Yvonne; I think many rheums are looking for young new talented trainees - and struggling either find them or keep them. There is already research out there that questions the return on investment in those seeking to do a rheumatology fellowship and specialization. You can make the same money or more by just being an internist. But this blog and this issue isnt about money - I didnt even address the cost advantages of hiring physician extenders. This is about who makes your practice better. I have several partners, I wish I had more nurse practitioners like Leilani Law. This blog was a tribute to her and a wake up call for those who have never considered such a hire. Lastly, I do support efforts to have more NPs and PA's. There will be 60 million arthritis patients out there in 2020!, There are currently 1.3 million RA patients and we "rheums" are taking care of less than half of them. I would argue our time and skills are tied up taking care of many who should be getting their care elsewhere from PCPs, neurologists, etc. I am totally against subjugating the care of OA, FM, gout and tendinitis to NPs and PA's. Their talents should be cultivated to take care of RA & lupus too