I was prompted to look for a mid-level provider because I was overwhelmed with requests for consultations and was unable to meet the needs of patients and referring physicians in this region,” says Kate Queen, MD, a rheumatologist in private practice at Mountain Medical Associates in Clyde, N.C. “I had attempted to recruit a second rheumatologist but had not been successful, and this seemed like a good alternative solution.”
Dr. Queen’s experience echoes the needs of many rheumatologists with overbooked schedules and limited financial resources. As doctors search for ways to deliver high-quality care in an environment of healthcare cost containment, many are embracing a team approach and collaborating with mid-level providers to meet the unique demands of their individual practices.
Research Leader with Versatility
The nature of healthcare delivery is changing to accommodate a decreasing supply of physicians, a trend toward increasing specialization, and an ever-growing number of older and uninsured patients. In many cases, mid-level providers or “physician extenders” bridge the gap between patient expectations and the overwhelming patient care demands placed on physicians—and their utilization is on the rise. In 2005, the U.S. Department of Labor noted that mid-level care delivery was the third-fastest growing profession in the United States, and projected a 53% increase in the hiring of such providers by 2010.
The term “mid-level provider” encompasses both nurse practitioners (NPs) and physician assistants (PAs), but these professions differ in training—and perhaps in outlook. Studies done in the primary care setting suggest that NPs gravitate toward the issues of health promotion and education instilled by the nursing paradigm, while PAs orient toward a diagnose-and-treat practice model. However, their roles in the rheumatology setting are influenced more by the type of practice—whether it’s private or based in an academic center—the practice goals of the supervising rheumatologist, and the individual interests of the mid-level provider.
What attracted Joyce Carlone, MN, RN, to the Emory University Rheumatology Division was the opportunity for job versatility. “I was attracted to this position because it promised to not only allow me to use my practitioner skills, but also to organize a new program that could really make a difference within the organization” she says. “Dr. Conn and I discussed how my job description could also evolve over time and allow me to do a variety of activities since I enjoy diversity.”
As doctors search for ways to deliver high-quality care in an environment of healthcare cost containment, many are embracing a team approach and collaborating with mid-level providers to meet the unique demands of their individual practices.
Doyt Conn, MD, professor of medicine and director of rheumatology at Emory University School of Medicine, initially hired Carlone to help form an early arthritis clinic; after its foundation was in place, they redirected their efforts toward clinical research.
