Physician: Answer to Rheumatologist Shortage May Be Training Physician Assistants

The answer to the shortage of rheumatologists in the United States may not rest in attracting more would-be-physicians to the field, but in training physician assistants.

Writing in the August issue of the Journal of Rheumatology, Dr. Alton Morris, a rheumatologist in Kingsport, TN, said the shortage in his profession has caused some rheumatology practices to be closed to new patients or to require patients to wait six months for an appointment.

"Some of us, as I have, chose to work far beyond our normal retirement age, but this is a temporary solution," wrote Morris. "Obviously, we need to train more rheumatologists."

But what to do while new rhuematologists are being recruited and trained? Morris said his partner recruited and trained a physician assistant to help care for arthritic patients and then, satisfied with the outcome, hired two more.

"This has worked out beautifully and has allowed us to see seriously ill patients immediately and others within a few weeks," Morris said. "There is some limitation to this but we have not reached it yet. Our physician assistants do an amazing job."

Morris said clinical rheumatologists could each employ two physician assistants and triple their availability for referrals and consultation and increase their availability to those requiring their expertise.

"The current shortage could be rapidly eliminated or reduced," Morris observed. "One can train (a physician assistant) with two years of graduate school, rather than the 10 years necessary for a trained MD rheumatologist."

"Do not be mistaken," Morris continued. "I am not proposing this as a temporary expedient but as a permanent method of rendering excellent rheumatologic care to all who need it, in a timely manner, at reasonable cost. For those of you who wish to be critical, try it. It really works."

Dr. Jody Lewtas, a rheumatologist at Markham-Stoufville Health Center in Canada, who wrote in the journal about Canada's impending rheumatologist shortage, said the solution breeds the same type of creativity that Morris has used.

"There is really no threat to our livelihood or profession to add other health care professionals to the team, and as rheumatologists we have been open to a multidisciplinary approach," Lewtas said.