Background/Purpose:  Since 80% of rheumatologists practice outside the university setting, training projects for rheumatoid arthritis (RA) may benefit from an improved understanding of RA management and care in private practice (PP). The aim of this study was to determine whether similarities and differences exist in the delivery of care and treatment of RA and other rheumatic diseases in PP and academic settings.

Methods: 18 rheumatology clinicians were observed by a second year medical student: 9 in PP and 9 at an academic medical center (UNV). Observational data (without chart review) were collected, including patient demographics, rheumatologic diagnoses, general physical exam, joint exam, and therapy. Clinicians were interviewed to survey therapeutic approaches to RA.

Results: Of 195 total patient visits, 83 (43%) were at UNV and 112 (57%) at PP. New patients represented 25% of UNV visits and 18% of PP visits. Visit length for new patients averaged 44 minutes at UNV and 29 minutes at PP. Established RA patients represented 38% of UNV visits and 22% of PP visits. Visit length for established RA patients averaged 33 minutes at UNV and 17 minutes at PP (Figure 1). For inspection, auscultation and joint palpation of established RA patients, the weighted point value averaged 2.4 points at UNV and 2.7 points at PP. UNV physicians were found to use Biologics 17% more frequently compared to PP physicians (Figure 2). Rank order of the top five diagnoses for UNV was RA, OA, fibromyalgia, Sjogrens, and gout. For PP the rank order was RA, OA, gout, psoriatic arthritis, and fibromyalgia.

Conclusion:  Average visit length for established RA patients differed between UNV and PP groups, with visits being 48% shorter in PP settings. Patient populations also differed, with new patient visits representing a greater proportion of UNV visits. The elevated frequency of biologic prescription in the UNV group suggests a difference in treatment approaches. In contrast, complexity of established RA patient physical exams (detail points) was similar between the two groups. Diagnostic frequency of common rheumatologic diseases was also similar.