Dr. Chatwell says getting patients into academic medical centers may take months, even when they pass the screening process. “When we have a personal physician-to-physician connection, a curbside opinion may be timely, but their availability for new patients is still limited,” he says.
To handle patient education, community practice rheumatologists use the range of resources available to them, and it’s often all hands on deck in terms of staffing to help with education. An initial patient consultation includes education regarding the disease process and medications involved. Before infusion of a new medication, an advanced practice provider will meet with a patient to discuss the rationale, infusion process and potential risks and benefits, Dr. Chatwell says. At Pacific Rheumatology, medical assistants provide injection training. Resources used at these practices include product pamphlets, non-sponsored informational handouts, ACR publications and more.
Involvement with Research, Precision Medicine
The rheumatologists interviewed for this article say that despite having a smaller private practice, they still can follow research avenues or special areas of interest. For example, Dr. Daugherty is incorporating more precision medicine tools into his practice, including the PrismRA biomarker, improved serology panels and multi-factor inflammatory markers in patients where traditional markers like C-reactive protein or erythrocyte sedimentation rate are not useful. He says patients have been excited about the opportunities these tools offer. “We’re achieving improved and more sophisticated diagnoses and treatment decisions using these tools, and these data have actually been appreciated by insurance company medical reviewers and been a factor in improved rates of approvals,” he says.
Having a strong relationship with patients makes use of these precision medicine biomarker tools possible and viable, Dr. Daugherty says.
Research has been a big component of the Arthritis Center of Nebraska since the mid-1980s, Dr. Chatwell says, including during the biologic revolution in the early 1990s. The practice has four to six trials enrolling at any time along with 20 ongoing trials. The practice also started Physician Research Collaboration, which he describes as a turnkey approach to help other physicians in the community take part in clinical research. The programs provide access to pharmaceutical companies, research administration, budgeting and staffing.
Dr. Chatwell says that this involvement with research helps show that a private practice can be tailored to a rheumatologist’s interests.
The Biggest Challenges
Of course, working as a community practice rheumatologist has challenges, some of which are also faced in academic and research settings and others that are more specific to private practice.
