RX for Practice Overload?

The latter survey found that 71% of rheumatology PAs were female and that they worked in a variety of practice settings: 29% in solo practices, 16% in dual-doctor partnerships, 29% in group practices, 10% in government (the VA, military, or public sector), and 16% in academic practice settings.

In the time that he has been working in rheumatology, Smith, who is also president-elect of the ARHP, has seen “a definite increase in the awareness of physician assistants and their use in medical practice.”

The Working Relationship

PAs practice under state licensing rules, which stipulate that they are under the supervision of the physician. “State licensing is more homogenous now than it has ever been,” notes labor analyst Roderick Hooker, PhD, PA, senior director at The Lewin Group in Falls Church, Va., where he is an analyst and economist. His work centers on predictive modeling of health professions’ workforce for the federal government and associations such as the ACR.

Dr. Hooker notes that the ways in which rheumatologists and PAs work out their spheres of care vary from practice to practice and tend to maximize access and care for the patient. At the McIntosh Clinic, Smith initially sees new patients to gather a history and perform a general physical examination and then he presents the patient to Dr. McMillan, who proceeds to obtain the history of present illness and a musculoskeletal and problem-focused exam, and then formulates the assessment and plan of management. Smith now handles a large part of the routine follow-up visits, says Dr. McMillan. “Our working relationship has continued in much the same way that I originally set it up. You have to find the right person, and someone who is not a risk taker who is going to go off on their own to do something beyond their level [of expertise].”

McTigue and her supervising physician, N. Lawrence Edwards, MD, professor of medicine in rheumatology and clinical immunology at the University of Florida, have worked out their interactions with patients to address the complexity of pain medication management. For example, it can be necessary to reiterate and enforce certain rules such as no early refills of pain medications without office visits. “Sometimes,” she says, “we have this drill called ‘good cop/bad cop’ where we switch roles depending on who best interacts with the patient.” In this way, they’re able to clarify to patients that pain management with medication is a mutual responsibility.