Roles of Nurse Practitioners and Physician Assistants in Rheumatology Practices in the US

Abstract

Background—A recent workforce study of rheumatology in the US suggests that during the next several decades the demand for rheumatology services will outstrip the supply of rheumatologists. Mid-level providers such as nurse practitioners (NPs) and physician assistants (PAs) may be able to alleviate projected shortages. Methods—We administered a nation-wide survey of mid-level providers during 2012. Invitations with the survey were sent with one follow-up reminder. The survey contained questions regarding demographics, training, level of practice independence, responsibilities, drug prescribing, use of objective outcome measures, and knowledge and use of treat to target (TTT) strategies. Results—The invitation was sent to 482 eligible mid-level providers via e-mail and 90 via US mail. We received a total of 174 (30%) responses. The mean age was 46 years and 83% were female. Nearly 75% had ≤10 years of experience, 53% had received formal training in rheumatology. Almost two-thirds reported having their own panel of patients. The top three practice responsibilities described were performing patient education (98%), adjusting medication dosages (97%), and conducting physical exams (96%). Over 90% felt very or somewhat comfortable diagnosing rheumatoid arthritis (RA) and a similar percentage prescribed DMARDs. Three-quarters reported using disease activity measures for RA and 56% reported that their practices used TTT strategies. Conclusion—Most respondents reported they they had substantial patient care responsibilities, used disease activity measures for RA, and incorporated TTT in their practice. These data suggest mid-level providers may help to reduce shortages in the rheumatology workforce and conform with recommendations to employ TTT strategies in RA treatment.