The Current Landscape of Rheumatology
Traditionally, people with RA have been seen by a rheumatologist, or a medical doctor with advanced training in diagnosing and treating arthritis and other diseases of the bones, joints, and muscles. But there’s currently a shortage of rheumatologists in the United States, and this is only projected to grow in the coming years. “There’s currently 5,500 board-certified rheumatologists in this country,” says Jonathan Greer, MD, a rheumatologist at the Arthritis & Rheumatology Associates of Palm Beach and an assistant clinical professor of biomedical sciences at Florida Atlantic University. “But by the year 2030, we’re expecting to be about 3,000 doctors short.” This shortage is because the current crop of rheumatologists are getting older, and fewer new doctors are opting to specialize in rheumatology. As it is now, it can be difficult to get an appointment because there just aren’t enough rheumatologists for all the people with arthritis who need to be seen. Sometimes people have to book an appointment many months out, all while they’re experiencing progressive and irreversible joint damage. “That’s why we have such a need for rheumatology practice extenders, such as nurse practitioners,” says Dr. Greer, especially true in underserved areas.
How Nurse Practitioners Fit in the Picture
Increasingly, nurse practitioners are being utilized as part of a multi-disciplinary rheumatology team that includes rheumatologists and physician assistants, to help people managing RA. Their integration into a rheumatology practice allows for improved access to care, which can lead to improved outcomes for those with RA. A nurse practitioner can diagnose RA, prescribe treatment, and monitor the condition. “Nurse practitioners are uniquely situated in and can be easily trained to manage patients with RA,” Greer says. In fact, a study published in June 2020 in the journal Healio Rheumatology found that rheumatology care led by a nurse practitioner was shown to be as effective as standard care with a rheumatologist for people with RA. Nurse practitioners who specialize in rheumatology get advanced training beyond their graduate or doctorate degree as a nurse practitioner. “When we graduate, nurse practitioners are trained as generalists,” explains Kori Dewing, DNP, ANP-BC, ARNP , an adult rheumatology nurse practitioner and professor in the School of Nursing at the University of Washington in Seattle. “From there, a nurse practitioner needs further specialty training. This includes working side by side with a rheumatologist, and independent study using resources like the Advanced Rheumatology Course offered by the American College of Rheumatology.”
What Does a Rheumatology Nurse Practitioner Do?
The role and scope of practice of the rheumatology nurse practitioner varies based on individual state nursing practice and licensing laws, as well as the experience and training of the individual within the rheumatology team. Rheumatology nurse practitioners almost exclusively work as a member of a rheumatologist-led team. Half of the United States allows nurse practitioners to practice with full autonomy, able to evaluate people with RA, order and interpret diagnostic tests, and prescribe treatments without restriction or oversight by a managing physician, though they work within the rheumatology team. Depending on the practice and the access available in that particular care team, you may be able to get in to see a nurse practitioner more quickly than the rheumatologist, and they may be able to spend more time with you than a rheumatologist would. Also, nurse practitioners approach RA through a nursing lens, with a focus on education. “When people come to see us, we often hear, ‘I really appreciate the time that you’ve taken to explain that to me,’” says Dr. Dewing. As such, nurse practitioners that are trained in rheumatology can be another option as a provider.
When to See a Rheumatologist
In some practices, rheumatologists prefer to make the initial diagnosis of RA themselves, before turning over the management of the condition to a nurse practitioner. But it many cases, a nurse practitioner can be the person you see for diagnosis, management, and treatment; it varies from practice to practice. “If a person is not doing well despite changing medications, then they probably should see a rheumatologist just in consultation,” Greer says. But because of the collaborative way rheumatology clinics are set up, a nurse practitioner can probably arrange for any care you may need. “That’s part of the way a rheumatology team functions,” Dewing says. “You are going to get the best care that you can receive no matter who it is you see.”
