Advanced Practice Provider (APP)

Training

Most advanced practice providers (APP) complete graduate-level programs leading to a master’s or doctoral degree. This training includes classroom coursework as well as clinical experience whereby the APP completes hundreds of hours of clinical rotations. Most APPs are trained as generalists but can specialize in adult or pediatrics and other specialty fields. Rheumatology education is typically provided by rheumatologists during employment in the specialty.

License/Certification

In most states, a master's degree in physician assistant (PA) studies is required. Moreover, PAs are required to take the certification exam, PANCE, to gain licensure. Nurse practitioners (NP) must complete a master/s or doctoral program, certification by the ANCC (adults) or PNCB (pediatrics) which are renewal annually to every 5 years; licensure is dictated by each state’s Board of Nursing.

General Description

Advanced practice providers, including nurse practitioners and physician assistants, diagnose and treat medical conditions in various settings including hospitals, clinics, home health, rehabilitation units, and long-term care facilities. APPs demonstrate a high level of independence and clinical expertise in the management of rheumatic diseases. They use advanced clinical skills, diagnostic reasoning, and therapeutic interventions. APPs integrate management, leadership, education, research, and collaboration with other health care professionals into their clinical roles to maximize rheumatology patients’ health.

Rheumatology Skill Set

• Take health histories
• Perform physical examinations
• Order and interpret diagnostic tests; make referrals to other medical specialties
• Make diagnoses
• Develop a course of treatment for patients in collaboration with other health care professionals
• Prescribe medications and other treatments (including occupational and physical therapy) in accordance with state laws; must have extensive knowledge of the pharmacology of rheumatic medications including DMARDs and biologics
• Perform interventions such as aspiration and injection of joints
• May be involved in research and program planning
• Educate patients and families about disease management and treatment, including medication administration and side effects as well as prognosis
• Serve as an advocate for patients and families within the healthcare facility, community, and regarding ongoing legislation

Case Study

Rose, a 50-year-old single female, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, morning stiffness lasting 2 hours, extreme fatigue and malaise, and often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.

What Can This Professional Do for Rose?

The APP can assess the current history of Rose’s disease and examine her joints. If the APP determines that methotrexate is not controlling her RA, lab testing or imaging can be done, and additional medications prescribed if she still has active disease. Physical therapy for strengthening and range of motion can be prescribed as well as occupational therapy for evaluation of workplace and possible adaptive devices provided. The APP may discuss psychosocial needs of the patients and recommend counseling to assist in management of chronic pain and stress, and evaluation of anxiety or depression often associated with chronic diseases. The APP may need to consult a social worker to assist with community or financial support for family or identify other resources.

Updated August 2024