1. Involve physicians more in leadership roles.
University of Michigan Health-West always aims to include physicians in different hospital projects, Dr. Hahn says. “This way they don’t feel they are just a cog in the wheel. When we implement a program, we want physicians actively involved and understanding the financials,” he says. One example is the creation and implementation of DAX, an app that uses artificial intelligence to take notes during patient visits. So far, the app is improving physician satisfaction, Dr. Hahn says.
2. Work with more advanced practice practitioners (APPs), such as nurse practitioners and physician assistants.
Attracting, training and retaining qualified APPs can help redistribute responsibility into a team-driven environment, Dr. Concoff says. Although this brings more clinical help to the specialty, APPs can also get saturated with too much work, Dr. Battafarano cautions.
3. Be clear about what the organization expects from rheumatologists.
Stu Schaff, founder of Contract Medicine, a service that helps physicians throughout the U.S. understand, evaluate and negotiate their employment contracts, often sees organizations hire physicians without communicating clear expectations from the beginning. This can leave a lot of room for misinterpretation about job responsibilities, work hours and other important matters. A better practice is to make it clear during recruitment, and regularly thereafter, what any expectations may be, so the physician can make informed decisions based on those expectations.
4. Ask what you can do to provide more support and resources…
…particularly to alleviate the daily burdens that pull rheumatologists away from patient care, Mr. Schaff advises. This could include the use of scribes, speech-to-text software and team-based care. “This is often more appreciated by clinicians than just cutting them a check,” he says.
Providing pharmacist resources to manage prior authorizations is another solution, Ms. Moody says.
Asking what rheumatologists find helpful can help systems de-emphasize what doesn’t work, Ms. Moody observes. She gives the example of patient–physician communication portals that are intended to make direct patient communication easier but have the unintended consequence of increasing after-hours workloads for providers.
5. Triage.
This likely happens already at many practices, but Dr. Concoff says triage may become a necessity to prioritize patients with inflammatory arthritis, vasculitis, or systemic lupus. Novel approaches, such as pre-consultation laboratory triage, also may become necessary, he adds.
The addition of rheumatology training fellowships in underserved areas could help sustain rheumatologists and rheumatology care in those regions since many graduating fellows stay within 100–200 miles of where they trained, Dr. Battafarano says.
