Another issue to consider before adding an NPP is having enough patients to justify the added personnel. Take the situation of Richard Lai, MD, a rheumatologist who joined the Great Falls (Mont.) Clinic, a physician-owned practice, in 2015.
“[The clinic] had a rheumatology practice in the past,” Dr. Lai says. “Unfortunately, the provider left. … I’m just [coming] on to reestablish the rheumatology practice, so [the clinic wasn’t] able to get a mid-level [provider] or an NPP for me right away, because the patient load [didn’t justify the addition].”
Bringing on NPPs
Two years after joining the clinic, Dr. Lai is now ready to add an NPP. The multi-specialty practice he works with is the largest referral center in a roughly 100–300 mile radius, and his census is growing quickly, because other regional rheumatologists are either not accepting many new patients or the wait times for existing patients are long.
“[Now] is actually a pretty good time [to add an NPP], because I’m seeing quite a number of patients already, and some of them are pretty stable,” he says. “And these [patients] can be delegated to the NPP. The [NPP] can do follow-ups, labs, treatments.”
One area in particular Dr. Lai sees a use for NPPs is in helping manage such diseases as myofascial pain syndrome (MPS) or fibromyalgia. Dr. Lai has even had preliminary discussions with his clinic’s pain management specialist to run a fibromyalgia center staffed by NPPs.
“I have quite a [few] fibromyalgia patients on board,” Dr. Lai says. “So I would like to start with an NPP who is trained in fibromyalgia … and I [can then] absorb more patients.”
Dr. Lai believes NPPs could also work with other stable patients diagnosed with inflammatory arthropathies, such as rheumatoid arthritis, gout, pseudogout and psoriatic arthritis, as well as connective tissue diseases, such as Sjögren’s syndrome.
Another area in which NPPs can be a benefit is in an infusion center. Dr. Lai’s multi-specialty clinical has a center already set up for hematology and oncology, and he has used it often. He would like to operate his own outpatient center, under the co-management of an experienced NPP.
“I know physicians need to be on board, at least within the same medical facility, in case something happens,” he says. “But … there aren’t a lot of issues with infusions.”
Experience is key. Rheumatology is a specialty that suffers from a shortage of trained professionals, and the same can be said of its support staff.
