation issue.”
He continued, “When considering an APC, rheumatologists also fear a lack of return on their investment: The average cost of an APC, the cost of benefits, and whether they can afford them as rheumatology is already a low-paying specialty.”
Mixon stressed that working as a cohesive team in the clinic is paramount, with the medical assistant, the nurse, the APC, the rheumatologist all functioning together and provided with the necessary on-the-job training, where needed, to continue to grow that success.
“What this really comes down to is the training that we have; APCs can all practice at the top of their license and it is important that we consider this from a global perspective and where we will go moving forward to 2030 — I think with proper training we can all reach for the sky.”– by Robert Stott
Reference:
Mixon A, Caldron PH. A 2020 Look at a Modern Rheumatology Practice. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure: Caldron reports clinical trial support from AbbVie, Amgen, AstraZeneca, MedImmune, BMS, Celgene, Eli Lilly, Gilead, HGS/GSK, Janssen, Mallinckrodt, Merck, Pfizer, Roche-Genentech, Sanofi, Sun Pharma, Takeda and UCB. Mixon reports she serves on the speakers bureau for AbbVie, Celgene, Eli Lilly and Novartis, and is a consultant for AbbVie, Eli Lilly and Regeneron.