Nancy Eisenberger, an NP in southern New Jersey, suggested that experienced APCs participating in the symposium collaborate to organize a nationwide fellowship training program to develop new graduates and pay them a small stipend. The collaborative could then align them with practices who want an APC but would not take someone on without some specialty training.
Richard Horn, NP, who currently works alone, recalled that in the first three years of training with a rheumatologist, he saw only established patients. When he was invited to see new patients, he felt insecure, but then, he says, “I got fired up, like this is really interesting.” Only then did he discover the motivation to study hard on his own.
Another APC who is the first in his practice group, which has several rheumatologists, is not allowed to see new consults due to the administrator’s interpretation of incident-to regulation. The PA is concerned that patients perceive a “bait and switch” dynamic when the rheumatologist hands them off later.
This contrasts with the team model, in which new patient confidence in APCs may blossom when witnessing the APC efficiently stand and deliver the history and exam to the attending rheumatologist. See Table 1 for a short list of suggested training settings.
What to Look for in an APC
Participants sketched an abstraction of the successful APC in rheumatology. Characteristics that a rheumatologist should look for when selecting an APC may include evidence of being detail oriented and attracted to complexity. High marks in an APC’s didactic training and selection of rheumatology, hematology/oncology, endocrinology or similar cognitive specialties as electives could signal these attributes. Although top grades may not predict a variety of clinical skills, they may suggest an inclination to aggregate information systematically.
Does the candidate have a level of comfort with ambiguity and uncertainty (i.e., the ability to move ahead with decision making on incomplete information)? This essential talent in clinical rheumatology should be sought through discussion of a clinical case or two that the candidate recalls as particularly challenging and why.
The candidate’s attraction to long-term relationships with patients and interest in watching clinical stories unfold over time should be explored.
Competitive salary and production incentives are universally sought, but a candidate who spends more time wanting to hammer out a reasonable offer over asking about the nature of rheumatology, the practice environment and vision within the organization suggests short-sightedness and a sense of entitlement rather than work ethic.
