Role delineation of rheumatology physician assistants

Background: Demand for rheumatology services is rising at the same time the number of rheumatologists is predicted to decline. Concurrently, the utilization of rheumatology physician assistants (PAs) is growing, although little is known about this role. Objective: A role delineation study of rheumatology PAs was undertaken to learn how they provide care. Methods: Four databases were merged into a master file of 112 rheumatology PAs. A combination of telephone interviews and web-based surveys allowed probing the role, relationship and scope of practice of the study population. Results: Females comprised 71% of the 112-PA cohort. A total of 58 individuals (54%) were interviewed. Employment settings: 29% in solo practice, 16% in partnership, 29% in group practice, and 16% in medical school/university. PAs spend at least 80% of their time caring for patients. Most provide the initial consultation for new patients. Almost all initiate disease-modifying drugs and joint injections; half participate in research. A total of 91% of the respondents acquired their skills through on-the-job training and medical education conferences; 3 were graduates of a rheumatology fellowship. Conclusions: PAs employed in rheumatology practices function in a role that is delegated by their supervising doctor. This self-report survey suggests this activity is at a high skill level. They are evaluating patients, initiating treatment, and following them longitudinally. Most find this career satisfying. Increasing the number of rheumatology PAs may offset some of the physician losses experienced as a result of retirement. How PAs acquire their skills and how well they function in delivering care should be the next focus of research.