Additionally, leadership style changes on entering private practice as you become responsible for managing support staff. Things that do not need to be directly done by the physician can and should be assigned to other members of your team. This allows more time with the patient, which enhances quality of care. Training staff to anticipate and understand the support you need requires mentoring and is not an intuitive skill. (Editor’s note: Rules governing what medical assistants, LPNs, RNs and APRNs, and APs can do with patient care and EMR management vary by state, dictate patient workflow and practice management and are not taught in fellowship.)
Importantly, the patient population changes, as well. The number of patients seen in a day quickly increases. How will you space out these patients in your schedule? How will you move between rooms as you see multiple patients at the same time? Where will you be when a patient is working with the X-ray technician, phlebologists or, perhaps, the ultrasound technician? How will you answer patient messages during the day or communicate with referring physicians?
Having the opportunity to establish long-term relationships with patients is also a unique opportunity afforded by practicing rheumatology. Learning to communicate with patients to help them understand your approach to diagnosis and treatment of their illness is a skill that I have refined during my first two years.
I have learned that it is my job to prove that the patient doesn’t have an illness I can treat. Gaslighting is a major issue with certain patient populations. Once inflammatory disease is ruled out, an important part of the rheumatology consultation involves validating patients’ experiences within a medical model, directing the patients toward next steps in management and avoiding the sense of gaslighting that can result from negative autoimmune workups. A positive anti-nuclear antibody test with a negative workup can become an opportunity to engage a patient in conversation about healthy lifestyle choices instead of dismissing autoimmune disease in the patient.
Fellows who join hospital-based groups or enter academic medicine will face similar challenges. It would be worthwhile to create a curriculum and resources for fellows as they transition into the role of rheumatologist. Introduced by the ACR in 2022, The Training Rheum is targeted to nurse practitioners and physician assistants to guide the education necessary for rheumatology practice. A similar course, or online community, could be offered on the practicalities and art of rheumatology.
