More Sources
Scoping other sources for perspectives from rheumatology APCs provides a measure of concept validation. In March 2019, we sought a confidential assessment from our director of human resources on the most prominent elements of practice satisfaction reported among 25 APCs during their annual employment reviews. Above all, our APCs valued the opportunity to specialize. Beyond this, not surprisingly, attributes reminiscent of those identified in the administrative study emerged. Satisfaction next related to the quality, comfort, flexibility, directness and openness of the relationship with the attending rheumatologist(s). Longevity of patient relationships, the visibility of treatment results from their care, and low mortality among their patient panel were also conveyed.
At the second annual Phoenix Rheumatology Association Strategic Training in Rheumatology for APCs held in Glendale, Ariz., March 29–31, 2019, a convenience survey was conducted with participants organized into six groups of four to nine members. Input was aggregated from 26 nurse practitioners and 24 physician assistants with a mean rheumatology practice experience of four years (range <1 to 31 years). Groups were asked to deliberate on how the rheumatology profession should promote careers and training for APCs in rheumatology, the most effective working environment, what measures drive career endurance and what else the profession should be asking.
Promotion of rheumatology, per the participants, would benefit from exposure in school by guest speakers, clinical rotations and job fairs. Participants endorsed the prospect of fellowships, rheumatology certification and more APC-focused conferences. General training elements should consist of clinical training by local mentors reinforced by nationalized didactic curricula, such as the ACR modular program, and supplemented by guidelines and training videos for new hires.
The most effective working environment would provide open communication with a supportive, respectful rheumatologist in a team structure, with more independence as experience accrues, supplemented with a variety of educational modalities and exposures.
Retention is driven by feeling valued and supported, transparency in achieving a competitive income, a broadly defined role in rheumatology and work-life balance. In private practice, consideration of a partnership model for long-experienced APCs should be considered. Additionally, the profession should make the APC universe aware of the huge projected demand in the field. Accordingly, APCs should not be relegated to unproductive work to lighten the load of the rheumatologist, but rather deployed to help shoulder that demand.
Training: The Physician’s Responsibility
Academic and public institutions that employ rheumatologists may bear the financial risk of developing advanced practice clinicians, but the physician staff must still provide the training. In private practice, the rheumatologist must do both. The realpolitik is that all rheumatologists may not be geared to train, empower and delegate effectively. For those who are, our practice community must pool its collective knowledge and pursue more stringent qualitative research on best practices for recruitment and selection, and strategies for training, career development, retention and management.
We should start by listening.
