Editor—My associate and I have had a busy practice limited to rheumatology, in addition to teaching students and residents at the local area medical school and publishing an occasional paper. Several years ago, we reached saturation point, when we were unable to accept referrals and consultations.
We employed a physician assistant, whom we trained to see return visits on long term patients. We did all initial visits and follow ups until the diagnosis was definitely established, treatment was started, and the patient's condition was stable. At that point the physician assistant would see the patient. The doctor would see the patient every third visit and would be available immediately if any question arose. We have since employed a second physician assistant, and a third will be starting in a few weeks, who will devote her time to patients with fibromyalgia. As a result, we are able to see patients referred to doctors in a timely manner and are the only rheumatologists to do so in a population area of over 1000 000 people.
Our physician assistants do a splendid job and improve in their ability month by month, but I would not recommend that they become independent practitioners. They are very effective in a subspecialty such as rheumatology, which is more cognitive than technical. They have allowed us to provide care that would otherwise be unavailable.