Community Practice Rheumatology Is Challenging, But Rewarding, Too

Community practice rheumatology may be a less-followed path within the specialty, and it brings with it certain challenges. However, it also offers rewards, such as autonomy and deep relationships with patients. The Rheumatologist recently interviewed three community practice rheumatologists from around the U.S. to find out about their approaches to patient management, staffing and other areas of the practice. Here’s what they shared.

Staffing

As in many other medical settings, staff recruitment can be a challenge for rheumatology private practices. Some of this is due to the aftereffects of the COVID-19 pandemic; other times, it’s due to a shortage of trained workers within certain roles. At Pacific Rheumatology Associates in San Francisco, few job seekers are looking for medical assistant, receptionist or infusion nurse positions, says Molly Magnano, MD. The practice has four rheumatologists and does not have advanced practice providers.

Retirements also play a role in staffing challenges. At its peak, the Arthritis Center of Nebraska in Lincoln had five rheumatologists. It’s down to two now because of retirements. It also has five advanced practice providers, says Rick Chatwell, MD. “The addition of advanced practice practitioners has allowed us to maintain an appropriate [number] of office visits to support our practice,” says Dr. Chatwell, who has been with the practice since 1991.

Dr. Magnano

The ability to pay a salary competitive with those offered at local hospitals is a challenge, Dr. Chatwell says. “Ultimately, our employees favor the work-life balance that a private practice offers. They may consider slightly lower wages a favorable trade-off for not working nights, holidays and weekends,” he says.

To help boost retention, Pacific Rheumatology Associates provides health insurance, a retirement plan and paid overtime, says Dr. Magnano.

At New England Rheumatology & Osteoporosis, Henniker, N.H., staff followed Todd Daugherty, MD, when he moved from a hospital-based system to a private practice that opened just a couple of weeks before the pandemic began in March 2020. A solo practitioner, Dr. Daugherty says his office staff is stable because he can offer a workplace that is a good fit for employees.

Patient Management

With all the responsibilities a rheumatologist has in private practice, the perception may be that patient visits are kept short to meet demands. Actually, the opposite is true. “While my clinic days are busy, the best part about owning my own practice is the autonomy I have to take as long or as little time as I need to see each patient,” Dr. Magnano says. The same is true at the Arthritis Center of Nebraska. “We have worked hard to design our practice and schedule to give both patients and providers time to have meaningful office visits,” Dr. Chatwell says. Return office visits are usually 15–20 minutes with physicians and 30 minutes with advanced practice practitioners. If needed, an extended visit may be offered, he adds.