CHICAGO—With the ongoing rheumatologist shortage, more practices are adding advanced practice providers (APPs), such as nurse practitioners (NPs) and physician assistants (PAs). However, it takes real-world experience and strategy to find the right APPs for your practice and help keep them satisfied. In the ACR Convergence 2025 session titled, Optimizing Patient Access: Integrating APPs, New Physicians, and Best Practices in Rheumatology, presenters shared tips to work effectively with APPs.
Recruiting APPs
Dr. Kori Dewing
Kori Dewing, DNP, ARNP, with the University of Washington’s Northwest Outpatient Medical Clinic in Seattle, noted that the best place to find nurse practitioners is within your local nurse practitioner programs. She recommended asking about providing hours for their clinical rotations. At a minimum, this can expose students to rheumatology and potentially spark their interest, Dewing said.
“When I see students with a passion for disease management, I’ll talk to them about rheumatology and doing a rotation,” she added.
Nancy Ellis, MBA, practice administrator for Piedmont Arthritis Clinic in Greenville, S.C., has encountered APPs who started out working at hospitals but then applied to work at private practices. Seeing how things work within a private practice may pique their interest, she said.
Ms. Nancy Ellis
As you work on recruiting APPs and even new, young MDs, make sure to give them a professional, structured recruiting experience, advised Colin Edgerton, MD, FACP, RhMSUS, with Articularis Healthcare in Charleston, S.C. This is often what they both expect and want.
It may take a little more spending to provide a higher-level recruitment experience, he said. Let APP recruits know of potential benefits and incentives, and prepare to expose them to practice routines. Priorities for an MD often include a competitive salary, a four-day work week and the possibility of becoming a partner in the practice, Ms. Ellis said.
When it comes time to decide what work an APP will handle, double-check your state laws. For example, some states may allow nurse practitioners to supervise an infusion suite, but not physician assistants.
Onboarding APPs
Although you may be eager for your APP to get to work and start seeing patients, you’ll benefit from taking time to train them thoroughly. It may take two to four months from hiring to when an APP sees their first patient.
Dr. Colin Edgerton
“If they’re green to rheumatology, I’d say six months,” Dr. Edgerton said. “People look at APPs and say, ‘Let’s get them in and get them seeing patients,’ but that’s a good way to lose the return on your investment if inadequate training leads to dissatisfaction and turnover.”
One helpful resource Dr. Dewing recommends is the ARP NP/PA Onboarding Toolkit, available in the ACR Education Center. The three webinars available cover why to hire an NP/PA, mentoring your APPs and providing evaluation and feedback.
The Rheumatology Research Foundation also offers one-year $25,000 awards via its Mentored Nurse Practitioner/Physician Assistant Award for Workforce Expansion, Dr. Dewing said. The deadline to apply for this funding is Dec. 1.
Another training option: The 19-module Advanced Rheumatology Course is geared toward health professionals who are new to rheumatology, Dr. Dewing said. It can be pricey, but using grants or awards from the Rheumatology Research Foundation may help.
As you train APPs, make sure to provide feedback, but do it in private—not in front of patients. “I don’t know how many times I’ve heard NPs and PAs frustrated about this,” she said.
Job Satisfaction
You’ve heard it before—a rheumatology practice invests a lot of money and time into familiarizing an APP with rheumatology, only to have them leave the practice. Although there’s no fool-proof way to stop this, you can employ a few strategies to keep them satisfied and sticking around longer:
- Help APPs find a mentor, whether that is someone inside or outside your practice.
- Consider having them work with one dedicated physician, Dr. Edgerton suggested. You can have more than one APP at your practice, but aim for one or two APPs dedicated to working with a specific rheumatologist. The rheumatologist can see a new patient and interpret lab results, and appropriate follow-up care can be managed by APPs, he explained. Learning and implementing one practice pattern, associated with only one physician, may be more tenable and satisfying for an APP.
- Invest in as much education for them as you can. “If education is important, they’re much less likely to leave and reinvest in another specialty,” Dr. Dewing said.
- Provide a specific time when APPs can sit with physicians in your practice for education or to discuss what’s going on in the practice. Sometimes, a Friday lunch can be an ideal time to talk about a case or something specific from the week. “You have to be available. Give them time to ask questions,” Dr. Edgerton said.
- Research salary and incentive options that are standard in your area.
The Challenge of Referrals
Dealing with referrals while the wait time to see patients expands can prove challenging, with no easy answer. “We’re getting a lot more referrals, but it couldn’t come at a worse time as there are fewer of us,” Dr. Edgerton said.
This is compounded by more rheumatologists asking for work-life balance but also facing an endless patient wait list, Ms. Ellis said.
Adding APPs may help address this challenge, but even then it takes some strategy. One idea Dr. Dewing shared is having NPs or PAs meet over lunch with local primary care physicians to talk about what’s a good referral to a rheumatologist.
Although scheduling is never easy, Dr. Edgerton urged rheumatologists to try and work in patients who must be seen within a reasonable amount of time. “I don’t think the right approach is to have them wait too long. I think there’s an opportunity to do it another way,” he said.
He also cautioned against investing excessive resources in reviewing or triaging consults. Too often the clinical information is inadequate to properly triage consults, and the time spent would be better used actually seeing the patient in the practice.
The wait time at his practice is currently about one month.
Vanessa Caceres is a medical writer in Bradenton, Fla.