Advanced Practice Clinicians in Rheumatology, Part 1

Advanced Practice Clinicians in Rheumatology, Part 1 Posted By:
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I have been practicing as an NP in rheumatology for 7 years and I love it. I got lucky, really: A recruiter reached out to a fellow student who was not interested in rheumatology and said to me and a few others, "Anyone have any interest in working in rheumatology?" This was about 3 weeks before graduation and at that point I had no idea where I would be working, so I said I was.

When I met my future employer, a physician who had been practicing in rheumatology for almost 30 years, she told me, "I'll teach you everything you need to know." This sounded appealing to me for a number of reasons: 1) I found the idea of starting my NP career without support or guidance daunting, and 2) I knew next to nothing about rheumatology or how to appropriately care for these patients, but she was willing to take the time to teach me and help me grow. And she did—I learned so much. Those first 6 months were a whirlwind of interesting and challenging disease states in patients who I came to know very well; I was able to understand them and help them feel more like themselves. I had found my niche.

As I mentioned, I was lucky. My NP program provided very little exposure to learning about or understanding rheumatic diseases. If I remember correctly, we spent no more than 1 day covering the specialty. Knowing what I know now, I feel that is a disservice to our patients with rheumatic diseases. These disease states impact all body systems and affect our patients from every angle. They are chronic, incurable, life-changing, and have consequences for other comorbidities.

I've found that at the heart of many NP programs is the desire to train NPs to stay in primary care rather than enter a specialty. Of course, I cannot speak to all programs, nor to physician assistant programs. Also, I do see the rationale behind this: Primary care is our frontline in medicine and needs well-trained advanced practice clinicians (APCs) to tackle the ever-growing and ever-sickening population. However, part of this training should include comprehensive experience in rheumatology.

This training should focus on how a primary care APC would identify a patient with potential rheumatic disease—such as how to gather a history; conduct a focused physical exam; and assess which baseline tests would be appropriate and clinically useful, including labs and radiographs, prior to referring to the specialist. For a patient with established rheumatic disease, APCs should be trained on which health screenings are necessary, as well as medication interactions and potential complications of their diagnosis.

The question is: "How do we provide primary care APCs with this training?" I can think of at least 2 options. Firstly, rheumatology APCs can make themselves available to their regional APC programs to act as guest lecturers and as clinical faculty, providing one-on-one clinical experiences for students. Secondly, continuing medical education outlets, like Practicing Clinicians Exchange, should continue to have programs with rheumatology focus to address the current gaps in APC programs.


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Filed under: Rheumatology , Practice Management/Career , NPs & PAs

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