Rheumatology in primary care physicians' practice implications for continuing education

The CME needs and degree of competency in managing 28 rheumatic disorders were assessed in a 20 percent stratified random sample of Illinois-based primary care physicians. Using a hierarchial scale of management complexity, the survey questionnaire was designed to test both the perceived level of competency and the level at which primary care physicians should be competent, the difference representing the need for CME. Demographic data from the respondents (19% of the entire survey), segregated into data from internists (n=225) and non-internists (n= 133), were similar. Although 57 percent of the entire group attended at least one ME program in rheumatology in the preceding 24 months, 67 percent (internists 62%; non-internists, 71%) were not satisfied with their current level of knowledge. This was rejected in the inability of non-internists to diagnose a number of less common diseases and the difficulty of both groups in long-term management. Not surprisingly, CME needs are inversely correlated with reported competency (internists, r= -.847, p<.0001; non-internists, r= −.680, p<,001) However CME content is different for each group. CME programs on the management of chronic rheumatic diseases are needed by both groups, with non-internists needing help to enhance their diagnostic skills. A correlation between competency score and frequency of consultation with a rheumatologist (internists, r =.394, p <, 001; non-internists, r = 829, p<.0002) suggests that proper diagnosis and initiation of firstline treatment are prerequisites for this practice behavior: In addition, the low rate of consultation for all diseases (internists, 23%; non-internists, 13%), which falls far below the expected consultation frequency (internists, 48%; non-internists, 43%), further impedes educational opportunities. These data suggest that CME in rheumatology should be directed toward disease recognition and management expertise, including the proper disposition of consultation.