Workforce Solutions: Invite a Primary Care Provider to Shadow You

As Kimberly Steinbarger discussed in her article “Make Way for the Interprofessional Rheumatology Team” (The Rheumatologist, October 2023), an interprofessional team approach would be crucial to the most appropriate management of rheumatology patients with multiple comorbidities. Unfortunately, in many rural areas throughout the country, subspecialists are in short supply or are lacking altogether. Patients are often referred to rheumatologists for evaluation of complaints that are typically the purview of other specialists, particularly regarding neurologic and cutaneous signs and symptoms. Because rheumatologists in underserved areas are often overwhelmed by the number and complexity of patients they are requested to evaluate, it would be extremely helpful for primary healthcare providers to have some knowledge regarding the evaluation and management of suspected or confirmed rheumatic diseases. This could be quite beneficial for patients who are not able to get an appointment with a rheumatologist in a timely manner. This way, evaluations, and perhaps even treatment, could be initiated while awaiting a rheumatology consult.

Shadowing a rheumatologist for a period of time could help a primary care provider learn the basic approach to evaluating a patient with a suspected rheumatic disorder and may also instill some degree of confidence in managing these patients.

This arrangement would likely also be beneficial to rheumatologists because referrals will likely be more appropriate. A bidirectional flow of information is also likely to occur, thereby enriching the rheumatologists’ knowledge of general internal medicine.

Our rheumatology practice in Ellsworth, Maine, hosted a family practitioner who wanted to gain more insight into the diagnosis and treatment of rheumatic diseases. I feel we all mutually benefited from this experience.

I think it would be of benefit to group and hospital practices to permit their employed providers to spend some time shadowing and learning from local rheumatologists. This will likely result in improvement in patients’ satisfaction because they would not feel as if they were in a holding pattern, with nothing being done, while waiting to be seen by a specialist. This would be a win-win for both patients and the medical practices of which they are a part.

David Engelbrecht, MD, is a board-certified rheumatologist who has been in practice since 1990. He currently runs a clinic in the Bronx at Union Community Health Center. He has also been an attending rheumatologist at Northern Light Maine Coast Hospital, Ellsworth, since 2016.

Editor’s note: Earlier this year, the ACR launched Rheumatology for Primary Care, a new resource for primary care physicians and advanced practice providers offering them expanded support and guidance to identify rheumatic diseases in their patients. For more information, visit rheumforprimarycare.org.