We have the same issues in Canada as outlined in this abstract presented at ACR 2015. "Measuring the Rheumatologist Workforce in Canada: Preliminary Results of the Stand up and be Counted Survey-"Claire E H Barber et al However, you have noted that " There is limited data on impact of nurse practitioners or physician assistants in rheumatology." The Canadian Rheumatologists have been working with Allied Health Professionals in various roles and will soon have some good data to share on improving the access to care for inflammatory arthritis patients.