Editor’s Note: This is the first in a two-part series about rheumatology health professionals who can help ease the time crunch for busy practices. Click here to read Part Two, about nurse practitioners.
Victor McMillan, MD, began his practice of rheumatology in 1991 as the sole rheumatologist in the multispecialty McIntosh Clinic in Thomasville, Ga. “As I was building the practice,” he recalls, “I very quickly began to see that I was going to need another practitioner to keep up with the patient demand.” He started “borrowing” the time of his partners’ nurse practitioners (NPs) and soon realized the usefulness of this strategy. What he really needed, though, was a dedicated practitioner to help expand his practice. He started recruiting for a physician assistant (PA), and eventually hired Benjamin J. Smith, PA-C. “It’s been a long marriage,” Dr. McMillan says of his and Smith’s association since 1999, the year he hired Smith.
An aging population is increasing demand for rheumatologists at a time when they are in short supply, so Dr. McMillan did what many of his rheumatology colleagues have done to deal with the workforce shortages in their field. A 2003 survey by the ACR found that one-fifth of the ACR membership employed an NP or PA in their practices. The trend is likely to increase: In 2007, the ACR’s Workforce Study Advisory Group projected that demand for rheumatologists in 2025 will exceed supply by 2,575 adult and 33 pediatric rheumatologists.1 The Advisory Group recommended, and the ACR endorsed, a strategy of expanding the use of rheumatology NPs and PAs as one way to address the workforce shortages.2
Rheumatology PAs provide a wide range of services, from evaluating new patients and managing ongoing patients to prescribing medication and performing procedures such as joint aspirations. Joan McTigue, MS, PA-C, a faculty member in the division of rheumatology at the University of Florida College of Medicine and the Veterans Affairs (VA) Medical Center in Gainesville, Fla., believes that most rheumatologists have a better sense of the role of PAs and the ways in which they can help to “decompress” a practice. That’s because they likely encountered them during their training. Still, some rheumatologists may not be familiar with PAs’ scope of practice and how they can be appropriately incorporated into a busy rheumatology practice.
The Rheumatology PA Profile
PAs have been a presence in U.S. healthcare delivery for 45 years and active in rheumatology for over 40 years. Estimates of their numbers in rheumatology vary. A report prepared for the Society of Physician Assistants in Rheumatology (SPAR) in 2008 identified 86 PAs specializing in rheumatology out of a total of more than 75,000 PAs who were eligible to practice nationwide.3 Another survey identified 112 rheumatology PAs by plumbing the SPAR, ARHP, and American Academy of Physician Assistants (AAPA) databases.4